Concurrent repetitions overestimate hamstring:quadriceps ratios at extended knee joint positions: implications for clinical practice

Most measurements of isokinetic hamstring:quadriceps (H:Q) strength ratios are conducted using concurrent repetitions, whereby active knee extension is immediately followed by active knee flexion. To reduce the influence of the stretch-shortening cycle and limit axis misalignment, isolated repetitions have been recommended, whereby extension and flexion are completed separately. To inform screening protocols, this study examined the effect of concurrent and isolated trials on discrete and angle-specific H:Q ratios. Fifteen males (age: 27 ± 4 years; height: 184 ± 9 cm; body mass: 80 ± 9 kg) performed isokinetic tests of the knee flexors and extensors (60 °/s) using concurrent and isolated trials while sagittal kinematics were captured (100 Hz). Statistical parametric mapping enabled the effects of protocol type (concurrent vs. isolated) and axis misalignment (uncorrected vs. corrected) to be compared. Uncorrected data resulted in an underestimation of discrete conventional (−10.17%, p < 0.001) and functional (−9.21%, p < 0.05) ratios with differences being observed for all angle-specific ratios (p < 0.001). The use of concurrent repetitions resulted in a significant overestimation of the conventional H:Q ratio (+7.41%, p < 0.05) with the differences being most prevalent at more extended (24 - 45° knee flexion, p < 0.05) knee joint positions. Dynamometer users should be aware that concurrent repetitions increase the likelihood of “false negative” injury risk categorisation. Nevertheless, the common practice of using uncorrected data from concurrent repetitions does not lead to significant differences in discrete or angle-specific H:Q ratios when compared with corrected data obtained from isolated repetitions.