An evaluation of the contribution of stability and manipulation in the characterization of footedness using preference and performance measures
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Abstract
Footedness is commonly defined in the literature through manipulation preference exclusively, with the opposite “non-dominant” leg assigned to an unsubstantiated stability dominant role. Female athletes are twice as likely to injure the ACL of their non-dominant as their dominant lower limb, and this has not been rationalized given its presumed role of stability dominance. Some researchers have suggested that lower limb stability is multifaceted, with changing sidedness depending on task and context. The aim of this study was to characterize footedness through examination of the contribution of individual manipulation and stability questions used to assign footedness, assessment of the relationship between lower limb preference and performance in stability and manipulation tasks, and identification of functional asymmetry in gait and cutting (implicated in ACL injury). A cross-sectional, observational design was used and 52 adult participants (25 females, 27 males) with a mean age of 25.5 years were recruited. Preference for manipulation and stability was evaluated using the Waterloo and Chapman footedness instruments, and performance in lower limb manipulation, stability, gait and cutting tasks was assessed bilaterally. Findings include that footedness should be identified with a combination of manipulation and stability tasks, and familiar tasks are more likely to elicit a lateralized response. Stability is task dependent and multimodal, with dynamic stability on the left and static and reach stability on the right. There is coherence between preference and performance across the stability modes, but preference for manipulation is substantially lateralized relative to performance (92% vs 61%). Males were nearly symmetrical in cutting (3.6%, NS), while females demonstrated sex dependent asymmetry left-to-right (35%, p<0.05) and in acceleration control during left plant, and also showed poorer dynamic stability on the left. This is consistent with their asymmetrical ACL injury incidence. Conclusions are that footedness is not exclusively determined by manipulation but should include stability components localized to the same side, and that the lower limb contralateral to the manipulation preferred lower limb is not automatically the stability preferred lower limb since stability laterality is task dependent. Explicit terminology related to limb preference and performance was developed and found to be effective in clarifying limb identification and functional roles.