1
Trakya University, Kırkpınar Faculty of Sports Sciences, Edirne, Türkiye
2
Trakya University, Kırkpınar Faculty of Sports Sciences, Edirne, Türkiye
Abstract
This study aimed to investigate the relationship between landing mechanics and lower extremity injury risk in elite female wrestlers. Considering the biomechanical requirements of wrestling, we hypothesized that elevated LESS scores would correspond to an increased injury risk. A prospective cohort study was conducted with 47 elite female wrestlers from the Turkish national team. Before the competitive season, participants underwent a standardized jump-landing assessment, and LESS scores were recorded. Injury occurrences were monitored throughout the two seasons. We conducted a Receiver Operating Characteristic (ROC) curve analysis to establish the optimal LESS cut-off value for predicting injury occurrence. The relationship between LESS scores and injury risk was evaluated using Pearson’s Chi-square and Fisher’s exact tests. The optimal LESS cut-off score was identified as 5.5 (AUC = 0.683, p = 0.025), with a sensitivity of 71.43% and specificity of 65.38%. Athletes with LESS scores >5 demonstrated a significantly higher injury incidence (p = 0.012). Notably, among the 21 athletes with LESS scores above the cut-off value, 15 experienced injuries. An increased risk of lower extremity injury was observed in elite female wrestlers exhibiting higher LESS scores. These findings highlight the importance of LESS as a screening tool for injury prevention strategies. Future studies should explore targeted neuromuscular training programs to enhance landing mechanics and reduce injury risk.
Keywords
ACL injury,Biomechanics,Elite Female Wrestlers,Injury prevention,Landing Error Scoring System
How to Cite
Saç, A., & Sağıroğlu, İsa. (2025). Landing mechanics as a predictor of lower extremity injury risk in elite female wrestlers: A prospective study. Journal of ROL Sport Sciences, 6(2), 236–249. https://doi.org/10.70736/jrolss.590
📄Agel, J., & Klossner, D. (2014). Epidemiologic review of collegiate ACL injury rates across 14 sports: National collegiate athletic association injury surveillance system data 2004-05 through 2011–12. British Journal of Sports Medicine, 48(7), 560-560.
📄Agel, J., Rockwood, T., & Klossner, D. (2016). Collegiate ACL injury rates across 15 sports: national collegiate athletic association injury surveillance system data update (2004-2005 through 2012-2013). Clinical Journal of Sport Medicine, 26(6), 518-523.
📄Barroso, B. G., Silva, J. M. A. d., Garcia, A. d. C., Ramos, N. C. d. O., Martinelli, M. O., Resende, V. R., . . . Santili, C. (2011). Musculoskeletal injuries in wrestling athletes. Acta Ortopedica Brasileira, 19, 98-101.
📄Butler, R. J., Lehr, M. E., Fink, M. L., Kiesel, K. B., & Plisky, P. J. (2013). Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study. Sports Health, 5(5), 417-422.
📄Clifton, D. R., Hertel, J., Onate, J. A., Currie, D. W., Pierpoint, L. A., Wasserman, E. B., . . . Marshall, S. W. (2018). The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school Girls' basketball (2005–2006 through 2013–2014) and National Collegiate Athletic Association Women's basketball (2004–2005 through 2013–2014). Journal of Athletic Training, 53(11), 1037-1048.
📄Daneshmandi, H., Zolghadr, H., & Sedaghati, P. (2020). Comparing the Musculoskeletal injuries Between the professional greco-roman and freestyle wrestlers. Physical Treatments - Specific Physical Therapy, 10(1), 15-22.
📄de la Motte, S. J., Clifton, D. R., Gribbin, T. C., Beutler, A. I., & Deuster, P. A. (2019). Functional movement assessments are not associated with risk of injury during military basic training. Military medicine, 184(11-12), e773-e780.
📄Everard, E., Lyons, M., & Harrison, A. J. (2018). Examining the association of injury with the Functional Movement Screen and Landing Error Scoring System in military recruits undergoing 16 weeks of introductory fitness training. Journal of Science and Medicine in Sport, 21(6), 569-573.
📄Foss, K. D. B., Thomas, S., Khoury, J. C., Myer, G. D., & Hewett, T. E. (2018). A school-based neuromuscular training program and sport-related injury incidence: a prospective randomized controlled clinical trial. Journal of Athletic Training, 53(1), 20-28.
📄Gribble, P. A., Terada, M., Beard, M. Q., Kosik, K. B., Lepley, A. S., McCann, R. S., . . . Thomas, A. C. (2016). Prediction of lateral ankle sprains in football players based on clinical tests and body mass index. The American journal of sports medicine, 44(2), 460-467.
📄Hanzlíková, I., Athens, J., & Hébert-Losier, K. (2021). Factors influencing the Landing Error Scoring System: Systematic review with meta-analysis. Journal of Science and Medicine in Sport, 24(3), 269-280.
📄Hewett, T. E., Ford, K. R., Hoogenboom, B. J., & Myer, G. D. (2010). Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations-update 2010. North American Journal of Sports Physical Therapy: NAJSPT, 5(4), 234.
📄Hewett, T. E., Ford, K. R., & Myer, G. D. (2006). Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. The American Journal of Sports Medicine, 34(3), 490-498.
📄Hewett, T. E., Myer, G. D., Ford, K. R., Heidt Jr, R. S., Colosimo, A. J., McLean, S. G., . . . Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. The American Journal of Sports Medicine, 33(4), 492-501.
📄Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., & Quatman, C. E. (2016). Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. Journal of Orthopaedic Research, 34(11), 1843-1855.
📄Hussain, F. (2010). Common sporting injuries of lower limbs and its management. British Journal of Sports Medicine, 44(Suppl 1), i2-i3.
📄James, J., Ambegaonkar, J. P., Caswell, S. V., Onate, J., & Cortes, N. (2016). Analyses of landing mechanics in division I athletes using the landing error scoring system. Sports Health, 8(2), 182-186.
📄Lisman, P., Wilder, J. N., Berenbach, J., Jiao, E., & Hansberger, B. (2021). The relationship between Landing Error Scoring System performance and injury in female collegiate athletes. International Journal of Sports Physical Therapy, 16(6), 1415.
📄Markolf, K. L., Burchfield, D. M., Shapiro, M. M., Shepard, M. F., Finerman, G. A., & Slauterbeck, J. L. (1995). Combined knee loading states that generate high anterior cruciate ligament forces. Journal of Orthopaedic Research, 13(6), 930-935.
📄Mauntel, T. C., Padua, D. A., Stanley, L. E., Frank, B. S., DiStefano, L. J., Peck, K. Y., . . . Marshall, S. W. (2017). Automated quantification of the landing error scoring system with a markerless motion-capture system. Journal of Athletic Training, 52(11), 1002-1009.
📄Myer, G. D., Sugimoto, D., Thomas, S., & Hewett, T. E. (2013). The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis. The American Journal of Sports Medicine, 41(1), 203-215.
📄Onate, J., Cortes, N., Welch, C., & Van Lunen, B. (2010). Expert versus novice interrater reliability and criterion validity of the landing error scoring system. Journal of Sport Rehabilitation, 19(1), 41-56.
📄Padua, D. A., Boling, M. C., DiStefano, L. J., Onate, J. A., Beutler, A. I., & Marshall, S. W. (2011). Reliability of the landing error scoring system-real time, a clinical assessment tool of jump-landing biomechanics. Journal of Sport Rehabilitation, 20(2), 145-156.
📄Padua, D. A., DiStefano, L. J., Beutler, A. I., De La Motte, S. J., DiStefano, M. J., & Marshall, S. W. (2015). The landing error scoring system as a screening tool for an anterior cruciate ligament injury–prevention program in elite-youth soccer athletes. Journal of Athletic Training, 50(6), 589-595.
📄Padua, D. A., Marshall, S. W., Boling, M. C., Thigpen, C. A., Garrett Jr, W. E., & Beutler, A. I. (2009). The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: the JUMP-ACL study. The American Journal of Sports Medicine, 37(10), 1996-2002.
📄Park, K. J., Lee, J. H., & Kim, H. C. (2019). Injuries in male and female elite Korean wrestling athletes: a 10-year epidemiological study. British Journal of Sports Medicine, 53(7), 430-435.
📄Schurr, S. A., Marshall, A. N., Resch, J. E., & Saliba, S. A. (2017). Two-dimensional video analysis is comparable to 3D motion capture in lower extremity movement assessment. International Journal of Sports Physical Therapy, 12(2), 163.
📄Smith, H. C., Johnson, R. J., Shultz, S. J., Tourville, T., Holterman, L. A., Slauterbeck, J., . . . Beynnon, B. D. (2012). A prospective evaluation of the Landing Error Scoring System (LESS) as a screening tool for anterior cruciate ligament injury risk. The American Journal of Sports Medicine, 40(3), 521-526.
📄Sugimoto, D., Myer, G. D., Foss, K. D. B., Pepin, M. J., Micheli, L. J., & Hewett, T. E. (2016). Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis. British Journal of Sports Medicine, 50(20), 1259-1266.
📄Theiss, J. L., Gerber, J. P., Cameron, K. L., Beutler, A. I., Marshall, S. W., Distefano, L. J., . . . Yunker, C. A. (2014). Jump-landing differences between varsity, club, and intramural athletes: the Jump-ACL Study. The Journal of Strength & Conditioning Research, 28(4), 1164-1171.
📄Walbright, P. D., Walbright, N., Ojha, H., & Davenport, T. (2017). Validity of functional screening tests to predict lost-time lower quarter injury in a cohort of female collegiate athletes. International Journal of Sports Physical Therapy, 12(6), 948.
📄Zazulak, B. T., Hewett, T. E., Reeves, N. P., Goldberg, B., & Cholewicki, J. (2007). Deficits in neuromuscular control of the trunk predict knee injury risk: prospective biomechanical-epidemiologic study. The American Journal of Sports medicine, 35(7), 1123-1130.
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İsa Sağıroğlu
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