ABSTRACT The dynamic knee valgus (DKV) during different sport maneuvers has been widely described as risk factor to develop an anterior cruciate ligament injury. Hip and knee muscles seem to

have a crucial role to prevent the dynamic knee valgus. This study aimed to give normative and correlational data about DKV and hip and knee neuromuscular response (NMR) among healthy

active males. The hypothesis is that DKV could be correlated with hip NMR. A cross-sectional correlational study. Research Anatomy Laboratory. The study was carried out among 50 active,

non-injured males. Dynamic Knee-Valgus angle and lower limb posterior chain muscles Neuromuscular Response. DKV was measured using Kinovea software during a Single-Legged Drop Jump test and

tensiomyography and myotonometry for healthy and active males. The DKV control seems to be non-correlated with isolated hip and knee muscles NMR so this suggests it is more about Central

Nervous System activity than about isolated muscles NMR. SIMILAR CONTENT BEING VIEWED BY OTHERS LOWER EXTREMITY ENERGY ABSORPTION STRATEGIES AT DIFFERENT PHASES DURING SINGLE AND DOUBLE-LEG

LANDINGS WITH KNEE VALGUS IN PUBERTAL FEMALE ATHLETES Article Open access 01 September 2021 THE EFFECT OF STOP X EXERCISES ON BALANCE, STRENGTH AND RANGE OF MOTION OF MALE ADOLESCENT

FOOTBALL PLAYERS WITH DYNAMIC KNEE VALGUS Article Open access 25 May 2025 THIGH MUSCLE CO-CONTRACTION PATTERNS IN INDIVIDUALS WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION, ATHLETES AND

CONTROLS DURING A NOVEL DOUBLE-HOP TEST Article Open access 19 May 2022 INTRODUCTION The anterior cruciate ligament (ACL) injury is a common injury in general population with an annual

incidence of 68.6 per 100,000 person-years1. This data is significantly higher among professional athletes (ranging from 150 to 370 injuries per 100,000 person-years) and amateur athletes

(ranging from 30 to 162 injuries per 100,000 person-years)2. Several authors have suggested that most of these injuries occur by non-contact mechanisms3. Video-analysis studies have

described the dynamic knee valgus (DKV) during landing, pivoting or deceleration maneuvers as the most common ACL injury in sports as football, basketball or handball4,5,6,7. The DKV is a

medial collapse of the knee resulting in a hip adduction and internal rotation, tibial abduction and medial knee displacement which increases the ACL strain8. Many studies have measured the

dynamic knee valgus in the sagittal plane using 2D video-analyisis9,10,11,12. The main cause of the DKV are neuromuscular control deficits and, therefore, injury prevention and

rehabilitation strategies are currently focusing on improving neuromuscular control in order to avoid this injury mechanisms13. Within neuromuscular system, the hip and the knee muscles seem

to have a crucial role to prevent the dynamic knee valgus. Specifically, athletes with poor glutes and hamstring activation are more likely to collapse the knee during a landing and then,

potentially increasing the risk of non-contact ACL injury14. In fact, a protocol for neuromuscular activation of the abductors and external hip rotators during warm-up has recently been

shown to reduce the DKV by 53–63% in youth male soccer players15. The relation between hip strength and the dynamic knee valgus seems to be clear16, but a possible relation between DKV and

neuromuscular response (NMR) as contraction time, stiffness, tone or muscular displacement remain unstudied. The NMR is a combination of biomechanical parameters of the muscle tissue that

measured by two different methodologies, the MyotonPro device (mytonPro, Myoton Ltds., Estonia) and Tensiomyography (TMG-BMC. Ljubljana, Slovenia). While the Myoton provides information

about the tone, stiffness, relaxation and elasticity of the muscle17,18, the TMG provides information about muscle stiffness or tone, contraction velocity, type of predominant skeletal

muscle fibers, or muscle fatigue19,20,21,22. The aim of this study was: (1) to give normative data about DKV and NMR among active, non-injured males and (2) to study a possible relation

between the dynamic knee valgus and hip and knee neuromuscular response as contraction time, stiffness, tone or muscular displacement. We hypothesized that DKV angle could be correlated with

hip and knee NMR parameters. MATERIALS AND METHODS ETHICAL CONSIDERATIONS Approval was obtained from the local ethics committee (CER-UIC-Barcelona; study code: CBAS-2018-17) and the study

was conducted in accordance with the declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. PARTICIPANTS The sample size was

calculated using the _Calculadora de Grandària Mostral_ (GRANMO v7.12) software based on McCurdy et al.23 results to detect correlation coefficients of 0.41 or greater at α = 0.05 and β = 

0.20. A sample size of minimum 50 participants was needed. The participants recruited for the present study were 50 healthy young adults (between 18 to 29 years old). A convenience sample

was recruited by informative posters put up across University asking for participants. The inclusion criteria were: (1) to have signed the informed consent and (2) to do physical activity at

least three times per week. Participants were not eligible to participate if they: (1) had sustained a lower limb injury for the last year or (2) did not understand the information given or

(3) had a history of ACL injury. Fifty healthy males participated in this study. Variables with normal distribution are described as mean ± standard deviation and variables with abnormal

distribution are described as median ± interquartile range. Baseline characteristics and DKV values of the sample are shown in Table 1. EXPERIMENTAL DESIGN A cross-sectional, correlation

study examining healthy active males were used for this study. The variables were dynamic knee valgus and hip and knee neuromuscular response. DYNAMIC KNEE VALGUS A two-dimensional

video-analysis was used to measure the knee-valgus/varus frontal-plane projection angle (FPPA) during a Single-Legged Drop Jump test12,24. The knee valgus/varus frontal-plane angle was

defined as the angle between (1) the ankle midpoint, (2) the patella midpoint and (3) the projection line between the patella midpoint and the anterior superior iliac spine8. The

Single-Legged Drop Jump test is a test where the subjects were asked to do a single-legged drop from a 50 cm box, to jump immediately as high as possible and to land with only one leg.

Subjects had to do it with the right leg firstly and with the left leg secondly. The _Kinovea software_ v0.8.26 (Kinovea open source project under GPLv2) was used to quantify the FPPA25. The

video camera was placed at the height of 50 cm from the bottom, three meters anterior to the subject and the maximum FPPA during the Single-Legged Drop Jump test was recorded (Fig. 1).

NEUROMUSCULAR RESPONSE (NMR) The methodologies for tensiomyography (TMG) and Myoton assessment were identical in both sides, and values were obtained by the same investigator, who had

experience with both tools. All subjects were instructed to come for measurements in the following conditions as previous research from Alvarez-Diaz et al26 suggested: (1) resting, with no

previous high intensity exercise and no intake of energy drinks within lasts 48 h; (2) no alcohol or caffeine at least 3 h before measurements; and (3) no food intake at least 2 h before

measurements. The environmental conditions of the room are controlled (temperature: 21–23 ºC and humidity: 40–50%) so that they were the same throughout the process. The TMG (Fig. 2) has

shown a good inter-observer, intra-session and between-day reliability for lower limb muscles21,26,27,28,29,30. The TMG provides data about the muscle belly radial displacement, which is

called maximal displacement (Dm). It is expressed in mm and it informs about muscle stiffness26,31. Moreover, TMG provides data about the delay time (Td), which is the time between the

initiation and 10% of _D_m; the contraction time (_T_c), which is the time between 10 and 90% of _D_m; the sustained time (_T_s) is the time in which the muscle response remains > 50% of

_D_m; and the half-relaxation time (_T_r), which is the time in which the muscle response decreases from 90 to 50% of _D_m26. From all this parameters, _Dm_ and _Tc_ are the two most

utilized among research29. The measurement methods, protocol and anatomical localization of the sensors were standardized for all subjects and established according a previous study from Rey

et al21 and Álvarez et al26. All measurements were obtained at rest in prone position. The self-adhesive electrodes (TMG electrodes, TMG-BMC d.o.o. Ljubljana, Slovenia) were placed

equidistant to the measuring point26. The digital transducer Dc–Dc Trans-Tek (GK 40, Panoptik d.o.o., Ljubliana, Slovenia) was placed perpendicular to the muscle belly between both

electrodes26. A TMG-100 System electrostimulator (TMG-BMC d.o.o., Ljubljana, Slovenia) with a pulse of 1 ms and initial amplitude of 50 mA was used for the electrical stimulation26. For each

test, amplitude was progressively increased by 10 mA increments until there was no further increase in _D_m or maximal stimulator output (110 mA)26. The tensiomyography test was carried out

in both glutes maximum (Gmax), biceps femoris (BF), semitendinosus (ST), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL). The MyotonPro (mytonPro, Myoton Ltds., Estonia) (Fig. 

3) uses a portable device to measure the deformation properties of natural damped oscillations produced due to a short (15 ms) mechanical tap to the surface of the skin with a good

reliability for lower limb muscles32,33,34,35. The parameters obtained by MyotonPro were (1) Frequency (natural oscillation frequency characterizing the _tone_ of the muscle in resting

state), (2) Displacement (logarithmic decrement of natural oscillation, characterizing _elasticity_), (3) Dynamic _stiffness_, characterizing the muscle resistance to contraction, (4) ratio

of relaxation time to deformation time, characterizing _creep_ and (5) mechanical stress _relaxation_ time. The measurement methods, protocol and anatomical localization of the sensors were

standardized for all subjects and established according to previous studies35. All measurements were obtained at rest in the prone position with the sensor device placed in the middle of the

muscle belly. (identified by manual palpation) and angled 90° to the skin surface. For each test, the MyotonPro device took three taps and the mean of each parameter was obtained.

Measurement was valid only if the variation between three taps was less than 5%. The MyotonPro test was carried out in both glutes maximum (Gmax), biceps femoris (BF), semitendinosus (ST),

gastrocnemius medialis (GM) and gastrocnemius lateralis (GL). STATISTICAL ANALYSIS SPSS v.20 (IBM Corp., Armonk, N.Y., USA) was used for the statistical analysis. Quantitative variables and

differences are expressed mean and standard deviation (SD) or median ± interquartile range (IQR). The level of significance was set at α = 0.05 and confidence interval limits at 95%. The

suitability of using parametric or non-parametric tests was verified with the Shapiro–Wilk test. The correlation analysis was performed using the Pearson correlation coefficient for

parametric variables or Spearman's rank correlation coefficient for non-parametric variables. ETHICAL APPROVAL The institutional ethics committee approved the present study

(CBAS-2018-17). Funding: There is no funding source. RESULTS Descriptive data for variables measured in this study are shown at Tables 2 and 3 for neuromuscular response measured by

Tensiomyography and MyotonPro respectively. Only contraction time and maximal displacement (for TMG) and tone and stiffness (for Myoton) are shown on the tables because they are the most

clinically relevance measures. The correlation analysis showed no significant correlation between DKV and any NMR parameter (p > 0.05; r < 0.3). Neither the Myoton nor the

Tensiomyography parameters measured in both glutes maximus, biceps femoris, semitendinosus, lateral gastrocnemius and medial gastrocnemius were significantly correlated with frontal plane

knee angle during the Single-Legged Drop Jump test (“Annex 1”). Moreover, no correlation was found between DKV or NMR with baseline characteristics as weight, height, BMI, days of physical

activity and age. Complete correlation analysis with all TMG and MTT parameters is available on Supplemental File 1. DISCUSSION NORMATIVE DATA ABOUT FPPA The principal aim of this study was

to show normative data for FPPA and NMR among healthy, non-injured population. As shown, males on this study had a FPPA mean ± SD of 12.06 ± 7.60 for right leg and a median ± IQR of 9.5 ± 

13.8 for left leg. Herrington et al.36 measured the FPPA among very similar population from this study. However, sample from this study seems to have greater valgus angle than those from

Herrington. They found a mean FPPA of 4.9˚ for both legs in a male population. Comparing data from this study to other types of population, Munro et al.37,38 showed a FPPA much smaller among

female basketball and football players in two different studies. It suggests that athletes and/or females had smaller FPPA than active and healthy males. It could be easily explained

because of the regular strength and motor control training that athletes do. It surely helps to avoid greater FPPA. Greater FPPA and then, DKV during jumping have been widely described as

biomechanical alteration that could lead to an ACL injury39, the responsibility to avoid this condition remains confuse. It is known that hip and knee muscle function have a crucial role

controlling the knee position40,41. However, the current evidence suggests that it is not only a question about muscle characteristics but about motor control13,15. Motor control means the

ability to control movements during functional activities such as jumping, running, squatting, pivoting, etc42. This obviously includes the Central Nervous System (CNS) into the game.

NORMATIVE DATA ABOUT NMR The TMG have been recently used to evaluate fatigue-induced muscle changes43,44, to assess muscle impairments45, to evaluate and quantify painful muscle trigger

points46 and to corroborate rehabilitation muscle adaptations along the time47 in specific populations. These studies showed the TMG as a really clinical useful tool to evaluate muscle

characteristics and changes but, due to the specificity of the population, it is not possible to compare them with data from this study48. No studies showing normative data for healthy and

active young adults were found. This study shows normative data for maximal displacement (_D_m) and the contraction time (_T_c) for all principal lower limb muscles among healthy and active

population. Many studies have studied neuromuscular response on biceps femoris in healthy population. Sánchez-Sánchez et al.49 found a mean of 5.7 mm Dm and 28.45 ms Tc in elite futsal

players. Other study from Sánchez-Sánchezet al.50 found a mean of 6.87 mm Dm and 37.36 ms Tc in u18 soccer players. García-García51 found a mean of 6.8 mm Dm and 34.2 ms Tc in elite

cyclists. Álvarez-Díazet al.26 found a mean of 4.6 mm Dm and 24.5 ms Tc in soccer players. Zubacet al.52 found a mean of 6.2 mm Dm and 42.1 ms Tc in a healthy and active population very

similar to those from the current study which found a mean of 7.1 mm Dm and 42 ms Tc. It suggests that biceps femoris Dm and Tc differs between different types of population showing lower

values for athletes than for active people. Only one study53 was found showing semitendinosus TMG data for healthy people and it showed 9.6 mm Dm and 35.4 ms Tc in contrast with 9.1 mm Dm

and 39 ms Tc showed in the present study. Same results have been found for gastrocnemius medialis and gastrocnemius lateralis. Zubacet al.52 found a mean of 4.5 and 4 mm Dm and 29.2 and 30 

ms Tc for gastrocnemius lateralis and medialis respectively among a very similar population from this study which found 5.2 and 3.6 mm Dm and 27 and 26 ms Tc for lateralis and medialis

gastrocnemius respectively. However, Alvarez-Diaz et al.53 found lower values of Dm and Tc for soccer players suggesting that gastrocnemius neuromuscular response differ between athletes and

active people showing lower values for athletes than for active people. No studies were found providing TMG data of the gluteus maximum in non-injured people so data from this study cannot

be compared. This is the first study showing TMG data from a crucial muscle to control and protect the knee as it is the gluteus maximus. On the other hand, the myotonometry usefulness in

order to evaluate the muscle stiffness seems to be doubtless32. Moreover, some studies have linked stiffness with sport-related injuries54,55,56. Only one study from Ditroilo et al.57 was

found in order to compare myotonometry data with population from the current study. It only measured biceps femoris neuromuscular response and it obtained a mean of 15.8 Hz for tone and

328.3 N m-1 for stiffness. This data is very similar to these from this study that found 15.3 Hz for tone and 271 N m-1 for stiffness. This is the first study showing normative data for

stiffness and tone for all principal lower limb muscles among healthy and active population. CORRELATION ANALYSIS TMG and Myoton are both really interesting tools that have demonstrated its

reliability to measure the neuromuscular response in an isolated muscle27,32. However, they do not take into account the Central Nervous System and his importance to produce a muscle strong

and quick contraction. So, regarding on the second aim of this study, the ability to control the knee valgus during a Single-Legged Drop Jump was not correlated (p > 0.05; r < 0.3)

with isolate neuromuscular response. This supports the hypothesis that dynamic knee valgus control is more about CNS function than isolated NMR. Exercises aiming improve isolated muscle such

as glute maximum or hamstrings may have a role on first states of the rehabilitation. But, if the aim is to control knee valgus, in order to prevent ACL injuries CNS training may be the

key. LIMITATIONS The biggest limitation of this study is the little specificity of the sample. Future research should be carried out with people or athletes at ACL injury risk to compare the

data and to evaluate a possible correlation between DKV and NMR. The present study did not found a relation but maybe, this relation could be appear in a sample more likely to suffer an ACL

injury due to sport type or injury history, for example. STRENGTHS This is the first study to show normative TMG data for gluteus maximus. No study has provided normative data about MTT

parameters in healthy and active sample so it is the first study providing it. In fact, two different and novel techniques have been used in order to inform about the neuromuscular response

of posterior chain muscles. Furthermore, this is the first study aiming to explore the relation between dynamic knee valgus and neuromuscular response of these muscles. CONCLUSIONS This

study shows normative data about dynamic knee valgus, tensiomyography and myotonometry for healthy and active population. Moreover, this study found no correlation between DKV and NMR and

this could be explained because of the influence of Central Nervous System. To control dynamic knee valgus during sport maneuvers such as single leg jumps is crucial in order to prevent

sport-related injuries as anterior cruciate ligament. This study suggests that Central Nervous System activity is more important than isolated hip and knee muscles response in order to

control this condition. So, anterior cruciate ligament injury prevention exercises should focus on motor control and CNS activity more than improving muscle strength and/or muscle tone.

ANNEX 1 Correlations table Muscle Right/left Device Variable Statistic Dynamic left knee valgus Dynamic right knee valgus Gluteus max Right Tensiomyography Tc Correlation coefficient  

0.219a Sig   0.127a Dm Correlation coefficient   0.161a Sig   0.263a Myotonometry Tone Correlation coefficient   0.181a Sig   0.212a Stiffness Correlation coefficient   0.206b Sig   0.156b

Left Tensiomyography Tc Correlation coefficient 0.121a   Sig 0.414a   Dm Correlation coefficient − 0.062a   Sig 0.674a   Myotonometry Tone Correlation coefficient 0.031a   Sig 0.836a  

Stiffness Correlation coefficient − 0.118a   Sig 0.431a   Bíceps femoris Right Tensiomyography Tc Correlation coefficient   0.218a Sig   0.128a Dm Correlation coefficient   − 0.016b Sig  

0.912b Myotonometry Tone Correlation coefficient   − 0.081a Sig   0.581a Stiffness Correlation coefficient   − 0.102a Sig   0.487a Left Tensiomyography Tc Correlation coefficient − 0.058a  

Sig 0.697a   Dm Correlation coefficient − 0.233a   Sig 0.112a   Myotonometry Tone Correlation coefficient − 0.201a   Sig 0.176a   Stiffness Correlation coefficient − 0.173a   Sig 0.244a   *

_Tc _contraction time, _Dm _muscle displacement, _Sig. _significance at α=95%. * aPearson. * bRho Spearman. REFERENCES * Sanders, T. L. _et al._ Incidence of anterior cruciate ligament tears

and reconstruction. _Am. J. Sports Med._ 44, 1502–1507 (2016). Article  PubMed  Google Scholar  * Moses, B., Orchard, J. & Orchard, J. Systematic review: Annual incidence of ACL injury

and surgery in various populations. _Res. Sport. Med._ 20, 157–179 (2012). Article  Google Scholar  * Griffin, L. Y. _et al._ Noncontact anterior cruciate ligament injuries: Risk factors and

prevention strategies. _J. Am. Acad. Orthop. Surg._ 8, 141–150 (2000). Article  CAS  PubMed  Google Scholar  * Olsen, O.-E., Myklebust, G., Engebretsen, L. & Bahr, R. Injury mechanisms

for anterior cruciate ligament injuries in team handball. _Am. J. Sports Med._ 32, 1002–1012 (2004). Article  PubMed  Google Scholar  * Cochrane, J. L., Lloyd, D. G., Buttfield, A., Seward,

H. & McGivern, J. Characteristics of anterior cruciate ligament injuries in Australian football. _J. Sci. Med. Sport_ 10, 96–104 (2007). Article  PubMed  Google Scholar  * Krosshaug, T.

_et al._ Mechanisms of anterior cruciate ligament injury in basketball. _Am. J. Sports Med._ 35, 359–367 (2007). Article  PubMed  Google Scholar  * Kiapour, A. M. _et al._ Strain response of

the anterior cruciate ligament to uniplanar and multiplanar loads during simulated landings. _Am. J. Sports Med._ 44, 2087–2096 (2016). Article  PubMed  Google Scholar  * Paz, G. A. _et

al._ Knee frontal plane projection angle: A comparison study between drop vertical jump and step-down tests with young volleyball athletes. _J. Sport Rehabil._ 28, 153–158 (2019). Article 

PubMed  Google Scholar  * Schurr, S. A., Marshall, A. N., Resch, J. E. & Saliba, S. A. Two-dimensional video analysis is comparable to 3D motion capture in lower extremity movement

assessment. _Int. J. Sports Phys. Ther._ 12, 163–172 (2017). PubMed  PubMed Central  Google Scholar  * Ortiz, A. _et al._ Reliability and concurrent validity between two-dimensional and

three-dimensional evaluations of knee valgus during drop jumps. _Open Access J. Sport. Med._65 , https://doi.org/10.2147/OAJSM.S100242 (2016). * Ramirez, M., Negrete, R., J Hanney, W. &

Kolber, M. J. Quantifying frontal plane knee kinematics in subjects with anterior knee pain: The reliability and concurrent validity of 2D motion analysis. _Int. J. Sports Phys. Ther._13,

86–93 (2018). * Gwynne, C. R. & Curran, S. A. Quantifying frontal plane knee motion during single limb squats: Reliability and validity of 2-dimensional measures. _Int. J. Sports Phys.

Ther._ 9, 898–906 (2014). PubMed  PubMed Central  Google Scholar  * Hewett, T. E., Di Stasi, S. L. & Myer, G. D. Current concepts for injury prevention in athletes after anterior

cruciate ligament reconstruction. _Am. J. Sports Med._ 41, 216–224 (2013). Article  PubMed  Google Scholar  * Rath, M. E., Stearne, D. J., Walker, C. R. & Cox, J. C. Effect of foot type

on knee valgus, ground reaction force, and hip muscle activation in female soccer players. _J. Sports Med. Phys. Fitness_ 56, 546–553 (2016). PubMed  Google Scholar  * García-Luna, M. A.,

Cortell-Tormo, J. M., García-Jaén, M., Ortega-Navarro, M. & Tortosa-Martínez, J. Acute effects of ACL injury-prevention warm-up and soccer-specific fatigue protocol on dynamic knee

valgus in youth male soccer players. _Int. J. Environ. Res. Public Health_ 17, 1–14 (2020). Article  Google Scholar  * Dix, J., Marsh, S., Dingenen, B. & Malliaras, P. The relationship

between hip muscle strength and dynamic knee valgus in asymptomatic females: A systematic review. _Phys. Ther. Sport_ https://doi.org/10.1016/j.ptsp.2018.05.015 (2018). Article  PubMed 

Google Scholar  * Meerits, T. _et al._ Acute effect of static and dynamic stretching on tone and elasticity of hamstring muscle and on vertical jump performance in track-and-field athletes.

_Acta Kinesiol. Univ. Tartu._ 20, 48 (2014). Article  Google Scholar  * Janecki, D., Jarocka, E., Jaskólska, A., Marusiak, J. & Jaskólski, A. Muscle passive stiffness increases less

after the second bout of eccentric exercise compared to the first bout. _J. Sci. Med. Sport_ 14, 338–343 (2011). Article  PubMed  Google Scholar  * Kokkonen, J., Nelson, A. G. &

Cornwell, A. Acute muscle stretching inhibits maximal strength performance. _Res. Q. Exerc. Sport_ 69, 411–415 (1998). Article  CAS  PubMed  Google Scholar  * Križaj, D., Šimunič, B. &

Žagar, T. Short-term repeatability of parameters extracted from radial displacement of muscle belly. _J. Electromyogr. Kinesiol._ 18, 645–651 (2008). Article  PubMed  Google Scholar  * Rey,

E., Lago-Peñas, C. & Lago-Ballesteros, J. Tensiomyography of selected lower-limb muscles in professional soccer players. _J. Electromyogr. Kinesiol._ 22, 866–872 (2012). Article  PubMed

  Google Scholar  * Rusu, L. D. _et al._ Tensiomyography method used for neuromuscular assessment of muscle training. _J. Neuroeng. Rehabil._ 10, 67 (2013). Article  PubMed  PubMed Central 

Google Scholar  * McCurdy, K., Walker, J., Armstrong, R. & Langford, G. Relationship between selected measures of strength and hip and knee excursion during unilateral and bilateral

landings in women. _J. strength Cond. Res._ 28, 2429–2436 (2014). Article  PubMed  Google Scholar  * Munro, A., Herrington, L. & Carolan, M. Reliability of 2-dimensional video assessment

of frontal-plane dynamic knee valgus during common athletic screening tasks. _J. Sport Rehabil._ 21, 7–11 (2012). Article  PubMed  Google Scholar  * Puig-Diví, A. _et al._ Validity and

reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. _PLoS ONE_ 14, e0216448 (2019). Article  PubMed  PubMed Central  CAS  Google Scholar

  * Alvarez-Diaz, P. _et al._ Comparison of tensiomyographic neuromuscular characteristics between muscles of the dominant and non-dominant lower extremity in male soccer players. _Knee

Surgery, Sport. Traumatol. Arthrosc._24, 2259–2263 (2016). * Tous-Fajardo, J. _et al._ Inter-rater reliability of muscle contractile property measurements using non-invasive tensiomyography.

_J. Electromyogr. Kinesiol._ 20, 761–766 (2010). Article  PubMed  Google Scholar  * Valenčič, V. & Knez, N. Measuring of skeletal muscles’ dynamic properties. _Artif. Organs_ 21,

240–242 (1997). Article  PubMed  Google Scholar  * Rusu, L. D. _et al._ Tensiomyography method used for neuromuscular assessment of muscle training. _J. Neuroeng. Rehabil._10 (2013). *

Šimunič, B. Between-day reliability of a method for non-invasive estimation of muscle composition. _J. Electromyogr. Kinesiol._ 22, 527–530 (2012). Article  PubMed  Google Scholar  *

Pérez-Belllmunt, A. _et al._ Neuromuscular response what is it and how to measure it ?. _Phys. Med. Rehabil. J._ 2, 118 (2019). Google Scholar  * Pruyn, E. C., Watsford, M. L. & Murphy,

A. J. Validity and reliability of three methods of stiffness assessment. _J. Sport Heal. Sci._ 5, 476–483 (2016). Article  Google Scholar  * Aird, L., Samuel, D. & Stokes, M. Quadriceps

muscle tone, elasticity and stiffness in older males: Reliability and symmetry using the MyotonPRO. _Arch. Gerontol. Geriatr._ 55, e31–e39 (2012). Article  PubMed  Google Scholar  * Lohr,

C., Braumann, K.-M., Reer, R., Schroeder, J. & Schmidt, T. Reliability of tensiomyography and myotonometry in detecting mechanical and contractile characteristics of the lumbar erector

spinae in healthy volunteers. _Eur. J. Appl. Physiol._ 118, 1349–1359 (2018). Article  PubMed  Google Scholar  * Bizzini, M. & Mannion, A. F. Reliability of a new, hand-held device for

assessing skeletal muscle stiffness. _Clin. Biomech. (Bristol, Avon)_18, 459–61 (2003). * Herrington, L. & Munro, A. Drop jump landing knee valgus angle; normative data in a physically

active population. _Phys. Ther. Sport_ 11, 56–59 (2010). Article  PubMed  Google Scholar  * Munro, A., Herrington, L. & Comfort, P. Comparison of landing knee valgus angle between female

basketball and football athletes: Possible implications for anterior cruciate ligament and patellofemoral joint injury rates. _Phys. Ther. Sport_ 13, 259–264 (2012). Article  PubMed  Google

Scholar  * Munro, A., Herrington, L. & Comfort, P. The relationship between 2-dimensional knee-valgus angles during single-leg squat, single-leg-land, and drop-jump screening tests. _J.

Sport Rehabil._ 26, 72–77 (2017). Article  PubMed  Google Scholar  * Paterno, M. V. _et al._ Biomechanical measures during landing and postural stability predict second anterior cruciate

ligament injury after anterior cruciate ligament reconstruction and return to sport. _Am. J. Sports Med._ 38, 1968–1978 (2010). Article  PubMed  PubMed Central  Google Scholar  * Ford, K.

_et al._ An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus. _Open Access J. Sport. Med._

291,https://doi.org/10.2147/OAJSM.S72432 (2015). * Alentorn-Geli, E. _et al._ Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury

and underlying risk factors. _Knee Surgery, Sport. Traumatol. Arthrosc._17, 705–729 (2009). * Winslow, J. J., Jackson, M., Getzin, A. & Costello, M. Rehabilitation of a young athlete

with extension-based low back pain addressing motor-control impairments and central sensitization. _J. Athl. Train._ 53, 168–173 (2018). Article  PubMed  PubMed Central  Google Scholar  * de

Paula Simola, R. Á. _et al._Assessment of neuromuscular function after different strength training protocols using tensiomyography. _J. Strength Cond. Res._29, 1339–1348 (2015). * Hunter,

A. M. _et al._ Assessment of eccentric exercise-induced muscle damage of the elbow flexors by tensiomyography. _J. Electromyogr. Kinesiol._ 22, 334–341 (2012). Article  PubMed  Google

Scholar  * Alentorn-Geli, E. _et al._ Assessment of neuromuscular risk factors for anterior cruciate ligament injury through tensiomyography in male soccer players. _Knee Surgery, Sport.

Traumatol. Arthrosc._23, 2508–2513 (2015). * Seijas, R. _et al._ Gluteus maximus impairment in femoroacetabular impingement: A tensiomyographic evaluation of a clinical fact. _Arch. Orthop.

Trauma Surg._ 136, 785–789 (2016). Article  PubMed  Google Scholar  * Alvarez-Diaz, P. _et al._ Effects of anterior cruciate ligament reconstruction on neuromuscular tensiomyographic

characteristics of the lower extremity in competitive male soccer players. _Knee Surg. Sport Traumatol. Arthrosc._23, 3407–3413 (2015). * García-García, O., Cuba-Dorado, A., Álvarez-Yates,

T., Carballo-López, J. & Iglesias-Caamaño, M. Clinical utility of tensiomyography for muscle function analysis in athletes. _Open Access J. Sport. Med._ 10, 49–69 (2019). Article  Google

Scholar  * Sánchez-Sánchez, J. _et al._ Effect of a repeated sprint ability test on the muscle contractile properties in elite futsal players. _Sci. Rep._ 8, 17284 (2018). Article  ADS 

PubMed  PubMed Central  CAS  Google Scholar  * Sánchez-Sánchez, J. _et al._ Repeated sprint ability and muscular responses according to the age category in elite youth soccer players.

_Front. Physiol._10 (2019). * García-García, O. _et al._ A maximal incremental test in cyclists causes greater peripheral fatigue in biceps femoris. _Res. Q. Exerc. Sport_ 1–9,

https://doi.org/10.1080/02701367.2019.1680789 (2020). * Zubac, D., Paravlić, A., Koren, K., Felicita, U. & Šimunič, B. Plyometric exercise improves jumping performance and skeletal

muscle contractile properties in seniors. _J. Musculoskelet. Neuronal Interact._ 19, 38–49 (2019). PubMed  PubMed Central  Google Scholar  * Alvarez-Diaz, P. _et al._ Comparison of

tensiomyographic neuromuscular characteristics between muscles of the dominant and non-dominant lower extremity in male soccer players. _Knee Surg. Sport. Traumatol. Arthrosc._24, 2259–2263

(2016). * Pruyn, E. C. _et al._ Relationship between leg stiffness and lower body injuries in professional Australian football. _J. Sports Sci._ 30, 71–78 (2012). Article  PubMed  Google

Scholar  * Watsford, M. L. _et al._ A prospective study of the relationship between lower body stiffness and hamstring injury in professional Australian rules footballers. _Am. J. Sports

Med._ 38, 2058–2064 (2010). Article  PubMed  Google Scholar  * Albin, S. R. _et al._ The effect of manual therapy on gastrocnemius muscle stiffness in healthy individuals. _Foot_ 38, 70–75

(2019). Article  Google Scholar  * Ditroilo, M., Hunter, A. M., Haslam, S. & De Vito, G. The effectiveness of two novel techniques in establishing the mechanical and contractile

responses of biceps femoris. _Physiol. Meas._ 32, 1315–1326 (2011). Article  PubMed  Google Scholar  Download references AUTHOR INFORMATION Author notes * These authors contributed equally:

Luis Llurda-Almuzara and Albert Pérez-Bellmunt. AUTHORS AND AFFILIATIONS * C/Josep Trueta s/n, Sant Cugat del Vallès, Facultat de Medicina i Ciències de la Salut, Universitat Internacional

de Catalunya, 08195, Barcelona, Spain Luis Llurda-Almuzara, Albert Pérez-Bellmunt, Carlos López-de-Celis, Roberto Seijas, Oriol Casasayas-Cos, Noe Labata-Lezaun & Pedro Alvarez *

Department of Orthopaedic Surgery, Hospital Quirónsalud, Barcelona, Spain Roberto Seijas & Pedro Alvarez * Universitat de Lleida, Lleida, Spain Ramón Aiguadé Authors * Luis

Llurda-Almuzara View author publications You can also search for this author inPubMed Google Scholar * Albert Pérez-Bellmunt View author publications You can also search for this author

inPubMed Google Scholar * Carlos López-de-Celis View author publications You can also search for this author inPubMed Google Scholar * Ramón Aiguadé View author publications You can also

search for this author inPubMed Google Scholar * Roberto Seijas View author publications You can also search for this author inPubMed Google Scholar * Oriol Casasayas-Cos View author

publications You can also search for this author inPubMed Google Scholar * Noe Labata-Lezaun View author publications You can also search for this author inPubMed Google Scholar * Pedro

Alvarez View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS L.L.L., A.P.B. and C.L.C. equally designed the study. C.L.C. and N.L.L. did the

statistical analysis. O.C.C. and R.A. recruited the sample and managed the data. R.S. and P.A. interpreted the data and wrote the final manuscript. All authors have approved the final

manuscript version. CORRESPONDING AUTHORS Correspondence to Luis Llurda-Almuzara, Albert Pérez-Bellmunt or Carlos López-de-Celis. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare

no competing interests. ADDITIONAL INFORMATION PUBLISHER'S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION. RIGHTS AND PERMISSIONS OPEN ACCESS This article is licensed under a Creative Commons Attribution 4.0 International License, which permits

use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the

Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless

indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory

regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

http://creativecommons.org/licenses/by/4.0/. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Llurda-Almuzara, L., Pérez-Bellmunt, A., López-de-Celis, C. _et al._ Normative data

and correlation between dynamic knee valgus and neuromuscular response among healthy active males: a cross-sectional study. _Sci Rep_ 10, 17206 (2020).

https://doi.org/10.1038/s41598-020-74177-8 Download citation * Received: 09 January 2020 * Accepted: 28 September 2020 * Published: 02 December 2020 * DOI:

https://doi.org/10.1038/s41598-020-74177-8 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not

currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative