Original article
Br J Sports Med: first published as 10.1136/bjsm.2008.048751 on 18 September 2008. Downloaded from http://bjsm.bmj.com/ on October 8, 2019 at National Cheng Kung University
1
Division of Physiotherapy,
School of Health and
Rehabilitation Sciences,
University of Queensland,
Brisbane, Queensland, Australia
2
Mater/UQ Back Stability Clinic,
Mater Health Services, South
Brisbane, Queensland, Australia
3 from 2005 to 2007 (start of preseason, end of season and
Brisbane Lions AFC, Brisbane,
Queensland, Australia
4
Centre for Magnetic
Resonance, University of
Queensland, Brisbane,
Queensland, Australia
5
School of IT and Electrical
Engineering, University of
Queensland, Brisbane,
Queensland, Australia
Correspondence to
Dr Julie Hides, Division of
Physiotherapy, School of Health
and Rehabilitation Sciences, The
University of Queensland,
Brisbane, 4072 Queensland,
Australia; j.hides1@uq.edu.au
Published Online First
18 September 2008
Br J Sports Med 2010;44:563–567. doi:10.1136/bjsm.2008.048751
Psoas and quadratus lumborum muscle asymmetry
among elite Australian Football League players
J Hides,1,2 T Fan,1,2 W Stanton,2 P Stanton,3 K McMahon,4 S Wilson5
ABSTRACT
Objective In this study, asymmetry relative to the
preferred kicking leg was determined if it exists for the
psoas and quadratus lumborum muscles among elite
Australian Football League (AFL) players.
Design AFL players were assessed at three time points
end of preseason training). MRI was used to determine
the cross-sectional areas (CSAs) of the psoas and
quadratus lumborum muscles at the L4–L5 vertebral level
(psoas) and the L3–L4 vertebral level (quadratus
lumborum).
Setting MRI was performed in a hospital setting.
Participants 54 professional AFL players were eligible to
participate in this study. The number of subjects at each
of the three time points was 36 for time 1 (T1 Nov 2005),
31 for time 2 (T2 Aug 2006) and 43 for time 3 (T3 Feb
Mar 2007).
Risk factors The repeated measures factor in the
analyses was ‘‘asymmetry’’, defined as ‘‘ipsilateral’’ or
‘‘contralateral’’ to preferred kicking leg. Number of injuries
(coded as 0, 1, 2 or more) was also included as a risk
factor.
Main outcome measurements The dependent vari-
ables were the CSAs of the psoas and quadratus
lumborum muscles.
Results At all three time points, the CSA of the psoas
muscle was significantly greater ipsilateral to the kicking
leg, while the CSA of the quadratus lumborum muscle
was significantly greater on the side contralateral to the
kicking leg. Asymmetry in muscle size was not related to
number of injuries.
Conclusions Asymmetry of the psoas and the quadratus
lumborum muscles exists in elite AFL players.
Australian rules football is in many ways similar to
soccer1 2 and Gaelic football2 3 and involves a
combination of repetitive, high-intensity activities
such as kicking,4 5 sprinting and jumping. These
activities are not only physically demanding on
players but may also be conducive to higher injury
incidences than other sports.2 3 5–8 Trunk and back
injuries have been documented longitudinally since
1992 in the AFL injury report.9 Injuries classified as
‘‘trunk/back’’ accounted for 9.4% of the new
injuries in the 2006 season, and this incidence has
stayed fairly constant over the last 10 years. This
would suggest that muscles of the trunk warrant
investigation in Australian Football League (AFL)
players.
Kicking is an asymmetrical and ballistic task
which involves trunk rotation and hip flexion,10–12
and it has been proposed that kicking may
contribute to muscle imbalances and induce tor-
sion on the spine.13 14 The effect of kicking on lower
limb muscles has been investigated.1 5 14
Researchers have identified the roles of specific
muscles relative to the kicking and stance leg, and a
link between muscle injuries and leg preference has
been determined. However, muscles of the hip and
lumbopelvic region have received less attention.
Two trunk muscles implicated in the task of
kicking are the psoas and the quadratus lumborum.
The quadratus lumborum muscle has been
investigated in soccer players.15 The cross-sectional
area (CSA) of the quadratus lumborum muscle was
found to be slightly larger in soccer players than in
other athletes including weight-lifters, distance
runners and shooters. Whether or not the muscle
was asymmetrical in size was not reported.
However, Raty et al15 did find a positive correlation
between trunk and side flexion strength and CSA
of the quadratus lumborum muscle. Another group
Hospital. Protected by copyright.
of athletes with documented hypertrophy and
asymmetry of the quadratus lumborum muscle
are cricket fast bowlers.16–18 Ranson et al17 measured
the CSA of the quadratus lumborum muscle in
cricketers and athletic control subjects. Results
showed that the quadratus lumborum muscle was
larger on the dominant side in the fast bowlers but
not in the control subjects. While the demands of
cricket and AFL are very different, what fast
bowling and kicking sports do have in common is
that they involve repeated, dynamic multidirec-
tional trunk and limb movements, particularly
asymmetrical trunk side flexion and rotation.17 19
These movements are likely to require high levels
of asymmetric activation of the quadratus lum-
borum muscle. Documentation of trunk muscle
asymmetry may be useful to future studies that
examine the relationship between trunk muscle
asymmetry and the prevalence and pattern of
trunk and back injuries in sport.
The psoas muscle has been examined in athletic
and non-athletic populations. In fast bowlers with
hypertrophy of the quadratus lumborum muscle
on the dominant side, hypertrophy of the psoas
muscle was reported on the non-dominant side at
the L4–L5 and L5–S1 vertebral levels.17 These
muscles were not found to be asymmetrical at
these vertebral levels in athletic control subjects.
Assessments have also been conducted in age-
matched athletic and non-athletic adolescent
girls.20 The sports undertaken by the athletic
subjects included gymnastics, ballet and figure
skating. The athletes had greater absolute psoas
muscle CSA and trunk flexion force than the
control subjects, which was explained by their
regular physical training. Size of the psoas, quad-
riceps femoris and hamstring muscles was recently
related to young male and female sprinters’ times
563
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Br J Sports Med: first published as 10.1136/bjsm.2008.048751 on 18 September 2008. Downloaded from http://bjsm.bmj.com/ on October 8, 2019 at National Cheng Kung University
to run 100 m.21 Results showed that for sprinters of both sexes,
the higher development of the psoas muscle relative to the
quadriceps femoris, rather than absolute muscle size, was a
factor in achieving better performance in a sprint. It would seem
from these studies that it is important to examine muscle size
and symmetry in different sports, as athletes may show
prominent development in muscle groups used in their
competitive activities and/or training regimes.22 23
The aims of this study were to explore whether asymmetry of
the psoas and quadratus lumborum muscles exists in AFL
players relative to the preferred kicking leg, and whether or not
this is related to number of injuries.

MATERIALS AND METHODS

Subjects
All players from a professional AFL club during the period of
investigation (late 2005 to early 2007) were eligible to
participate in this study. Among this group (n = 54), 18.5%
(n = 10) were left-leg dominant, 79.6% (n = 43) were right-leg
dominant and 1.9% (n = 1) reported no leg dominance. The
number of cases at each of the time points was 36 for time 1 (T1
Nov 2005), 31 for time 2 (T2 Aug 2006) and 43 for time 3 (T3
Feb/Mar 2007). Significant attendance variability exists across
the three assessment points because of player recruitment and
retirement. The mean age, height and weight of the total
Figure 1 Cross-sectional area measurements (in square centimetres)
of the psoas muscles on an MRI at the level of the L4–L5 disc. The
muscles were asymmetrical between sides. The CSAs of the right and
left psoas muscles were 27.23 and 21.91 cm2, respectively.
MRI measurements
MR images were stored offline under an allocated number for
the purposes of subject de-identification. Measurements were
completed with the image processing package ImageJ (V.1.37,
http://rsb.info.nih.gov/ij/) by manually tracing around the
muscle borders (figs 1 and 2). The CSAs of the psoas and

Hospital. Protected by copyright.

quadratus lumborum muscles in square centimetres were taken
sample was 22.4 (3.9) years, 188.2 (6.6) cm and 87.8 (7.6) kg, at the vertebral level where the CSA of the muscle was the
respectively. greatest, as identification of the largest CSA is important as it is
related to the maximal force generation of the muscle.24–26 This
Procedures was at the level of the disc at the L3–L4 vertebral level for the
This study was approved by the Ethics Committees of the quadratus lumborum muscle and at the level of the L4–L5 disc
relevant organisations. MRI assessments and subject interview for the psoas muscle as shown by Marras et al,27 who measured
and questionnaires were performed in a hospital setting. All trunk muscles at multiple vertebral levels (from T8 to S1).
participants were screened for MRI contraindications, and Similar protocols have been used for the psoas20 21 and
written, informed consent was obtained. Self-reported activity quadriceps21 muscles. Muscle CSAs were measured by an
levels, leg preference and general medical history were obtained operator who was blinded to the subjects’ identities, past
from the responses of each subject to (1) a general ques- histories and information such as preferred kicking leg. Inter-
tionnaire, which included the number and type of current rater and intra-rater reliability of the assessor for MRI
lumbopelvic and/or lower limb injuries, (2) a habitual activity measurements of trunk muscle CSAs has previously been
questionnaire, (3) a low back pain-specific questionnaire (with a established.29
body chart for those with current low back pain to indicate its
location). Statistical analysis
SPSS (V.15; www.spss.com) was used for data analysis.
MRI protocol Repeated measures analysis of covariance (ANCOVA) with a
MRI assessments were conducted at three time points:
November 2005 (T1, preseason), August 2006 (T2, end-of-
season) and February/March 2007 (T3, preseason training).
Subjects were instructed to void their bladder and bowel
before imaging to avoid tension on the anterior abdominal
wall during imaging; they were positioned in supine, lying
with their knees and hips resting on a foam wedge. Transverse
MR images at rest (a breath-hold at mid-expiration) were
acquired using a 1.5-Tesla Siemens Sonata magnetic resonance
system. Image slices were oriented to be perpendicular to the
anterior abdominal wall and consisted of 10 slices at a
thickness of 8 mm with an interslice distance of 0.5 mm. A
fast gradient recalled echo sequence was used with repetition
time = 4.8, echo time = 2.3 ms, flip angle = 70u, field of
view = 40 cm and number of acquisitions = 2. A spine coil
array was used for image acquisition. The resulting image Figure 2 Cross-sectional area measurements of the quadratus
matrix for all images was 1286128 interpolated to 2566256. lumborum muscles on an MRI at the level of the L3–L4 disc. The muscles
Total scanning time required 23 s which was within the were asymmetrical between sides. The CSAs of the right and left
breath-hold tolerance of all subjects. quadratus lumborum muscles were 7.44 and 9.48 cm2, respectively.

564 Br J Sports Med 2010;44:563–567. doi:10.1136/bjsm.2008.048751


Table 1 Number (%) of current lumbopelvic or lower limb injuries at
time of assessment
T1 (November 2005) T2 (August 2006) (%) T3 (February/March 2007)
0 16.7 12.9 25.6
1 44.4 35.5 53.6
2 30.6 25.8 18.5
3 8.3 25.8 2.3
0, no lumbopelvic or lower limb injuries at time of assessment; 1, one lumbopelvic or
lower limb injury at time of assessment; 2, two lumbopelvic or lower limb injuries at
time of assessment; 3, three or more lumbopelvic or lower limb injuries at time of
assessment.
type I sums of squares model was used to analyse CSA for the
psoas muscle and the quadratus lumborum muscle. The
repeated measures factor in the analyses was ‘‘asymmetry’’,
coded as ‘‘ipsilateral’’ or ‘‘contralateral’’ to preferred kicking leg.
Number of injuries in the past season or since the last MRI
assessment (coded as 0, 1, 2 or more) was included as a between-
subjects factor. The factors of ‘‘age’’, ‘‘height’’ and ‘‘weight’’
were included as covariates. A type I model was used as our
previous analysis has shown that higher-order interactions
involving weight and muscle size can be problematic for a type
III model.
As the number of squad members varied greatly across
assessment times, the data for each time point were analysed
separately. This method of analysis provides the most accurate
assessment of the prevalence of asymmetry. MRI data was not
collected for one case with a history of claustrophobia and
another case with no kicking leg preference was omitted from
the analysis at T1 (November 2005). As unilateral low back pain
has been shown to be related to psoas muscle size,30 two cases
who reported the presence of unilateral low-back pain were not
included in the analyses. The number of cases in each analysis
was 35 for T1 (November 2005), 28 for T2 (August 2006) and 41
for T3 (February/March 2007).
RESULTS
The mean total score to the habitual activity questionnaire of
the total sample was 10.9 (1.3). This implies a higher-than-
average level of activity than the normal person (ie, non-elite
athlete). Some of the reported injuries attained by the players
during the season included osteitis pubis, low back pain as well
as many multiple combinations of injuries. Table 1 shows that
by the end of the playing season (T2, highest workload during
the playing season), there was the least proportion of players
who did not sustain lumbopelvic or lower limb injuries (12.9%),
while it also had the largest group of players who had three or
more current injuries (25.8%).
There was a significant difference between sides for the CSA
of the psoas muscle at all three time points. The psoas muscle
was significantly larger on the side of the preferred kicking leg at
T1 (November 2005) (F = 39.6, p,0.001), T2 (August 2006)
(F = 12.2, p = 0.002) and T3 (February/March 2007) (F = 44.1,
Table 2 Marginal means and SEs (adjusted for age, height and weight) for the CSAs of the psoas at the level
of the L4–L5 disc and quadratus lumborum muscles at the level of the L3–L4 disc
T1 (November 2005)
Ipsilateral Contralateral Ipsilateral
Psoas (cm2) 25.05 (0.50) 23.23 (0.46)
Quadratus lumborum (cm2) 8.79 (0.29) 9.90 (0.31)
Ipsilateral, same side as the preferred kicking leg; contralateral, opposite side to the preferred kicking leg.
Br J Sports Med 2010;44:563–567. doi:10.1136/bjsm.2008.048751
Original article
Br J Sports Med: first published as 10.1136/bjsm.2008.048751 on 18 September 2008. Downloaded from http://bjsm.bmj.com/ on October 8, 2019 at National Cheng Kung University
p,0.001) (table 2). There was no significant effect for ‘‘number
of injuries’’ at any of the three time points (p.0.05).
There was also significant difference between sides for CSA of
the quadratus lumborum muscle at all three time points. The
quadratus lumborum muscle was significantly smaller on the
side of the preferred kicking leg at T1 (November 2005)
(F = 40.7, p,0.001), T2 (August 2006) (F = 25.9, p,0.001) and
T3 (February/March 2007) (F = 34.8, p,0.001) (table 2). There
was no effect for ‘‘number of injuries’’ at any time point
(p.0.05).
DISCUSSION
The results of this study suggest that psoas and quadratus
lumborum muscle asymmetry occurred in the elite AFL players
studied at all of the three time points measured. Despite the
previous lack of evidence relating to asymmetry of muscles
around the pelvis and hips in kicking sports, several coaching
and training sources state that kicking practices using both legs
during training should be encouraged in players of professional
sports such as AFL31 32 and soccer.12 33 34 The rationale for
training both legs equally is to minimise potential asymmetrical
forces acting on joints, reduce muscle imbalances and decrease
the workload of the dominant leg which may eventually lead to
overuse injuries.10 However, even if players use both legs equally
at training, they may change strategy and kick predominantly
Hospital. Protected by copyright.
using their preferred leg during competition. Further investiga-
tion of the relevance of between-side asymmetries seen in AFL
players seems warranted.
Asymmetry of the quadratus lumborum muscle has pre-
viously been reported in cricket fast bowlers on their dominant
side.16–18 This is thought to be related to a role of the quadratus
lumborum muscle as a powerful side flexor of the lumbar spine
and as a provider of frontal plane segmental stabilisation during
contralateral leg loading as well as spinal movement.35 During
the front foot contact phase of the delivery stride of fast
bowling, the lower trunk is reported to side flex towards the
non-bowling side.19 The dominant quadratus lumborum is
reported to eccentrically control contralateral side flexion and
isometrically control ipsilateral frontal plane posture.35
Hypertrophy is thought to be because of repeated eccentric
and isometric overload.36 A similar explanation could be used to
explain the hypertrophy of the quadratus lumborum muscle
contralateral to the kicking leg in AFL. The non-dominant
(stance) quadratus lumborum may be active to provide frontal
plane segmental stabilisation during contralateral leg loading,
and control frontal plane posture, as proposed by Ranson et al.17
The CSAs of the quadratus lumborum muscle reported for
the L3–L4 vertebral level in the current study are comparable
with those reported in previous studies. While there might be
slight differences attributable to equipment and measurement
techniques adopted, the present results (February/March 2007),
ipsilateral quadratus lumborum CSA = 8.17 (0.22) cm2 and
contralateral = 9.31 (0.26) cm2, are comparable with others; in
cricketers, the results are ipsilateral to bowling arm = 9.5
T2 (August 2006) T3 (February/March 2007)
Contralateral Ipsilateral Contralateral
24.43 (0.83) 23.31 (0.67) 24.48 (0.45) 23.05 (0.45)
8.84 (0.41) 9.54 (0.45) 8.17 (0.22) 9.31 (0.26)
565
 Original article
(2.7) cm2 and contralateral = 8.6 (2.6) cm217 and ipsilateral to
bowling arm = 9.1 (2.19) cm2 and contralateral = 8.61
(2.09) cm216, remembering that the quadratus lumborum muscle
is larger on the dominant side in cricket as opposed to the stance
leg in AFL. Muscle CSAs of the quadratus lumborum muscle
documented in the current study are larger and more
asymmetrical than those reported for male non-athletes
(left = 5.38 (1.9) cm2, right = 5.2 (1.2) cm2)27 and active male
non-cricketers (dominant hand = 7.8 (1.8) cm2, non-domi-
nant = 7.9 (1.9) cm2).17
Hypertrophy of the psoas muscle in AFL players is most
likely related to its role as a primary hip flexor,37 38 as was seen
in gymnasts, ballet dancers, figure skaters20 and cricketers.17
The results from the current study regarding CSA of the psoas
muscle at the L4–L5 vertebral level can be compared with
others that have used a similar protocol. The present results
(February/March 2007, dominant psoas CSA = 24.48
(0.45 cm2); non-dominant = 23.05 (0.45) cm2) are comparable
with results for cricketers (dominant = 24 (3.7) cm2, non-
dominant = 24.9 (4.1) cm2),17 remembering that the psoas
muscle is larger on the non-dominant side in cricket as
opposed to the kicking leg in AFL. Psoas muscle CSAs from the
current study are larger and less variable than those reported
for male non-athletes (18.9 (3.8) cm2),27 active male non-
cricketers (dominant hand = 22.1 (3.6) cm2, non-domi-
nant = 22.1 (3.6) cm2),17 young male sprinters (17.1
(2.6) cm2) and female athletes (13 (2) cm2).21
While the primary aim of this study was focused on
asymmetry of the psoas and quadratus lumborum muscles,
information about current lumbopelvic and/or lower limb
injuries were collected at each time point. This kind of
information is important because, in AFL players, it is
unknown whether asymmetry of trunk muscles is a normal
finding related to function for this group or is potentially
problematic. Results of the study indicated no overall effect
for number of injuries on muscle size or asymmetry. However,
this aspect could be further examined, as the relationship may
be far more complex than can be explained by relating
asymmetries to number of injuries. For example, injuries in
AFL are both extrinsic and intrinsic in nature. If asymmetry of
trunk muscle size was to be related to number of injuries, it
might be expected to be more related to intrinsic rather than
extrinsic injuries. Furthermore, while it is quite possible that
asymmetries of key lumbopelvic muscles may induce deleter-
ious forces on the spine, it may be that the presence of an
operational stability system (provided by other muscles such
as the deep abdominal and paraspinal muscles such as the
multifidus) may counter these forces and protect the spine
from injury.16 A possibility is that injuries ensue when the
stability system is inadequate to negate the forces induced on
the spine by the torque-producing muscles. Future studies
could investigate this aspect further.
What is already known on this topic
c Kicking is an asymmetrical, ballistic action common in sports
such as soccer, AFL and rugby.
c The psoas muscle has been shown to atrophy in people with
unilateral low back pain.
c Asymmetry of the quadratus lumborum muscle has been
shown to be associated with L4 pars defects in cricket fast
bowlers.
566
Br J Sports Med: first published as 10.1136/bjsm.2008.048751 on 18 September 2008. Downloaded from http://bjsm.bmj.com/ on October 8, 2019 at National Cheng Kung University
What this study adds
c Asymmetry of the psoas and quadratus lumborum muscles
exists in AFL players.
c The CSA of the psoas muscle was shown to be significantly
larger on the side of the preferred kicking leg, while the CSA of
the quadratus lumborum muscle was larger contralateral to the
preferred kicking leg.
c Asymmetry in psoas and quadratus lumborum muscle size
was not related to number of injuries.
One of the limitations of this investigation was the lack of
consistency in attendance level at each time point. However,
this was unavoidable because of the recruitment and retire-
ments within the team. Another limitation was the relatively
small sample size, but the numbers are comparable to other
studies conducted in this area. Notably, participants in this
study who reported current low-back pain presented with pain
of a central or bilateral nature in all but two cases. Future
studies could examine for a relationship between unilateral low-
back pain and psoas asymmetry. Another possible direction for
further research is to investigate whether particular AFL
positions are related to muscle asymmetry.
Hospital. Protected by copyright.
CONCLUSION
The main finding of the current study is that asymmetry of the
psoas and quadratus lumborum muscles exists in AFL players
with the CSA of the psoas muscle larger ipsilateral to the
kicking leg and the CSA of the quadratus lumborum muscle
larger ipsilateral to the stance leg.
Acknowledgements The authors thank the UQ/Wesley MRI unit, Mark Strudwick,
Matt Meredith, Marcus Ashcroft, Victor Popov, Lachlan Penfold, Nathan Carloss, Carly
Boughan and the subjects.
Funding This study was funded by a sports medicine research grant provided by the
Brisbane Lions AFC.
Competing interests None.
REFERENCES
1. Orchard J. Intrinsic and extrinsic risk factors for muscle strains in Australian Football.
Am J Sports Med 2001;29:300–3.
2. Orchard J, Verrall G. Groin injuries in the Australian Football League. ISMJ 2000;1.
3. Wilson F, Cafrey S, King E, et al. A 6-month prospective study of injury in Gaelic
football. Br J Sports Med 2007;41:317–21.
4. Orchard J. Recurrent hamstring injury in Australian Football [abstract]. Med Sci
Sports Exerc 1998;30(Suppl):52.
5. Baczkowski K, Marks P, Silberstein M, et al. A new look into kicking a football: an
investigation of muscle activity using MRI. Australas Radiol 2006;50:324–9.
6. Hoskins W, Pollard H. Injuries in Australian rules football: a review of the literature.
Australas Chiropr Osteopathy 2003;11:49–56.
7. Seward H, Orchard J, Hazard H, et al. Football injuries in Australia at the elite level.
Med J Aust 1993;159:298–301.
8. Braham R, Finch C, McIntosh A, et al. Community level Australian Football: a profile
of injuries. J Sci Med Sport 2004;7:96–105.
9. Orchard J, Sweward H, AFLMOA. AFL injury report: season 2006. http://afl.com.au/
Portals/0/afl_docs/06injsurv2_5.pdf (accessed July 2007).
10. Anderson K, Strickland S, Warren R. Hip and groin injuries in athletes. Am J Sports
Med 2001;29:521–33.
11. Luhtanen P. Kicking. http://www.coachesinfo.com/article/106/#2 (accessed Aug
2007).
12. Mozes M, Papa M, Zweig A, et al. Iliopsoas injury in soccer players. Br J Sports Med
1985;19:168–70.
13. James T. Hypertonicity of the iliopsoas muscle. J Myo 2002;1:1–6.
14. Orchard J, Walt S, McIntosh A, et al. Muscle activity during the drop punk kick.
J Sports Sci 1999;17:837–8.
15. Raty H, Kujala U, Videman T, et al. Associations of isometric and isoinertial trunk
muscle strength measurements and lumbar paraspinal muscle cross-sectional areas.
J Spinal Disord 1999;12:266–70.
Br J Sports Med 2010;44:563–567. doi:10.1136/bjsm.2008.048751

16. Hides JA, Stanton W, Freke M, et al. MRI study of the size, symmetry and function
of the trunk muscles among elite cricketers with and without low back pain.
Br J Sports Med 2008;42:509–13. Published Online First: 7 Dec 2007. doi:10.1136/
bjsm.2007.044024
17. Ranson C, Burnett A, O’Sullivan P, et al. The lumbar paraspinal muscle morphometry
of fast bowlers in cricket. Clin J Sport Med 2008;18:31–7.
18. Engstrom C, Walker D, Kippers V, et al. Quadratus lumborum asymmetry and L4
pars injury in fast bowlers: a prospective MRI study. Med Sci Sports Exerc
2007;39:910–7.
19. Burnett AF, Barrett CJ, Marshall RN, et al. Three-dimensional measurement of
lumbar spine kinematics for fast bowlers in cricket. Clin Biomech (Bristol, Avon)
1998;13:574–83.
20. Peltonen JE, Taimela S, Erkintalo M, et al. Back extensor and psoas muscle cross-
sectional area, prior physical training and trunk muscle strength—a longitudinal study
in adolescent girls. Eur J Appl Physiol 1998;77:66–71.
21. Hoshikawa Y, Muramatsu M, Iida T, et al. Influence of the psoas major and thigh
muscularity on 100 m times in junior sprinters. Med Sci Sports Exerc
2006;38:2138–43.
22. Kanehisa HK, Funato K, Kuno S, et al. Growth trend of the quadriceps femoris
muscle in junior Olympic weight lifters: an 18-month follow-up survey. Eur J Appl
Physiol 2003;89:238–42.
23. Kanehisa H, Nemoto IT, Fukanaga T. Strength capabilities of knee extensor muscles
in junior speed skaters. J Sports Med Phys Fitness 2001;41:46–53.
24. Brand RA, Pedersen DR, Fiederich JA. The sensitivity of muscle force predictions to
changes in physiologic cross-sectional area. J Biomech 1986;19:589–96.
25. Close RI. Dynamic properties of mammalian skeletal muscles. Physiol Rev
1972;52:129–97.
26. Narici M. Human skeletal muscle architecture studied in vivo by non-invasive
imaging techniques: functional significance and applications. J Electromyogr Kinesiol
1999;9:97–103.
Br J Sports Med 2010;44:563–567. doi:10.1136/bjsm.2008.048751
Original article
Br J Sports Med: first published as 10.1136/bjsm.2008.048751 on 18 September 2008. Downloaded from http://bjsm.bmj.com/ on October 8, 2019 at National Cheng Kung University
27. Marras WS, Jorgensen MJ, Granata KP, et al. Female and male trunk geometry:
size and prediction of the spine loading trunk muscles derived from MRI. Clin Biomech
(Bristol, Avon) 2001;16:38–46.
28. Mulder ER, Stegeman DF, Gerrits KHL, et al. Strength, size and activation of knee
extensors followed during 8 weeks of horizontal bed rest and the influence of a
countermeasure. Eur J Appl Physiol 2006;97:706–15.
29. Hides JA, Richardson CA, Jull GA. Magnetic resonance imaging and ultrasonography of the
lumbar multifidus muscle. Comparison of two different modalities. Spine 1995;20:54–8.
30. Barker K, Shamley D, Jackson D. Changes in the cross-sectional area of multifidus
and psoas in patients with unilateral back pain. Spine 2004;29:E515–9.
31. Parkin D, Smith R, Schokman P. Skill development. In: Parkin D, Smith R, Schokman
P, eds. Premiership football: how to train, play and coach Australian football. 2nd edn.
Melbourne, Australia: Hargreen, 1987:19.
32. Parkin D, Smith R, Schokman P. Questions—facts, fads and fallacies. In: Parkin D,
Smith R, Schokman P, eds. Premiership Football: How to train, play and coach
Australian football. 2nd edn. Melbourne, Australia: Hargreen, 1987:204.
33. McLean B, Tumilty D. Left-right asymmetry in two types of soccer kick. Br J Sports
Med 1993;27:260–2.
34. Starosta W. Symmetry and asymmetry in shooting demonstrated by elite soccer
players. In: Reilly T, Lees A, Davids K, Murphy W, eds. Science and football. London,
UK: E & FN Spon, 1988:346–55.
35. McGill S, Juker K, Kropf P. Quantitative intramuscular myoelectric activity of quadratus
lumborum during a wide variety of tasks. Clin Biomech (Bristol, Avon) 1996;11:170–2.
36. Danneels L, Vanderstraeten G, Cambier D, et al. Effects of three different training
modalities on the cross sectional area of the lumbar multifidus muscle in patients
with chronic low back pain. Br J Sports Med 2001;35:186–91.
37. Bogduk N, Pearcy M, Hadfield G. Anatomy and biomechanics of psoas major. Clin
Biomech (Bristol, Avon) 1992;7:109–19.
38. Penning L. Psoas muscle and lumbar spine stability: a concept uniting existing
controversies. Critical review and hypothesis. Eur Spine J 2000;9:577–85.
Hospital. Protected by copyright.
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