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Muscle function of the lower limb-Do we really test what we are looking for?

Schaefer LV, Bittmann FN, Ulrich J, Prill R, Becker R. ยท Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA ยท 2026

This is a perspective/opinion piece arguing that standard lower-limb strength tests (like max force or torque measures) have consistently shown weak or no ability to predict injuries, re-injuries and other musculoskeletal problems. The authors propose that assessments should instead measure 'Adaptive Force' a a joint position while an external load progressively increases, since that better reflects the stabilising control needed to avoid non-contact injuries.
Takeaway: Treat max-strength test scores as a poor injury-risk predictor, and include holding-position-against-rising-load challenges when assessing readiness.
Abstract (source)

Established measures of lower-limb muscle function repeatedly show weak, inconsistent or absent association and predictive value for injury, re-injury and other musculoskeletal complaints. Progress in prevention, rehabilitation, and return-to-sport decision-making is unlikely to come from recombining or modifying them. The question is whether the quantity they capture is unsuitable-calling for a change in what is measured. Muscle-function assessment should match the demand it sets out to capture: non-contact injuries occur when muscles must stabilise a joint and adapt to a rising external load. This adaptive, stabilising control is largely unaddressed by established measures. Shifting the focus from muscle strength to muscle stability-from producing force against a resistance to holding a position while adapting to a rising external load (Adaptive Force)-may bring assessment closer to what actually determines joint protection and clinical outcome.

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