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Journal of Sports Sciences

ISSN: 0264-0414 (Print) 1466-447X (Online) Journal homepage: https://www.tandfonline.com/loi/rjsp20

Fatigue increases ankle sprain risk in badminton


players: A biomechanical study

Alexis Herbaut & Julien Delannoy

To cite this article: Alexis Herbaut & Julien Delannoy (2020): Fatigue increases ankle
sprain risk in badminton players: A biomechanical study, Journal of Sports Sciences, DOI:
10.1080/02640414.2020.1748337

To link to this article: https://doi.org/10.1080/02640414.2020.1748337

Published online: 02 Apr 2020.

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JOURNAL OF SPORTS SCIENCES
https://doi.org/10.1080/02640414.2020.1748337

SPORTS MEDICINE AND BIOMECHANICS

Fatigue increases ankle sprain risk in badminton players: A biomechanical study


Alexis Herbaut and Julien Delannoy
SportsLab, Decathlon, Villeneuve d’Ascq, France

ABSTRACT ARTICLE HISTORY


Ankle sprains are the most common injury in regular badminton players and usually occur at the end of a Accepted 13 March 2020
match or training. The purpose of the present study was to examine the influence of fatigue produced by
KEYWORDS
badminton practice on the lower limb biomechanics of badminton players. It was hypothesized that fatigue Ankle kinematics; muscle
induces ankle kinematic and lower leg muscle activity changes which may increase the risk of ankle sprain. activity; fatiguing protocol;
Ankle kinematics, ankle kinetics and muscles activities of 17 regular badminton players were recorded injury risk; lateral movement
during lateral jumps before and after an intense badminton practice session. Post-fatigue, ankle inversion at
foot strike and peak ankle inversion increased (+2.6°, p = 0.003 and +2.5°, p = 0.005, respectively). EMG pre-
activation within 100 ms before foot landing significantly decreased after fatigue for soleus (−23.4%,
p = 0.031), gastrocnemius lateralis (−12.2%, p = 0.035), gastrocnemius medialis (−23.3%, p = 0.047) and
peroneus brevis (−17.4%, p = 0.036). These results demonstrate impaired biomechanics of badminton
players when fatigue increases, which may cause a greater risk of experiencing an ankle sprain injury.

Introduction However, it is not known whether the accumulation of


fatigue modifies the ankle kinematics and kinetics when per-
Badminton is one of the most popular sports worldwide, prac-
forming a badminton-specific movement. Therefore, the pur-
tised by more than 200 million players from every level
pose of the present study was to examine the influence of
(Fahlström & Söderman, 2007). It is the fastest racket sports,
fatigue produced by badminton practice on the lower limb
characterized by high-intensity shots requiring multiple specific
biomechanics of badminton players. It was hypothesized that
movements, such as forward lunges or backward/lateral jumps
to perform a lateral jump in a fatigued state, the ankle inversion
(Cabello Manrique & González-Badillo, 2003; Phomsoupha &
angle at foot strike and the peak ankle inversion during stance
Laffaye, 2015). Even though the injury incidence rate is quite
would increase whereas the pre-activation of the ankle evertor
low (2.3–3.2 injuries/player/1000 badminton hours), many bad-
muscles would decrease.
minton players experience various injuries each year
(Jørgensen & Winge, 1987). The lower extremity is particularly
vulnerable since it accounts for 43% to 86% of all injuries in Methods
badminton (mean = 64%) (Fahlström, 2009; Goh et al., 2013;
Participants
Hensley & Paup, 1979). Ankle and knee joints are the most
commonly injured body locations (Krøner et al., 1990; Shariff Seventeen male regular badminton players were recruited from
et al., 2009; Yung et al., 2007). More precisely, it was reported local badminton clubs and volunteered to participate in this
that the ankle sprain was the most common injury, accounting study. Inclusion criteria were: regular practice of badminton
for 33% to 49% of all lower limb injuries in European and (minimum of 2 h of badminton exposure per week), minimum
Chinese regular badminton players (Herbaut et al., 2018). of 2 years of playing experience, older than 18 years of age,
According to this study, ankle sprains often occurred during right-handed and injury-free for at least one year. Each partici-
jump reception, with a large prevalence at the end of match pant was informed about the procedure of the experiment and
play or training, likely due to the presence of fatigue. signed a written informed consent for the participation in this
Fatigue can be defined as a reduction in force production study, which was approved by the local ethics committee and
capacity regardless of the movements performed (Gandevia, in agreement with the Declaration of Helsinki.
2001). It has several detrimental effects regarding performance
and injury risk. First, a decrease in the capacity of the evertor
Experimental set-up
muscles to contract and produce sufficient force to counteract
inversion movement. Second, a reduction in the joint position Participants were instructed not to engage in strenuous activity
sense (Mohammadi & Roozdar, 2010; Sandrey & Kent, 2008), the day before testing. The experiment consisted of 3 parts: a
leading to an insufficient response from the muscles to counter- biomechanical evaluation of a badminton-specific movement
act the inversion moment. Third, an alteration of lower limb (PRE), a fatiguing protocol and the same biomechanical evalua-
biomechanics and decreased dynamic postural control tion as before fatigue (POST) (Figure 1). The POST test started as
(Christina et al., 2001; Kellis & Liassou, 2009; Sarshin et al., 2011). soon as possible (within 5 min) after the fatiguing protocol. A

CONTACT Alexis Herbaut herbaut.alexis@gmail.com SportsLab, Decathlon, 4 Boulevard De Mons, Villeneuve d’Ascq 59650, France
© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 A. HERBAUT AND J. DELANNOY

Figure 1. Front (a), Lateral (b) and Posterior (c) views of a participant equipped with retro-reflective markers and EMG sensors.

pair of badminton shoes (Artengo® BS800) was provided to graduate coach according to the current rules of the
each participant to perform the experimentation. Badminton World Federation. The subjective score of rating of
perceived exertion (CR-10) from 0 to 10 was measured at the
Biomechanical evaluation end of the match (Borg, 1982). If a participant rated less than 7
The experiment was conducted on a badminton court in a on the scale (very hard), they had to perform shadow badmin-
gymnasium. Participants were asked to warm-up for 5 min ton movements until they reached this threshold (only one
before performing the task: a lateral jump (LJ). More precisely, participant was under 7 at the end of the match and had to
they were instructed to hit a shuttlecock suspended with a perform additional shadow movements).
fishing line at 1.5 times the height of each participant then to
return as quickly as possible to the starting point (see supple-
Instrumentation
mentary material). This movement was chosen because it was
considered as one of the highest risks to sustain an ankle sprain Twenty-three retro-reflective markers were placed on the right
injury due to the ankle plantarflexed and inverted position lower limb on the following locations: tip of the shoe, hallux, 2nd
when landing (D.T.-P. Fong et al., 2009). The task was repeated and 5th metatarsal heads, medial and lateral shoe forepart, inter-
to obtain 10 valid trials both in PRE and POST (whole foot nal and external rearfoot, calcaneus, internal and external mal-
contact with force plate and correct movement performance leoli, mid tibial, tibial tubercle, head of the fibula, internal and
at the discretion of the investigator). external femoral epicondyles, mid femoral, greater trochanter,
and anterior and posterior superior iliac spines (Figure 2). An 8-IR
Fatiguing protocol optoelectronic camera system (®Qualisys Oqus 7+ Series,
The fatiguing protocol was an intense badminton training ses- Gothenburg, Sweden) and a force plate embedded into the
sion designed by a graduate coach. Participants started with floor (®Kistler 9287CA, Switzerland) recorded both marker posi-
5 min of warm-up (badminton shadow movements). After tions and ground reaction force data synchronized at 250 and
1 min of rest, they performed 3 repetitions of the badminton- 2000 Hz, respectively.
specific speed test (BST) developed and validated by Madsen et The surface EMG activity of six lower limb muscles was
al. (2015), with 2 min of rest between each trial. The best time recorded using the DelSys (®DelSys Inc, Boston, Massachusetts,
performance of the 3 tests was kept. Then, participants per- 2000 Hz) double-differential Ag-AgCl surface electrodes with an
formed 6 sessions of 2 min where they had to hit shuttlecocks interelectrode distance of 10 mm: soleus (SOL), gastrocnemii
sent by the coach everywhere on badminton court under time- medialis (GM) and lateralis (GL), peroneus longus (PL), peroneus
pressure, with 1 min of rest between each session. Finally, each brevis (PB), tibialis anterior (TA). These muscles were selected
player played a 10-min simulated badminton match against the because they were the main muscles responsible for ankle dorsi/

Figure 2. Experimental set-up. PRE: biomechanical evaluation before the fatiguing protocol, FATIGUE: fatiguing protocol, POST: biomechanical evaluation after the
fatiguing protocol, RPE: rating of perceived exertion. The numbers in brackets correspond to the time of each sequence (PRE/POST).
JOURNAL OF SPORTS SCIENCES 3

plantarflexion and in/eversion, measurable with surface EMG size was assessed with Cohen’s d to determine the meaningful-
sensors. Surface electrodes were positioned in the middle of ness of the statistical differences between PRE and POST. It was
muscle bulks and aligned in parallel with the muscle fibres in defined as trivial (0–0.19), small (0.20–0.49), medium (0.50–0.79)
accordance with SENIAM recommendation (Hermens et al., and large (0.80 and greater) (Cohen, 1992).
2000). Before placing the surface electrodes, the skin surface
was shaved and cleaned with alcohol to reduce skin impedance.
Finally, the surface electrodes were firmly strapped to avoid any Results
movement during the tests. Participants
The mean ± SD demographic data of the participants were: age:
Data processing 23.2 ± 5.6 years, height: 1.76 ± 0.06 m, body mass: 69.4 ± 7.2 kg,
badminton exposure: 3.4 ± 1.5 h/per week, years of playing
Ankle joint motion was quantified using Visual 3D software (®C-
experience: 13.2 ± 7.1 years.
Motion, Rockville, MD) and normalized to a reference position
taken with the participant standing upright before PRE and
POST. The three-dimensional kinematics of the joints was cal- Fatiguing protocol
culated using an XYZ cardan sequence of rotations (X: flexion-
extension, Y: ab-adduction and Z: in-external rotation) (Wu et Participants were significantly slower to perform the BST after
al., 2002). Marker trajectories and ground reaction force (GRF) the fatiguing protocol (PRE: 34.7 ± 3.0 s, POST: 36.7 ± 3.7 s,
data were low-pass filtered using a fourth-order zero-lag p = 0.002). Mean RPE score significantly increased after the
Butterworth filter with cut-off frequencies of 12 and 50 Hz, fatiguing protocol (PRE: 2.1 ± 1.0, POST: 8.3 ± 0.8, p < 0.001).
respectively. Net joint moment was calculated using the
Newton-Euler inverse dynamics approach and joint power
Biomechanics
was determined as the product of the internal joint moment
and the joint angular velocity. Only the first phase of stance was After fatigue, ankle plantarflexion at foot strike decreased
evaluated and the negative values of the joint power corre- (PRE: −12.2 ± 6.4°, POST: −9.0 ± 6.5°, p = 0.002, d = 0.50)
sponded to the absorption phase. whereas ankle inversion at foot strike and peak ankle inver-
EMG data were processed using Visual 3D software (®C- sion increased (PRE: 1.7 ± 3.6°, POST: 4.3 ± 2.3°, p = 0.003,
Motion, Rockville, MD). First, EMG signals of each muscle d = 0.88 and PRE: 5.0 ± 3.4°, POST: 7.5 ± 2.6°, p = 0.005, d = 0.83,
were filtered with a Butterworth filter (bandpass, 4th order, respectively). A reduction in peak ankle plantarflexors
zero phase lag, bandwidth 20–400 Hz), in order to attenuate moment (PRE: 2.13 ± 0.50 Nm/kg, POST: 1.87 ± 0.50 Nm/kg,
movement artefacts. After rectifying the signal, the EMG p = 0.006, d = 0.52), peak ankle plantarflexors power absorp-
root-mean-square (RMS) value was computed. For each tion (PRE: −7.4 ± 3.1 W/kg, POST: −5.8 ± 2.8 W/kg, p = 0.010,
muscle, the muscle activation was assessed by normalizing d = 0.54) and peak ankle evertors moment (PRE:
the RMS value during each task with the highest RMS value 0.67 ± 0.39 Nm/kg, POST: 0.56 ± 0.37 Nm/kg, p = 0.042,
recorded among all trials (PRE and POST). Muscular pre- d = 0.29) was also observed (Table 1).
activations (% highest RMS value) were computed as aver-
aged muscle activation magnitudes during the pre-impact
phase, defined as the interval of 100 ms before foot strike Muscular activities
(Huang et al., 2014). EMG pre-activation significantly decreased after fatigue for SOL
(PRE: 17.1 ± 14.1%, POST: 13.1 ± 8.3%, p = 0.031, d = 0.36), GL
(PRE: 32.0 ± 17.9%, POST: 28.1 ± 15.1%, p = 0.035, d = 0.24), GM
Statistical analysis
(PRE: 31.8 ± 18.6%, POST: 24.4 ± 16.2%, p = 0.047, d = 0.43) and
All statistical analyses were done using Statistica (®Statsoft, PB (PRE: 24.7 ± 16.6%, POST: 20.4 ± 13.2%, p = 0.036, d = 0.29),
USA). Paired Student t-tests were performed between PRE but increased for TA (PRE: 16.3 ± 12.0%, POST: 19.6 ± 13.1%,
and POST. Significance threshold was set at p < 0.05. Effect p = 0.038, d = 0.26) (Figure 3).

Table 1. Kinematic and kinetic variables before (PRE) and after (POST) fatigue.
PRE POST t-test Effect size
Variables Mean (SD) Mean (SD) p Cohen’s d
Kinematics
Foot sagittal angle vs ground at foot strike (°) 27.4 (13.1) 19.8 (10.8) 0.005 0.64
Ankle plantarflexion at foot strike (°) 12.2 (6.4) 9.0 (6.5) 0.002 0.50
Ankle inversion at foot strike (°) 1.7 (3.6) 4.3 (2.3) 0.003 0.88
Peak ankle inversion during stance (°) 5.0 (3.4) 7.5 (2.6) 0.005 0.83
Kinetics
Peak ankle plantarflexor moment (Nm/kg) 2.13 (0.50) 1.87 (0.50) 0.006 0.52
Peak ankle evertor moment (Nm/kg) 0.67 (0.39) 0.56 (0.37) 0.042 0.29
Peak ankle plantarflexor power absorption (W/kg) 7.4 (3.1) 5.8 (2.8) 0.010 0.54
The initial contact with the ground was done with the forefoot.
4 A. HERBAUT AND J. DELANNOY

Figure 3. Muscular pre-activation (100-ms window before foot strike) of the six lower limb muscles recorded for lateral jump (black: pre-fatigue, grey: post-fatigue). *
p ≤ 0.05.
SOL: soleus, GL: gastrocnemius lateralis, GM: gastrocnemius medialis, TA: tibialis anterior, PB: peroneus brevis, PL: peroneus longus.

Discussion position due to the increased moment arm of the GRF (Wright
et al., 2000). The lower plantarflexor muscles mean pre-activa-
The aim of the present study was to investigate the influence of
tion (GL, GM and SOL) and the greater dorsiflexor muscle mean
fatigue induced by badminton practice on the ankle biomecha-
pre-activation (TA) may indicate impaired lower limb neuro-
nics of skilled badminton players performing lateral jumps. The
muscular control due to fatigue since the eccentric action of
main results confirmed our first initial hypothesis related to more
the plantarflexor muscles is necessary just after foot strike to
ankle inversion at foot strike and greater peak ankle inversion
slow the heel lowering. It resulted in a reduced peak ankle
during stance. Our second initial hypothesis regarding the
plantarflexor moment and peak ankle plantarflexor power
decreased evertor muscles pre-activation was partially verified
absorption after fatigue.
since the peroneus brevis pre-activation was significantly reduced,
The participants also landed with a more inverted ankle posi-
but the peroneus longus pre-activation did not decrease
tion after fatigue. It was observed that when the ankle evertor
statistically.
muscles were fatigued, the absolute error in ankle inversion and
eversion repositioning tasks was significantly increased
Fatiguing protocol (Mohammadi & Roozdar, 2010; Sandrey & Kent, 2008). Joint
position sense may have been impaired in a fatigued state
We decided to design a customized fatiguing protocol with a since the most important source of information would be the
graduate badminton coach, containing typical exercises of a muscle receptors, whose activity was observed to decrease with
badminton practice session rather than fatiguing isolated mus- fatigue (Gandevia, 1998). It has been stated that increasing ankle
cles. The goal was to be more representative of an actual inversion angle at ground contact, as observed in the present
badminton game, by generating both peripheral and central study, may increase the risk of sustaining a lateral ankle sprain,
fatigue due to the attention required for the double-task (mov- notably due to the more laterally positioned centre of pressure at
ing on badminton court and hitting the shuttlecock). Two initial contact (Robbins et al., 1995; Willems et al., 2005).
parameters indicated that the fatiguing protocol was effective: Furthermore, even though the participants were quite far from
mean badminton-specific speed test (BST) time increased by 2 s the biomechanical limits leading to an ankle sprain, the peak
and mean RPE score was above 7 (very hard). ankle inversion angle during stance was larger in the fatigued
state. This may be due to the lower muscular pre-activation of
the peroneus brevis following fatigue, which acts to limit the
Lateral jump biomechanics rapid ankle inversion just after the foot strike with the ground.
To perform the lateral jump, the participants landed with
reduced ankle plantarflexion after fatigue. Such a kinematic
Implication for performance and injuries
change has already been observed in forefoot runners, who
can generally not maintain a forefoot strike pattern after an It was generally hypothesized in the literature that excessive
exhaustive run (Jewell et al., 2017). Repeated stretch-shorten- ankle inversion and plantarflexion angles at initial contact
ing cycles in badminton movements produced plantarflexor would increase the risk of ankle sprain injury, due to the larger
muscles fatigue and likely reduced their ability to contract ground reaction force moment arm about the subtalar joint
eccentrically to attenuate the impact. This altered landing posi- (Willems et al., 2005). In this study, the increased ankle inversion
tion may also be a protective mechanism adopted by the angle post-fatigue suggests an increased risk of ankle sprain
participants, consciously or unconsciously, against ankle while the decreased ankle plantarflexion angle at foot contact
sprains since a pronounced plantarflexion angle at foot strike suggests a decreased risk of ankle sprain. However, in those
reduces ankle stability compared with a neutral or dorsiflexed studies reporting accidental ankle sprains during experimental
JOURNAL OF SPORTS SCIENCES 5

protocols, it was shown that the ankle plantarflexion angle was the deleterious effects of fatigue. Furthermore, future studies
similar in the injury trial compared with the control trials wanting to evaluate equipment, designed to reduce ankle sprain
(Kristianslund et al., 2011; Li et al., 2019). In addition, based on risks, should fatigue participants before any measurements are
video analyses, ankle sprain injuries were also observed at a taken.
very low plantarflexion angle (5°) and even in a dorsiflexed
position at ground contact, demonstrating that a large ankle
plantarflexion angle is not systematically required for the injury Disclosure Statement
to occur (D.T. Fong et al., 2009; Mok et al., 2011). All authors have no conflict of interest to disclose.
Post-fatigue, the increase in ankle inversion at foot strike
and peak ankle inversion during stance were substantial, as
evidenced by the large effect size (2.6°, d = 0.88 and 2.5°, ORCID
d = 0.83, respectively), which suggests a larger risk of sustaining
Alexis Herbaut http://orcid.org/0000-0002-9643-8917
an ankle sprain. The fatiguing protocol was particularly stren-
uous according to the participants’ feedback and the RPE
scores. However, longer training sessions and the repetition References
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