Influence of trunk flexion on hip and knee joint kinematics during a controlled drop landing

Background. An erect posture and greater knee valgus during landing have been implicated as anterior cruciate ligament injury risk factors. While previous research suggests coupling of knee and hip kinematics, the influence of trunk positioning on lower extremity kinematics has yet to be determined. We hypothesized that greater trunk flexion during landing would result in greater knee and hip flexion and lesser knee valgus. Identification of a modifiable factor (e.g. trunk flexion) which positively influences kinematics of multiple lower extremity joints would be invaluable for anterior cruciate ligament injury prevention efforts. Methods. Forty healthy individuals completed two drop landing tasks while knee, hip, and trunk kinematics were sampled. The first task constituted the natural/preferred landing strategy (Preferred), while in the second task, subjects actively flexed the trunk upon landing (Flexed). Findings. Peak trunk flexion angle was 47 degrees greater for Flexed compared to Preferred (P < 0.001), and was associated with increases in peak hip flexion angle of 31 degrees (P < 0.001) and peak knee flexion angle of 22 degrees (P < 0.001). Interpretation. Active trunk flexion during landing produces concomitant increases in knee and hip flexion angles. A more flexed/less erect posture during landing is associated with a reduced anterior cruciate ligament injury risk. As such, incorporating greater trunk flexion as an integral component of anterior cruciate ligament injury prevention programs may be warranted. (C) 2007 Elsevier Ltd. All rights reserved.