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Vol. 58. Issue 218.
(April - June 2023)
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Vol. 58. Issue 218.
(April - June 2023)
Editorial
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Hamstrings/quadriceps ratio in isokinetic tests: are we looking in wrong direction?
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Pavel Loeza Magañaa,
Corresponding author
doctor.pavel@hotmail.com

Corresponding author.
, Iván Giovani Valdez Solisa, Delia Daniela Fernández Carapiaa, Lezly Elizabeth Alcalá Moralesa, Pedro Iván Arias Vázquezb, Héctor Ricardo Quezada Gonzálezc
a National Medical Center “20 de Noviembre”, Félix Cuevas 540, col. Del Valle, Mexico City, Mexico
b “Juárez” Autonomous University of Tabasco, División Académica Multidisciplinaria de Comalcalco. Ranchería Sur 4ta Sección, s/n. Comalcalco, Tabasco, Mexico
c Sporthabilia medical center. Remedios Valle 19A, Culhuacán, Mexico City, Mexico
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Table 1. Summary of Hcon/Qcon ratios studied.
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In knee isokinetic tests, the ratios have had a specific value, in addition to the torque peak;1 and for years, the concentric hamstrings/quadriceps ratio [Hcon/Qcon] has been accepted as an indicator of kinetic stability in topics such as injury prevention and functional recovery,2 with a value of 0.6 as normal,3 in tests performed at 60°/s. Steindler, who first described this, established a 3:2 ratio as the cutoff.4 However, we have observed that, in our own data, and in different published works, a value lower than this is frequently reported, both in people with knee pathology and in athletes. Already previously, it had been questioned in isometric values as well.4

In apparently healthy people, not athletes, Muff5 reports a ratio of 0.52 and 0.53, on the dominant and non-dominant sides, respectively; while Wong6 reports 0.47, in a comparable group, without differentiating sex or side. Kong and Burns7 studied the ratios in men and women, without finding significant differences between them, in terms of these balances; the reported value was 0.52.

In athletes, Rosene8 summarizes different collegiate sports [soccer, volleyball, basketball and softball], separated according to whether they are male or female, and on average, it is found that this ratio is 0.5 on average, in both genders; with similar values​ in sports studied; although Dos Santos,9 finds an average of 0.54 for female athletes and 0.62 for male athletes. Correia10 found in professional soccer players with hamstring muscle injury, a value of 0.55 on the side without previous injury, and 0.59 on the side previously injuried.

Ruiz,11 in a population with knee arthroplasty, after completing an rehabilitation process, found a ratio of 0.51 on the affected side, and 0.49 on the unaffected side.

Finally, in a systematic review, Hewett12 summarizes some papers about people without injury, 396 women and 319 men, finding a ratio of 0.51 for women and 0.67 for men.

When we carry out a simple analysis of these authors, we find that the average obtained for women is 0.51 and 0.53 for men; for subjects without specifying sex, 0.53; and for the total population from these studies, 0.53. The results are described in Table 1.

Table 1.

Summary of Hcon/Qcon ratios studied.

Author  Gender  n  Right side  Left side 
Muff5  Women  10  0.52  0.53 
  Men  20     
Wong6  Women  16  0.47   
  Men  14     
Kong7  Women  15  0.52  0.52 
  Men  25     
Partial: non-athletes, non-injuried100  0.50  0.52 
Rosene8  Women  55  0.50  0.48 
  Men  26  0.50  0.49 
Dos Santos9  Women  65  0.54   
  Men  101  0.62   
Partial, athletes, non-injuried
  Women  120  0.52   
  Men  127  0.56   
Correia10  Without previous injury  12  0.55   
Previously injuried  12  0.59     
Ruiz11  Affected/non-affected side  44  0.51  0.49 
Hewett12  Women  396  0.51   
  Men  319  0.67   
Total  Women  557  0.51   
  Men  505  0.53   
  Unspecified  56  0.53   
  Total population  1118  0.53   

We know the importance of biomechanical balance for knee stability, but we also know the importance of returning to activity in people who are recovering from an injury, which is why we must reconsider whether the value of 0.6 is really the expected, or if we must accept that, it is at 0.5 ± 0.05, giving the weight of a new value, to the Hcon/Qcon, in non-athletes, or in athletes in return-to-activity phase, where a neuromuscular control is the aim13; beyond the importance of the functional ratio Hexc/Qcon, the functional tests to determine dynamic knee valgus,14 or the assessment of this ratio in a specific torque angle, or the rate of torque development.4

References
[1]
K.N. Sharma, N. Quddus, U.A. Hameed, S.A. Khan, A. Kumari, A.H. Alghadir, M. Khan.
Mode-specific effects of concentric and eccentric isokinetic training of the hamstring muscle at slow angular velocity on the functional hamstrings-to-quadriceps ratio—a randomized trial.
PeerJ, 10 (2022), pp. e13842
[2]
G. Umutlu, A.T. Erdogan.
A different insight into neuromuscular performance evaluation: the influence of fatigue in hamstrings: quadriceps ratio.
Hacettepe J Sport Sci, 31 (2020), pp. 152-162
[3]
G Davies.
Cap. 10: isokinetic approach to the knee.
Physical therapy of the knee, 19th ed., pp. 221-243
[4]
C.V. Ruas, R.S. Pinto, G.G. Haff, C.D. Lima, M.D. Pinto, L.E. Brown.
Alternative methods of determining hamstrings-to-quadriceps ratios: a comprehensive review.
Sports Med Open., 5 (2019), pp. 11
[5]
G. Muff, S. Dufour, A. Meyer, F. Severac, F. Favret, B. Geny, et al.
Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer.
Phys Ther Sci, 28 (2016), pp. 2445-2451
[6]
O.M.H. Wong, R.T.H. Cheung, R.C.T. Li.
Isokinetic knee function in healthy subjects with and without Kinesio taping.
Phys Ther Sport, 13 (2012), pp. 255-258
[7]
P.W. Kong, S.F. Burns.
Bilateral difference in hamstrings to quadriceps ratio in healthy males and females.
Phys Ther Sport, 11 (2010), pp. 12-17
[8]
J.M. Rosene, T.D. Fogarty, B.L. Mahaffey.
Isokinetic hamstrings: quadriceps ratios in intercollegiate athletes.
J Athl Train, 36 (2001), pp. 378-383
[9]
M. Dos Santos, C.A. Barbosa, F. De Carvalho, N.C. Mascarin, A.A. Benedito, A.C Da Silva.
Isokinetic hamstrings-to-quadriceps peak torque ratio: the influence of sport modality, gender, and angular velocity.
J Sports Sci, 30 (2012), pp. 547-553
[10]
P. Correia, P. Santos, GomesM Mil-HomensP, A. Dias, M.J Valamatos.
Rapid hamstrings to quadriceps ratio at long muscle lengths in professional football players with previous hamstring strain injury.
[11]
M. Ruiz, M. Torra, L. Sola, N. Perez, M. Carrillo, M. Guma, et al.
Changes in physical function and isokinetic muscular strength of quadriceps and hamstrings three months after a rapid recovery total knee arthroplasty.
Ann Phys Rehabil Med, 61S (2018), pp. e103-e308
[12]
T.E. Hewett, G.D. Myer, B.T. Zazulakd.
Hamstrings to quadriceps peak torque ratios diverge between sexes with increasing isokinetic angular velocity.
J Sci Med Sport, 11 (2008), pp. 452-459
[13]
A. Fort-Vanmeerhaeghe, J. Arboix-Alió, A.M. Montalvo.
Return-to-sport following anterior cruciate ligament reconstruction in team sport athletes. Part II: progressive framework.
[14]
Eduard Mercader-Vila.
Prevention of non-contact anterior cruciate ligament injuries in female athletes. Let us make it easy.
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