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Mon, Oct 20, 2025
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Fatigue-Induced Changes in Lower Extremity Landing Kinematics: A Systematic Review and Meta-Analysis
Mohammad Salsali1 
, Parisa Sayyadi2 , Elnaz Rajabi3 , Rahman Sheikhhoseini *4 , Ebrahim Ebrahimi2 , Trent M. Guess5
, Parisa Sayyadi2 , Elnaz Rajabi3 , Rahman Sheikhhoseini *4 , Ebrahim Ebrahimi2 , Trent M. Guess5
1- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
2- Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
3- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
4- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
5- Department of Physical Therapy, University of Missouri, Columbia, Missouri, United States of America
2- Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
3- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
4- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
5- Department of Physical Therapy, University of Missouri, Columbia, Missouri, United States of America
Abstract: (13 Views)
Purpose: Fatigue may have a negative impact on joint biomechanics during landings. This systematic review aimed to synthesize and gather available data on the effects of fatigue on the biomechanics of the lower extremity limbs during various movements, such as landing, among physically active populations.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, searching the PubMed, Scopus, Web of Science, and Google Scholar databases for original and peer-reviewed articles using selected keywords from inception to June 2025. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis (CMA) software version 4. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger’s test was used to assess publication bias.
Results: After examining the titles and abstracts of 1692 studies from chosen databases, 44 articles were deemed suitable for inclusion in meta-analyses. Fatigue showed no significant effect on lower extremity kinematics during landing for hip flexion (P = 0.947, 95% CI = -0.206 to 0.192), knee flexion (P = 0.885, 95% CI = -0.135 to 0.156), knee adduction (P = 0.402, 95% CI = -0.060 to 0.149), knee internal rotation (P = 0.263, 95% CI = -0.091 to 0.334), hip abduction (P = 0.516, 95% CI = -0.099 to 0.197), hip rotation (P = 0.760, 95% CI = -0.391 to 0.286), ankle dorsiflexion (P = 0.372, 95% CI = -0.116 to 0.309), and ankle supination (P = 0.326, 95% CI = -0.230 to 0.692). However, a significant effect was observed for ankle inversion (P = 0.003, 95% CI = 0.114 to 0.537). No significant differences were found between males and females across all kinematic variables. High heterogeneity was noted in most analyses (I² ranging from 28.877% to 83.642%), except for ankle inversion (I² = 0.000%). Egger’s test indicated no significant publication bias across all variables (P > 0.05).
Conclusions: Contrary to common belief, fatigue does not appear to consistently alter hip and knee landing kinematics in healthy, active individuals, though it does increase ankle inversion, potentially elevating the risk of ankle sprains.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, searching the PubMed, Scopus, Web of Science, and Google Scholar databases for original and peer-reviewed articles using selected keywords from inception to June 2025. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis (CMA) software version 4. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger’s test was used to assess publication bias.
Results: After examining the titles and abstracts of 1692 studies from chosen databases, 44 articles were deemed suitable for inclusion in meta-analyses. Fatigue showed no significant effect on lower extremity kinematics during landing for hip flexion (P = 0.947, 95% CI = -0.206 to 0.192), knee flexion (P = 0.885, 95% CI = -0.135 to 0.156), knee adduction (P = 0.402, 95% CI = -0.060 to 0.149), knee internal rotation (P = 0.263, 95% CI = -0.091 to 0.334), hip abduction (P = 0.516, 95% CI = -0.099 to 0.197), hip rotation (P = 0.760, 95% CI = -0.391 to 0.286), ankle dorsiflexion (P = 0.372, 95% CI = -0.116 to 0.309), and ankle supination (P = 0.326, 95% CI = -0.230 to 0.692). However, a significant effect was observed for ankle inversion (P = 0.003, 95% CI = 0.114 to 0.537). No significant differences were found between males and females across all kinematic variables. High heterogeneity was noted in most analyses (I² ranging from 28.877% to 83.642%), except for ankle inversion (I² = 0.000%). Egger’s test indicated no significant publication bias across all variables (P > 0.05).
Conclusions: Contrary to common belief, fatigue does not appear to consistently alter hip and knee landing kinematics in healthy, active individuals, though it does increase ankle inversion, potentially elevating the risk of ankle sprains.
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