The Influence of Hop Width during the Crossover Hop Test

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Jon Albright, SPT, Barry Ehlers, SPT, Taylor Glasoe, SPT, & Shanna Selby, SPT

26 Comments on “The Influence of Hop Width during the Crossover Hop Test

  1. This is one of the most fascinating things I’ve read all day. I think the preponderance of evidence telling us clinicians that hop testing is flawed and your study seems to add to the body of research. After reading your poster I’m reminded of the quote from a comic, Kelvin and Hobbs: “How do you know the load limit on bridges? Drive bigger and bigger trucks over it until it breaks, then weigh the last truck and rebuild the bridge.” We need to test the load limits of our patients in order for making a prudent return to sport decision. What advice would you give to a struggling clinician when he is making a return to play decision for an athlete with a torn ACL? What tests or group of tests should we utilize?

    Go Yotes,
    James

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    • James, thank you for that amazing compliment!! Through our research and literature review, we have found that 90% LSI may not be adequate for RTS protocol due to the deconditioning of the contralateral limb that often takes place. Along with this, athletes can be great at compensating to make things look better than they actually are, especially when the tests for RTS do not load the limb with appropriate physical demands that are required in competition. Our advice for struggling clinicians would be to ensure they are having the patient engage in activities that will place both limbs in similar physical demands that will occur in competition. It would be important to also assess the patient’s perceived readiness to return to competition based on how they personally feel they are doing. Our advice would be a comprehensive battery of tests that include both physiological and psychological measures to ensure that the patient is ready to return.

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  2. Hey guys, your poster is very visually appealing with all the figures! I think this is such a great research topic as it delves into the standardization of outcome measures which we know is so important. Do you think your healthy participant data is enough to determine a difference in the narrow vs standard conditions? If your participants were actually recovering from ACL injury do you think results would change? I’m wondering if that extra few centimeters for the standard condition really would be more challenging and it would be harder to achieve <10% difference between injured and non injured limbs. Thanks!

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    • Hi Molly,
      Great question! The choice to recruit individuals without a history of ACL injury is a limitation of this study and it certainly limits the generalizability of our findings. This is the first study to our knowledge that compared hop distance, so it was important to start with a healthy population. However, it would absolutely be beneficial for future studies to examine the effects of standardized hop widths in an injured population. Our research suggests there is no difference in hop distance between the narrow and standard conditions in a healthy population. It’s reasonable to assume that the standard width would pose a greater physical challenge for an injured population as compared to a healthy population, however it’s difficult to accept this assumption without the proper evidence to back it. In addition, it’s important to acknowledge that the patient has made significant functional gains and is often nearing the end of their recovery when these hop tests are implemented. Our findings suggest the standard and narrow widths may not be adequate in loading the limb with the physical demands required during competition, and therefore may not be effective in gauging return to sport readiness. With this in mind, our research suggests there should be less emphasis on standard and narrow width performance, and more on standardized width performance.

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  3. Hey guys. Great presentation! I was easily able to understand all of the figures and how they related to the testing you completed. My question is how did you determine what to do for a warm up? Was it based on time constraints with squats and jumps being the most efficient? I think they are great warm up activities, I just wanted to know if you considered any other activities for the participants before they completed the tests. Good job all around!

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    • Good question Aaron. After reviewing the research, this warm-up is what was recommended with the past studies and we wanted to keep this part of our research consistent with previous studies. Our main goal with the warm-up was to allow the participant time to warm-up without causing fatigue. These were also more simple exercises that most participants understand.

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  4. Nice job guys!! In your research did you come across any information regarding the healthy leg compared to the reconstructed leg? Do they expect the participate to be within a certain distance compared to the healthy leg to return to sport?

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    • Thanks for the question Brett! Yes in our research we found that 90% limb symmetry is usually used as an indication that an athlete is ready to return to sport. However, recently there have been some questions in recent research about if limb symmetry is good measure for return to sport since there is usually deconditioning of the contralateral limb secondary to them being less active after surgery.

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  5. Great presentation guys! I love your poster as much as I loved being part of your study! I see that you only included physically active females in your research. Why did you choose to exclude males? And how do you think that the mean results for hop distance and hop width would have been different if you would have included physically active male within your study? Thanks!

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    • Hi Brooke! Thanks for the great questions! We chose to exclude males and exclusively recruit females due to females being at higher risk of sustaining an ACL injury and/or second ACL injury following ACL reconstruction compared to their male counterparts. Additionally, we wanted to focus on females to limit the variability of our results. To our knowledge, this is one of the first studies to assess the impact of line width during the crossover hop test, so we wanted to control as many variables as possible. Further research would need to be conducted to understand the implications of increased hop width in the physically active male population. However, we would expect the physically active males to perform similarly to the females since the hop widths were standardized to each individual’s height. It’s reasonable to assume the hop distance would decrease as hop width increases in the male population just as it did in the female population.

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  6. Excellent presentation! I really appreciated the figures of the actual test that you included. How do you see the hop test being implicated clinically with future ACL reconstruction patients?

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    • Hello Jenna, thanks for the question! Clinically it is important to utilize a battery of tests that will holistically assess the patient and their readiness to return to sport. This includes performing tests that will accurately load the tissues similarly to competition. In regards to the hop test specifically, we cannot encourage the use of wider line as the standardized line width is currently set at 15 cm. Our hope is that this study prompts further research into the influence of hop width to appropriately assess the patient’s readiness to return to competition.

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  7. Well done, everyone! Your presentation was concise and very informative. In terms of hop width, I see you have the four conditions of 2.54 cm, 15 cm, 12.5% of height, and 25% of height. What made you guys decide on these specific widths?

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    • Hello Trey, thanks for the question! 15 cm is the standard width for testing. We wanted to see if we could find a width that could be more challenging, while not being too challenging. We wanted to standardize the width based on the participants height in order to make it challenging for each participant. We tested some different widths out ourselves and found that 25% of height tended to be where we saw it being the most challenging while also being able to complete the hops. We chose 12.5% of height because this was half of the 25% and wanted to see how these widths differed. The 2.54 cm was the width of the tape as this is what some clinicians use even though this width is not the typical width used in research. We also wanted to see if there was a significant difference between this shorter width and the standard 15 cm width.

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  8. Great presentation everyone! I was super excited when I saw that I had the opportunity to review the results of your research. Being a part of your study, it was very easy to understand. With that being said, my question for you is what was your reasoning behind randomly selecting hop width and limb order? And by not doing so, how do you think your results would have differed? Again, super interesting and great job!

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    • Hello Drew, thanks for the question! We wanted to randomly test the hop width and limb order so that fatigue would not factor into the results. For example, if we would have started with the shorter width and ended with the widest width, there could have been fatigue that could have factored into the results. There also could have been a learning curve with the tests and participants could get better by the end of the testing, so randomizing the order made sure every patient wasn’t completing the same widths at the same time during their testing. If
      we did not randomize, the results could have been skewed by one width having better results due to the order completed.

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  9. Great presentation everyone! You discussed that the 2.54 cm width was commonly used by clinicians, which is why you wanted to include this in the study. Do you know if using a width based on the participant’s height is currently being employed by many clinicians, or is it mostly just 2.54 cm and also the standard width of 15 cm?

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  10. Hi Caleb! Thanks for the question. To our knowledge, participant height is not routinely used to determine hop width for the crossover hop test. Realistically, clinicians should be using the recommended standard width of 15 cm, however it is well known that many clinicians opt to use a 2.54 cm wide piece of tape instead. Based on our findings, there was no difference found in hop distance between the narrow (2.54 cm) and standard (15 cm) width conditions, so in reality, clinicians could use either of these widths and receive similar results.

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  11. Hey guys, great poster! I feel that this topic is so important because of the high prevalence of female athlete ACL injuries. It is vital for us as clinicians to know how to properly train these athletes and to know what tools are the most valid when assessing these athletes to make sure that they are ready to return to sport! Did all of the participants in the study have similar background in terms of training and if they did or did not, do you think this would affect the results of your study?

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    • Hey Cassandra, thanks for the question! Our eligibility criteria included that all participants must have participated in high school and/or college athletics. Due to this, our participants did have some similarity in their backgrounds in regards to training as it was required the sport involved cutting/running activities. Our goal was to include participants who had competed in sporting activities that have the most prevalent ACL injuries. One limitation, though, was that some participants had not competed in competitive sports for upwards to 10 years. For example, a participant who was 27 years old who had only competed in high school athletics. However, we also had the participants rate their level of activity with the Tegner Activity Scale, which found a mean of 5.3. This means that participants were active at least twice a week with physical activity, including recreational sports, cycling/cross country skiing, or working in heavy labor profession. This rating ensured that the participants were all physically active at the time of testing. If the participants did not have similar backgrounds of physical activity, this may have skewed the results as the participants may have required more of a learning curve to perform the movements required for testing.

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  12. Great presentation everyone! Your study was informative and clinically relevant as well, given the prevalence of ACL tears in the athletic community. Not knowing a lot about this topic, I was curious if there were tests used to determine the patient’s readiness for the crossover hop test? Since the test puts an increased amount of stress through the ACL, is there any precautions that should be taken into consideration before using this test with a patient?

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    • Hello Emily, thank you for the question. Return to sport testing is usually completed around the time an athlete could potentially be returning to their sports. Due to this, the tests are normally completed many months after surgery. At this point many patients have had extensive therapy and have been working on strength, balance, and landing mechanics. Single leg hop testing is also performed alongside other tests such as limb symmetry tests in order to see how strong the muscles are. A patient should demonstrate adequate strength and adequate landing mechanics in order to safely complete this test.

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  13. Awesome presentation! I enjoyed your presentation and thought that it was clinically meaningful with returning athletes to their respected sport. As I am not an expert on the return to sport for ACLR patients is the hop width test the best test to utilize for outcome measures, or is there a specific test cluster that is the ‘ gold standart’ ?

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    • Hey Paul, great question! Usually return to sport is determined by the physician after ACLR with input from the physical therapist since we are movement experts and spend a lot of time with these patients. Different areas that physical therapists can look at to determine if a patient is ready for return to sport are limb symmetry in muscle strength testing, hop testing, and knee range of motion. The common hop tests that can be performed are the single hop, triple hop, crossover hop, and timed hop. There isn’t necessarily a gold standard test so the hop tests that a clinician performs can be determined by therapist, clinic, and physician preferences. You also want to ensure that there is an absence of joint effusion and the patient has no pain with activity. This is in no way a comprehensive list of things to look at but important ones to ensure that a patient is ready to return to sport after ACLR.

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  14. Great study! I like how your poster is super easy to follow and the graphics are easy to understand. I know your research was primarily focused on RTP after ACL reconstruction, but do you think this could potentially be a helpful outcome measure to incorporate in testing protocols for other pathologies as well or is most of the research out there focused on post op ACL repair rehab? Also, are there any studies out there that you found that compare the crossover hop test to the triple hop test when determining readiness to RTP?

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    • Hey Taylor, thanks for the question! A lot of the research regarding hop tests is completed on RTP for those who have undergone ACLR, and throughout our literature review, we only searched for post-operative ACL. Due to this, we cannot definitively say that it can be used for other pathologies. However, it would be reasonable to assume that it would be beneficial for RTP for other pathologies if the patient is returning to an activity involving the running/cutting activities that the test is trying to simulate. We did come across a couple studies comparing all of the hop tests to which it was determined that they were comparable in effectiveness. However, it would be in the best interest of the patient to complete a battery of tests when determining RTP so utilizing both the crossover hop and triple hop test in conjunction may be best to get a comprehensive assessment.

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