Comparison of unilateral and bilateral strength ratio, strength, and knee proprioception in older male fallers and non-fallers

Exp Gerontol. 2023 May:175:112161. doi: 10.1016/j.exger.2023.112161. Epub 2023 Apr 3.


Background: Asymmetry of lower limb muscle strength and knee proprioception have been linked with risk of falling among elderly with and without history of falling.

Objective: This study aimed to determine the comparison of hamstrings to quadriceps strength ratio (CSR) and bilateral knee strength ratio, hamstrings and quadriceps muscles' strength and knee proprioception in elderly male fallers and non-fallers.

Methods: Sixty older adults, 65 years and older were recruited into faller (fell twice in the last six months) and non-faller groups. Then, the knee extension and flexion strength and proprioception at 45° knee flexion for the dominant leg (DL) and non-dominant legs (NDL) were measured with a Biodex Isokinetic Dynamometer.

Results: The strength of quadriceps and hamstring muscles showed significantly higher values in DL by 5.4 %, 9.2 % and NDL by 11.7 %, 15.5 % in the non-faller compared to the faller (p < 0.05). Significantly greater bilateral asymmetry (>10 % difference) was observed with the quadriceps (p = 0.014, -7.9 %, ES = 0.76) and hamstrings (p < 0.001, -18.4 %, ES = 1.5) as well as reduced CSR (<72 %) by 7.6 % in DL (ES = 0.64) and 11.3 % in NDL (ES = 0.81) with fallers versus non-fallers. Significantly less knee proprioception was found with the DL by -1.5 % (ES = 1.15) and NDL (ES = 1.50) by -2.1 % (p < 0.001) in non-faller compared to faller.

Conclusion: It concluded that non-fallers have better strength symmetry, bilateral and unilateral knee strength ratios as well as more sensitive knee proprioception than fallers. It is suggestive that older adult fallers may need to improve bilateral knee strength symmetry and proprioception to prevent the risk of falling.

Keywords: Deficit; Elderly; Falling; Peak torque; Slips.

MeSH terms

  • Aged
  • Humans
  • Knee Joint / physiology
  • Leg / physiology
  • Lower Extremity*
  • Male
  • Muscle Strength* / physiology
  • Proprioception / physiology
  • Quadriceps Muscle / physiology
  • Torque