Letter to the Editor to Article “Effect of the Perception of Knee Pain on Muscle Strength and Endurance among Elite Female Handball Players”

I read with great interest the study by Kim and Park titled “Effect of the Perception of Knee Pain on Muscle Strength and Endurance among Elite Female Handball Players” [1]. This research makes a valuable contribution to the literature by exploring the impact of knee pain perception on muscle strength and endurance. The findings provide critical insights into the development of strategies aimed at enhancing athletic performance, particularly in the context of knee biomechanics and sports injury rehabilitation. However, I believe there are areas in the study’s statistical methods and methodological scope that could be further developed and deepened. The use of the Cybex HUMAC system to assess muscle strength and endurance stands out as a significant strength of the study. This system is well-known for its high accuracy and repeatability, which enhances the reliability of the findings [2]. Additionally, focusing on the relationship between the hamstring/quadriceps (H/Q) ratio and knee pain perception contributes to a better understanding of knee stability and injury risk [3]. This analysis provides a solid foundation for understanding the biomechanical implications of muscular imbalances on performance.

However, the study is limited by its small sample size of 60 participants, all of whom are elite female handball players. This narrow sample scope restricts the generalizability of the findings. Including participants from different age groups, genders, and amateur sports backgrounds could broaden the applicability of the results [4]. A more diverse sample could also provide insights into whether the findings are relevant across various sports or athlete populations with differing physical demands. The statistical analyses successfully elucidated the relationship between knee pain perception and muscle endurance. However, the regression models lacked sufficient detail about the control variables included, which makes it unclear which factors were independently significant. Moreover, the absence of statistical performance metrics, such as the coefficient of determination (R²), limits the evaluation of the model's explanatory power [5].

Incorporating variables such as psychological resilience, training intensity, and injury history would provide a more comprehensive understanding of the effects of knee pain perception. The cross-sectional design of the study poses another limitation, as it only allows for the examination of the relationship between knee pain perception and muscle endurance at a single time point. A longitudinal design would offer a better understanding of how this relationship evolves over time and during the rehabilitation process [6]. Such an approach would be particularly valuable in assessing the long-term impact of knee pain on athletic performance and designing effective rehabilitation protocols. The results clearly demonstrate a significant negative effect of increased knee pain perception on muscle endurance. Specifically, a one-unit increase in pain perception is associated with a 3.07-unit decrease in endurance performance for knee flexor and extensor muscles. This finding highlights the direct impact of knee pain on athletic performance. However, more detailed analyses are needed to determine whether this effect varies across sports and physical activity levels. Evaluating the efficacy of specific rehabilitation protocols aimed at improving muscle endurance, such as targeted exercises, would provide further practical insights [7].

Kim and Park’s study is a significant step toward understanding the effects of knee pain perception on athletic performance. However, the inclusion of larger sample sizes, longitudinal designs, and additional variables in statistical models could enhance the generalizability and impact of the findings. Validating the study’s results in a broader context would establish a stronger foundation for developing effective rehabilitation strategies to optimize athlete recovery and performance.

Publikationsverlauf

Eingereicht: 23. November 2024

Angenommen nach Revision: 19. Dezember 2024

Artikel online veröffentlicht:
28. Januar 2025

• References

• 1 Kim C, Park KJ. Effect of the Perception of Knee Pain on Muscle Strength and Endurance among Elite Female Handball Players. Phys Medizin Rehabil Kurortmedizin. 2021; 31: 262-267
• 2 Bala K, Gakhar M, Jagga V. Effect of endurance training of trunk extensor muscles on pain and endurance in patients with sub acute nonspecific low backache. J Exerc Sci Physiother 2012; 8: 82-86
• 3 Fousekis K, Tsepis E, Vagenas G. Multivariate isokinetic strength asymmetries of the knee and ankle in professional soccer players. J Sport Med Phys Fit. 2010; 50: 465-474
• 4 Øiestad BE, Juhl CB, Eitzen I. et al. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthr Cartil 2015; 23: 171-177
• 5 Smith HC, Vacek P, Johnson RJ. et al. Risk factors for anterior cruciate ligament injury: a review of the literature-part 2: hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Sports Health. 2012; 4: 155-161
• 6 Angelozzi M, Madama M, Corsica C. et al. Rate of force development as an adjunctive outcome measure for return-to-sport decisions after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2012; 42: 772-780
• 7 Islam MS, De A. Functional Hamstring to Quadriceps Strength Ratio (H:Q) and Hamstrings Injury of Soccer Players: A Qualitative Analysis. Orthop Sport Med Open Access J. 2018; 2