between Short-Step

ForcesLunge
Ligament
Cruciate
and Long-Step Forward
3
2
, RODNEY IMAMURA 4,
RAFAEL F. ESCAMILLAt, NAIQUAN ZHENG , TORAN D. MACLEOD
6
4
5
W. BRENT EDWARDS , ALAN HRELJAC , GLENN S. FLEISIG , KEVIN E. WILK7, CLAUDE T. MOORMAN III",
6
LONNIE PAULOS', and JAMES R. ANDREWS"
2
and Engineering
'Andrews-PaulosResearch and EducationInstitute, GulfBreeze, FL; Department ofMechanical Engineering
3
Departmentof Physical
Science, The Centerfor BiomedicalEngineering, University ofNorth Carolinaat Charlotte, NC;
4
Therapy, Centerfor Biomedical EngineeringResearch, University ofDelaivare,Newark, DE; Kinesiology and Health Science
5
Department, CaliforniaState University, Sacramento, CA; Department7ofKinesiology and Nutrition, University of Illinois
at Chicago, IL; 6American Sports Medicine Institute, Birmingham, AL; Champion Sports Medicine, Birmingham, AL;
8
Duke University Medical Center; Durham, NC

ABSTRACT
ESCAMILLA, IL F.,N. ZHENG, T. D. MACLEOD, RL IMAMURA, W. B. EDWARDS, A. HRELJAC, G. S. FLEISIG, K. E. WILK,
C. T. MOORMAN III, L. PAULOS, and J. IRANDREWS. Cmuciate Ligament Forces between Short-Step and Long-Step Forward Lunge.
Med. Sci. Sports Exerc., Vol. 42, No. 10, pp. 1932-1942, 2010. Purpose: The purpose of this study was to compare cruciate ligament
forces between the forward lunge with a short step (forward lunge short) and the forward lunge with a long step (forward lunge long).
Methods: Eighteen subjects used their 12-repetition maximum weight while performing the forward lunge short and long with and
without a stride. EMG, force, and kinematic variables were input into a biomechanical model using optimization, and cruciate ligament forces were calculated as a function of knee angle. A two-factor repeated-measure ANOVA was used with a Bonferroni adjustment
(P < 0.0025) to assess differences in cruciate forces between lunging techniques. Results: Mean posterior cruciate ligament (PCL) forces
(69-765 N range) were significantly greater (P < 0.001) in the forward lunge long compared with the forward lunge short between 00 and
800 knee flexion angles. Mean PCL forces (86-691 N range) were significantly greater (P < 0.001) without a stride compared with
those with a stride between 00 and 20' knee flexion angles. Mean anterior cruciate ligament (ACL) forces were generated (0-50 N range
between 0* and 100 knee flexion angles) only in the forward lunge short with stride. Conclusions: All lunge variations appear appropriate and safe during ACL rehabilitation because of minimal ACL loading. ACL loading occurred only in the forward lunge short
with stride. Clinicians should be cautious in prescribing forward lunge exercises during early phases of PCL rehabilitation, especially
at higher knee flexion angles and during the forward lunge long, which generated the highest PCL forces. Understanding how varying
lunging techniques affect cruciate ligament loading may help clinicians prescribe lunging exercises in a safe manner during ACL and
PCL rehabilitation. Key Words: ACL, PCL, KNEE KINETICS, REHABILITATION, CLOSED CHAIN

no studies that have examined the effects of technique variations on cruciate ligament loading while performing the
forward lunge. Because patients use the forward lunge after
ACL and PCL reconstruction, it is important to understand
how the cruciate ligaments are loaded, especially during the
early phases of rehabilitation when the goal is to minimize
ACL or PCL loading.
There are multiple techniques that individuals can use
during the forward lunge, such as lunging using a sbort step
length or a long step length. Lunging forward using a long step
typically results in the lead knee being maintained over the
lead foot throughout the knee range of motion, whereas
lunging forward using a short step length lunge typically
results in the lead knee translating beyond the toes throughout
much of the knee range of motion. Some clinicians believe
that anterior movement of the lead knee beyond the toes during a short step forward lunge increases cruciate ligament
loading, although there are very limited data that support this
belief (2). Moreover, it is unclear if the ACL or the PCL is
loaded when anterior knee movement occurs.

losed chain weight-bearing exercises such as the

squat, leg press, and forward lunge are commonly
used in rehabilitation settings, such as after anterior
cruciate ligament (ACL) or posterior cruciate ligament (PCL)
reconstruction surgery (10,39). These exercises can be performed with technique variations, which may affect ACL and
PCL loading. Although the effects of exercise technique
variations on cruciate ligament loading have been examined
while performing the squat and the leg press (13,14), there are
&

Address for correspondence: Rafael F. Escamilla, PILD., P.T., CSCS, FACSM,

Director of Research, Andrews-Paulos Research and Education Institute, 1020
GulfBreeze Parkway, Gulf Breeze, FL 32561; E-mail: rescamil@csus.edu.
Submitted for publication November 2008.
Accepted for publication December 2009.
0195-9131/10/4210-1932/0
MEDICINE & SCIENCE IN SPORTS & EXERCISFO
Copyright 2010 by the American College of Sports Medicine
DOI: 10.12491MSS.0b013e3181d966d4

1932

The forward lunge can be performed and progressed using

varying techniques. One technique involves starting in an
upright position, stepping forward with the lead leg and
flexing the lead knee until the rear knee touches the ground,
and then pushing back to the starting upright position. Because a stride is taken by the lead leg during each repetition,
this technique may be called a forward lunge with a stride.
Another technique involves first stepping forward with the
lead leg and starting with both knees fully extended. From
this position, the individual flexes the lead knee until the rear
knee touches the ground, and then both knees are extended
back to the starting position. In this technique, which has
been previously described (16), both feet remain stationary
as the individual lunges up and down. Because this technique does not involve striding forward during each repetition, this technique may be called a forward lunge without a
stride. The lunge with a stride can be a progression of the
lunge without a stride, with the lunge without a stride being
a beginning exercise and the lunge with a stride being more
difficult to perform and advanced. The lunge with a stride
requires higher levels of lower body strength and coordination compared with the lunge without a stride.
Understanding how cruciate ligaments are loaded differently among these technique variations of the forward lunge
may allow clinicians to prescribe safer and more effective
knee rehabilitation treatment to patients during ACL or PCL
rehabilitation. For example, during the forward lunge, if
ACL loading occurs when using a short step but not when
using a long step, the forward lunge with a long step may be
more appropriate for the patient if the clinician's immediate
goal for the patient is to minimize ACL loading. Similarly,
during the forward lunge, if PCL loading occurs with a stride
but not without a stride, the forward lunge without a stride
may be more appropriate for the patient if the clinician's
immediate goal for the patient is to minimize PCL loading.
Our purpose was to compare cruciate ligament tensile
forces while performing the forward lunge with a long step
(forward lunge long), with a short step (forward lunge short),
with a stride, and without a stride. It was hypothesized that
ACL tensile forces would be greater in the forward lunge
short compared with the forward lunge long, PCL tensile
forces would be greater in the forward lunge long compared
with the forward lunge short, and PCL tensile forces would
be greater during the forward lunge with a stride compared
with without a stride. Muscle force magnitudes in each
subject's quadriceps and hamstrings will also be estimated to
help better understand ACL and PCL force magnitudes.

lunge exercises pain free and with proper form and technique for 12 consecutive repetitions using their 12-repetition
maximum (12RM) weight.
To control the EMG signal quality, this study was limited
to men and women who had average or below average body
fat, which was assessed by the Baseline skinfold calipers
(Model 68900; Country Technology, Inc., Gays Mills, WI),
and appropriate regression equations and body fat standards
set by the American College of Sports Medicine (3). Average body fat was 12% 4% for men and 18% 1% for
women. The protocol used in the current study was approved
by the institutional review board at the California State University, Sacramento, CA, and all subjects provided written
informed consent.
Exercise description. Each subject performed the forward lunge long (Fig. 1) and the forward lunge short (Fig. 2)
with and without a stride. The starting and the ending positions of the forward lunge long with stride and forward lunge
short with stride were the same, which involved standing
upright with both feet together and the knees fully extended
(full knee extension = 00 knee angle). From this position, the
subject held a dumbbell weight in each hand and lunged
forward with the right leg toward a force platform at ground
level. At right foot contact, the right knee flexed at approximately 45.s-I until approximately 9001000 knee angle, at
which time the left knee made contact with the ground. From
this position, the subject immediately pushed backward off
the force platform and returned to the upright standing position with feet together.
During the forward lunge long, each subject used a long
step length that resulted in the right leg (tibia) being approximately vertical at the lowest position of the lunge (Fig. 1), thus
maintaining the knee over the foot. The average step length
(measured from left toe to right heel) for the forward lunge

METHODS
Subjects. Eighteen healthy individuals (nine men and
nine women) without a history of cruciate ligament pathology participated with an average age, mass, and height of
29 t 7 yr, 77 9 kg, and 177 6 cm, respectively, for men
and 25 2 yr, 60 4 kg, and 164 6 cm, respectively, for
women. All subjects were required to perform the forward

SHORT-STEP AND LONG-STEP FORWARD LUNGE

FIGURE 1-Fonvard lunge with a long step (forward lunge long).

Medicine & Science in Sports & Exercisee

1933

11111:10",j
FIGURE 2-Forward lunge with a short step (forward lunge short).

long was 89 + 4 cm for men and 79 :6 cm for women. The

step length for the forward lunge short was one half the distance of the step length of the forward lunge long. The shorter
step length for the forward lunge short caused the anterior
surface of the knee to translate beyond the distal end of the
toes, as shown in Figure 2.
The forward lunge long and short without stride was
performed the same as the forward lunge long and short
with stride, with the exception that during the forward lunge
long and short without stride both feet remained stationary
throughout each repetition. That is, from the lowest position
of the forward lunge long and short shown in Figures 1 and 2,
the subject fully extended both knees and then flexed both
knees returning back to the lowest position of the lunge. For
all lunge variations, a metronome was used to help ensure
the right knee flexed and extended at a normal rate of approximately 45-s- 1. During the forward lunge long and short
with and without a stride, maximum forward trunk tilt (which
occurred near maximum lead knee flexion) was approximately 10'-20' for all subjects.
Data collection. Each subject came in for a familiarization session 1 wk before the testing session. The experimental protocol was reviewed, the subject was given the
opportunity to practice the lunge variations, and each subject's
step length for the forward lunge long was determined. In addition, each subject's 12RM was determined while performing
the forward lunge with stride using a step length halfway between the forward lunge long and the forward lunge short.
Subjects used their 12RM weight for the four lunge variations
during data collection. The mean total dumbbell mass used
was 49: 11 kg for men and 32 8 kg for women.
To collect EMG data, Blue Sensor (Ambu Inc., Linthicum,
MD) disposable surface electrodes (type M-00-S) 22 mm wide

1934

Official Journal of the American College of Sports Medicine

and 30 mm long were positioned in a bipolar configuration

along the longitudinal axis of each muscle, with a centerto-center distance of approximately 3 cm between electrodes.
Before applying the electrodes, the skin was prepared by
shaving, abrading, and cleaning with isopropyl alcohol wipes
to reduce skin impedance. Each subject had electrode pairs
positioned on the right side using previously described
locations (4) for the following muscles: a) rectus femoris,
b) vastus lateralis, c) vastus medialis, d) medial hamstrings
(semimembranosus and semitendinosus), e) lateral hamstrings
(biceps femoris), and f) gastrocnemius (middle portion between medial and lateral bellies).
Spherical markers (3.8 cm in diameter) covered with
3MTM reflective tape were attached to adhesives and positioned over the following bony landmarks: a) third metatarsal head of the right foot, b) medial and lateral malleoli of
the right leg, c) upper edges of the medial and lateral tibial
plateaus of the right knee, d) posterosuperior greater trochanters of the left and right femurs, and e) lateral acromion
of the right shoulder.
After the subject warmed up and practiced the exercises
as needed, data collection commenced. A six-camera Peak
Performance motion analysis system (Vicon-Peak Performance Technologies, Inc., Englewood, CO) collected 60 Hz
of video data. A force platform (Model OR6-6-2000;
Advanced Mechanical Technologies, Inc., Watertown, MA)
collected 960 Hz of force data, while a Noraxon EMG system
(Noraxon USA, Inc., Scottsdale, AZ) collected 960 Hz of
EMG data. The EMG amplifier bandwidth frequency was
10-500 Hz with an input impedance of 20,000 k.M, and
the common-mode rejection ratio was 130 dB. Video, EMG,
and force data were electronically synchronized and collected
simultaneously as each subject performed one set of three
repetitions using their 12RM weight of the forward lunge
long with stride, forward lunge long without stride, forward

FIGURE 3-Computer optimization with input from measured knee

torque from inverse dynamics and predicted knee torque from muscle
model, where TK = resultant knee torque, FK = resultant knee force,
I = moment of inertia about leg center of mass, ax= angular acceleration
leg, a - linear acceleration of leg, g = gravitation
of leg, m = mass of
2
constant 9.80 mrs- , Fe,t = external force acting on foot, T., = external
torque acting on foot, FQ = quadriceps force, Fp = patellar tendon force,
Fu = hamstrings force, and FG = gastrocnemius force. Note- to simplify
the drawing, the equal and opposite forces and torques acting on the
distal leg and proximal ankle are absent.

http://www.acsrn-msse.org

FIGURE 4-Forces acting on the proximal tibia: F11 = force from hamstrings, FG = force from gastrocnemius (note: this force does not act
directly on proximal tibia), Fpr = force from patellar tendon, FACL
force from ACL, FpcL = force from PCL, and FTF, = force from femur.

lunge short with stride, and forward lunge short without stride,
assigned in a random order. Each subject rested approximately
2-3 min between lunge variations. Tape markers were used to
help each subject identify the proper stride length distance
between their rear and lead foot for each lunge variation.
After completing all lunge variations, each subject performed maximum voluntary isometric contractions (MVIC) to
normalize the EMG data collected during each lunge variation. The MVIC for the rectus femoris, the vastus lateralis, and
the vastus medialis were collected in a seated position at 90'
knee and hip flexion with a maximum effort knee extension
(13). The MVIC for the lateral and medial hamstrings were
collected in a seated position at 900 knee and hip flexion with
a maximum effort knee flexion (13), with the ankle main-

tained in a neutral position. MVIC for the gastrocnemius

was collected during a maximum effort standing one leg toe
raise with the ankle positioned approximately halfway between neutral and full plantarflexion (13). Two 5-s trials were
randomly collected for each MVIC, with 1-2 min of rest
given between trials.
, Data reduction. Video images for each reflective
marker were tracked and digitized in -three-dimensional
space with Peak Performance software (version 5.0), using
the direct linear transformation calibration method (34). Ankle, knee, and hip joint centers from the link segment model
were mathematically determined using the external markers
and appropriate equations as previously described (7,13).
Testing of the accuracy of the calibration system resulted in
reflective markers that could be located in three-dimensional
space within our laboratory with an error less than 7 mm. The
raw position data were smoothed with a double-pass fourthorder Butterworth low-pass filter with a cutoff frequency
of 6 Flz (13). Joint angles, linear and angular velocities, and
linear and angular accelerations were calculated in a twodimensional sagittal plane of the knee using appropriate kinematic equations (13).
Raw EMG signals were full-waved rectified, smoothed
with a 10-ms moving average window, linear enveloped (5).
throughout the knee range of motion for each repetition, and
normalization by expressing the data as a percentage of each
subject's highest corresponding MVIC trial. The highest
EMG signal over a 1-s time interval throughout the 5-s MVIC
was determined to calculate MVIC trials. Normalized EMG
data for the three repetitions (trials) were then averaged at
corresponding knee flexion angles between 0' and 90' and
were used in the biomechanical model described below.

TABLE 1. Mean t SD cruciate ligament force (N)values between forward lunge step length variations and between forward lunge stride variations. ACL forces represent negative values
and PCL forces represent positive values.
Step Length Varialions
Stride Variations
Long Step
Short Step
P Value
With Stride
Without Stride
P Value
Knee angles for descent phase
0.
349 i 202
69 169
<0.001
86 i 202
352 i 177
<0.001
100
3965: 177
125 i 157
<0.001
140i 208
362: 157
<0.001*
20*
420:t205
136 142
<0.001"
192 224
341 i 203
<0.0010
301
387 207
124: 97
<0.001
224 219
285 193
0.254
40o
383 195
139 71
<0.001*
258 210
264i 172
0.961
50.
422 155
174 73
<0.001
314 187
282 159
0.282
60*
474 141
240 70
<0.001
368 i 155
344 170
0.327
70*
521 173
316 85
<0.001
421 141
413 197
0.969
800
570 205
418 101
<0.0010
479:t 142
508 * 209
0.340
9D0
591 218
505 127
0.030
524 136
571 219
0.184
Knee angles for ascent phase
9D0
682 t275
612 157
0.326
602: 174
691 262
0.046
800
740 247
610 196
0.020
663 : 224
686 241
0.539
700
600
50,

765 220
744 233
706 264

549 195
485 194
452 219

<0.001"
<0.001
<0.001

400
300
200
100
0.

676 + 279
657 259
580 268
488 212
412 185

390 184
375 201
340 163
279 142
219 150

<0.001
<0.001
<0.0010
<0.001
<0.0010

681 248
669 i 266
642 281
563 285

515 285
418 263
305 i 168
266 183

632 218
560 223
514 : 251

0.301
0.056
0.005

509 269
522 261
502 239
448 216
360 193

0.224
0.675
0.355
0.015
0.126

The mean values given for the two step length variations (long step and short step) were collapsed across the two stride variations (with stride and without stride), whereas the mean
values given for the two stride variations were collapsed across the two step length variations. The P values shown for step length variations and stride variations represent the main
effects of the ANOVA.
Significant difference (P< 0.0025) between step length variations or stride variations.

SHORT-STEP AND LONG-STEP FORWARD LUNGE

Medicine & Science in Sports & Exercisev, 1935

~-800
S6 0 0
E? 400

200
20

40

60

lbo

86

io
Knee i %xtending(Ascent)

Knee Flexing (Descent)

Knee Flexion Angle (deg)

Forward Lunge Long Without Stride

---

Forward Lunge Short Without Stride

FIGURE 5-AMean (SD) PCL tensile force during forward lunge long and short without stride.

Biomechanical model. As previously described (13,41),

a biomechanical model of the knee (Figs. 3 and 4) was used to
continuously estimate cruciate ligament forces throughout a
90* knee range of motion during the knee flexing (squat descent) phase (0o--90') and the knee extending (squat ascent)
of the lunge. Resultant force and torque
phase (90o0o--)
equilibrium equations were calculated using inverse dynamics
and the biomechanical knee model (13,41). Anteroposterior
shear forces in the knee were calculated and adjusted to ligament orientations to estimate ACL or PCL forces, while
moment arms of muscle forces and angles for the line of action for the muscles and cruciate ligaments were expressed as
polynomial functions of knee angle (23). Knee torques from
cruciate and collateral ligament forces and bony contact were
assumed to be negligible, as were forces and torques out of
the sagittal plane.
Quadriceps, hamstrings, and gastrocnemius muscle forces
were estimated an EMG-driven biomechanical knee model,
as previously described (13,41). Because the accuracy of
estimating muscle forces depends on accurate estimations of

a muscle's physiological cross-sectional area (PCSA), maximum voluntary contraction force per unit PCSA, and EMGforce relationship, resultant force and torque equilibrium
equations may not be satisfied. Therefore, the modified
muscle force Fm( equation at each knee angle is as follows:
F.( = cik1krtA1orm(.) [EMG 1/MV1C 1 ],

where Ai is the PCSA of the ith muscle, o-m() is the MVIC

force per unit PCSA of the ith muscle, EMG and MVICi are
the EMG window averages of the ith muscle EMG during
exercise and MVIC trials, ci is a weight factor (values given
below) adjusted in a computer optimization program to minimize the difference between the resultant torque from the
inverse dynamics (Tw,) and the resultant torque calculation
from the biomechanical model (Tin) (Fig. 3), k-l represents
each muscle's force-length relationship as function of hip and
knee flexion angles (on the basis of muscle length, fiber
length, sarcomere length, pennation angle, and cross-sectional
area) (36), and kv1 represents each muscle's force-velocity
relationship on the basis of a Hill-type model for eccentric

1000C

800
600

E-.
+

400
200

0
-200.
"200

2'0

40

60

Knee Flexing (Descent)

-F--

100

80

8'0

6'0

4/0

20

Knee Extending (Ascent)

Knee Flexion Angle (deg)

Forward Lunge long Nwith Stride

Forward Lunge short with Stride

stride.
FIGURE 6-Mean (SD) ACL and PCL tensile force between forward lunge long and short with

1936

Official Journal of the American College of Sports Medicine

http://www.acsm-msse.org

U
0i

Knee Flexing (Descent)

Knee Extending (Ascent)

Knee Flexion Angle (deg)

-

Forward Lunge Long with Stride

Forward Lunge Long without Stride

FIGURE 7-Mean (SD) PCL tensile force during forward lunge long with and without stride.

and concentric muscle actions using the following equations

from Zajac (40) and Epstein and Herzog (12):
kv = (b - (a/Fo)%,)/(b + v)

The objective function used to determine each ith muscle's coefficient c, was as follows:

concentric

k,. = C- (C- l)(b+ (a/Fo)v)/(b- v)

-in

eccentric

with Fo representing isometric muscle force; lo, muscle fiber

length at rest; v, velocity; a = 0.32 Fr
0 ; b = 3.210 per second;
and C = 1.8.
Ratios of PCSA between muscle groups (41) were determined from the PCSA data from Wickiewicz et al. (36).
According to Narici et al. (29), the total PCSA of the quadriceps was approximately 160 cm 2 for a 75-kg man, and the
total PCSA of the quadriceps was scaled up or down by individual body mass (41). Forces generated by the knee flexors
and extensors at MVIC were assumed to be linearly proportional to their PCSA (41). Muscle force per unit PCSA
was 35 N.cm- 2 for the hamstrings and gastrocnemius and
40 N-cm- 2 for the quadriceps (11,28,29,37).

f (ci) = J=t_(I

c)2 +X(T.,

I-1

T.X

subject to clow <_ct< Chigl, where Clow and Ciligil were lower
and upper limits for ci, and X was a constant. The weight
factor c was to adjust the final muscle force calculation. The
bounds on c were set between 0.5 and 1.5, which resulted in
the torques predicted by the EMG-driven model matching
well (less than 2% of the knee torques) with the torques
generated from the inverse dynamics.
Data analysis. To determine significant differences in
cruciate ligament forces between the two step length variations (forward lunge long and forward lunge short) and
two stride variations (with stride and without stride), cruciate
ligament forces were statistically analyzed every 10' during
the 0O-90' knee flexing (descent) phase and the 90w-0o knee

extending (ascent) phase using a two-factor (step length

1000-i

".

800

S600
S400
:200
0-

--

-I

20

40

60

Knee Flexing (Descent)

80

100

80

60

4,o

ib

Knee Extending (Ascent)

Knee Flexion Angle (deg)

Forward Lunge Short With Stride

Forward Lunge Short Without Stride

FIGURE 8-Mean (SD) ACL and PCL tensile force during forward lunge short with and without stride.

SHORT-STEP AND LONG-STEP FORWARD LUNGE

Medicine & Science in Sports & ExerciseD

1937

TABLE 2. Mean + SD quadriceps and hamstrings force values during forward lunge exercises.
Quadriceps (N)
Stride Variations
Step Length Variations
Without Stride
With Stride
Short Step
Long Step
Knee angles for descent phase
0.
87: 84
111 * 67
10*
131 68
200
179 80
300
227 117
40*
326 163
500
435 186
60*
551 204
700
560 157
o0o
540: 172
900
Knee angles for ascent phase
400 120
90B
434 156
80
516 175
700
532 192
600
486: 188
50
409 165
400
336 i 144
300
268 119
200
206 105
10*
136 90
0.

Stride Variations
Without Stride
With Stride

63 49
99: 76
109: 74
126: 76
157: 94
235 131
344 187
469 i 247
527: 239
599 219

80 * 84
116 89
135 90
158 81
176 105
258 147
354: 191
471 221
510 212
563 196

71 + 49
94 t 55
105 t 51
147 75
207 + 106
303 146
425 182
549 230
577 t 183
577 195

47 121
64 38
66: 40
69 i 39
67: 39
70: 36
71 41
67!43
60 37
57 33

29 15
28 18
31 20
34 20
38; 23
41 27
39 24
34 * 21
32t20
36: 21

22 15
34 30
38 34
46 34
50 37
58 38
63 42
61 43
51 34
49 28

54:20
57* 26
58: 26
56 25
56 * 25
53: 25
47 23
41 + 23
41 :t 23
44* 26

542 129
623 211
681 272
658 290
577 278
437t203
349: 165
257 124
183 101
141 80

459 130
515 :L208
613 264
620 283
571 273
468 212
410 191
338: 166
269 149
199 127

483: 120
542: 159
585 182
570: 199
492 193
377 156
275: 118
187 .77
119 57
79 43,

101 48
108 48
120 58
128 63
134 64
139: 71
143 74
140 75
142 80
121 t 84

99 51
94 59
92 52
90: 50
87 49
82 45
84 42
83 + 42
81 41
70 36

102 49
103 58
112 65
118 70
122 71
122 75
125 75
120 76
119 81
88 84

98: 50
99 49
101 45
100 43
99: 41
100 41
102 41
103 42
104 40
103 36

variations and stride variations) repeated-measures ANOVA.

To minimize the probability of type I errors secondary to the
use of a separate ANOVA for each knee angle, the Bonferroni
adjustment had a level of significance set at P < 0.0025
(0.05/20 knee angles).

RESULTS
Table I and Figures 5-8 display cruciate ligament force
magnitudes and patterns. Comparing the forward lunge
long with the forward lunge short across stride variations
(Table 1), mean PCL forces ranged between 69 and 765 N
and were significantly greater (P < 0.001) in the forward
lunge long at 00, 10', 200, 300, 40, 500, 60', 700, and 800
knee flexion angles of the descent phase and at 70', 60',
50, 40%, 30, 200, 10', and 0' knee flexion angles of the
ascent phase. Comparing with and without stride differences
across step length variations (Table 1), mean PCL forces
ranged between 86 and 691 N and were significantly greater
(P < 0.001) without a stride at 00, 100, and 200 knee flexion
angles during the descent phase. There were no significant
interactions between levels of step length (forward lunge
long and forward lunge short) and stride (with stride and
without stride).
Visual observation of the data (Figs. 5-8) indicates that
PCL force generally increased progressively as knee angle
increased and decreased progressively as knee angle decreased. Moreover, for a given knee angle, cruciate ligament
forces were greater during the ascent phase compared with
the descent phase (Table 1).
ACL forces were observed only during the forward lunge
short with stride, occurring between 0 and 100 knee flexion
angles during the descent phase and ranging from 0 to 50 N

1938

Hamstrings (N)
Step Length Variations
Short Step
Long Step

Official Journal of the American College of Sports Medicine

(Figs. 6 and 8). Compared with the forward lunge short with
stride, between 00 and 100 knee flexion angles during the
descent phase, mean PCL forces occurred during both the
forward lunge long with stride (approximately 250-300 N
from Fig. 6) and the forward lunge short without stride
(approximately 250 N from Fig. 8).
Table 2 displays descriptive data of mean quadriceps and
hamstrings force values during the forward lunge exercises.
Quadriceps force ranged between approximately 65 and
680 N and generally increased with knee flexion, whereas
hamstring force ranged between approximately 20 and 145 N
and remained relatively constant throughout the descent phase
and throughout the ascent phase. At each knee angle, quadriceps and hamstrings forces were generally greater during the
ascent phase compared with the descent phase.
DISCUSSION
Our results demonstrate that performing the forward
lunge with varying techniques does affect cruciate ligament
loading. For healthy individuals or during the early phases
of ACL rehabilitation when the goal is to minimize ACL
loading (such as after ACL reconstruction), all four forward
lunge variations may be appropriate because relatively low
ACL forces were generated (<50 N). However, it is unknown how much loading can safely occur in the reconstructed ACL (and graft type must also be considered),
although some ACL loading during rehabilitation is probably desirable (18). Although the ultimate strength of the
healthy ACL is in excess of 2000 N (38) and the ultimate
strength of the reconstructed ACL has been estimated between approximately 2500 and 4000 N (8,33), it is unclear
how much ACL loading may become injurious to the graft
healing site during ACL rehabilitation.

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As hypothesized, the forward lunge short, which resulted

in the lead knee translating forward beyond the toes 8 3 cm
at maximum knee flexion, generated greater ACL forces
and smaller PCL forces compared with the forward lunge
long, which maintained the lead knee over the foot throughout the knee range ofmotion. These results support thebeliefs
of some clinicians that cruciate ligament loading is different
between the forward lunge short and the forward lunge long.
When the goal is to minimize ACL loading, the forward
lunge long may be a more appropriate and safer choice compared with the forward lunge short, especially the forward
lunge short with stride, which was the only lunge variation that
generated ACL loading. In addition, lunging without a stride
may be a safer choice compared with lunging with a stride
because on the basis of the results of this study, the ACL is
less likely to be loaded without a stride compared to with a
stride. Moreover, performing the lunge with more knee flexion may be preferred compared with less knee flexion because
ACL forces occurred only when the knee was flexed between
00 and 100.
In contrast to ACL rehabilitation, during the early phases
of PCL rehabilitation, when the goal is to minimize PCL
loading (such as after PCL reconstruction), all lunge variations should be used cautiously, especially at higher knee
flexion angles between 60' and 900 where mean PCL forces
ranged between approximately 475 and 775 N for the forward lunge long, between 250 and 600 N for the forward
lunge short, between 375 and 675 N for lunging with a
stride, and between 350 and 700 N for lunging without a
stride. Like the reconstructed ACL, it is unknown how
much loading can safely occur in the reconstructed PCL, and
graft type is important to consider. Because the ultimate
strength of the healthy PCL is approximately 4000 N (32), all
four lunge variations appear appropriate for healthy individuals. However, although the reconstructed PCL typically has
equal or greater ultimate strength compared with the healthy
PCL, it is unclear how much PCL loading may become injurious to the healing graft site during PCL rehabilitation.
As hypothesized, PCL forces were greater while performing the forward lunge long compared with the forward
lunge short. Therefore, when the goal is to minimize PCL
loading, the forward lunge short may be a more appropriate and safer choice compared with the forward lunge long. In
addition, lunging with a stride may be a safer choice compared
with lunging without a stride, but only when the knee was
flexed at lower angles between 00 and 200. Moreover, performing the lunge throughout a lower knee flexion range
may be preferred compared with a higher knee flexion range
because PCL forces were generally greater at higher knee
flexion angles.
An unexpected finding was that at lower knee flexion
angles, lunging without a stride loaded the PCL to a greater
extent compared with lunging with a stride. In contrast, at
lower knee flexion angles, lunging with a stride loaded the
ACL to a greater extent compared with lunging without a
stride but only during the forward lunge short (Fig. 8). One

SHORT-STEP AND LONG-STEP FORWARD LUNGE

possible explanation on why cruciate ligament forces were

different only at lower knee flexion angles (00-20) between
lunging with and without a stride is because compared with
lunging without a stride, lunging with a stride produced
15%/o-30% greater quadriceps forces when the knee was
flexed between 00 and 200 during the descent. Higher quadriceps force at these lower knee flexion angles has been shown
to result in greater ACL loading (13,15). At these lower knee
flexion angles, force from the patellar tendon via the quadriceps attempts to pull the tibia anterior, which is restrained
primarily by the ACL (9). Because the lines of pull of the
cruciate ligaments change at different knee flexion angles
(23), which affects cruciate ligament loading, this should be
investigated more thoroughly in future studies.
One reason quadriceps forces were greater with a stride
compared to without a stride is that the peak resultant ground
reaction forces acting on the lead foot were approximately
15%-20% greater with a stride between 00 and 200 knee
flexion angles of the descent. The resultant ground reaction
force vector acting on the lead foot produced a flexor torque
on the lead knee throughout the lunge, opposed by the knee
extensors. Just after lead foot contact during the descent, when
the knee was flexed 0V-20', peak resultant ground reaction
forces acting on the lead foot were greater with a stride because the center of mass of the body had more forward and
downward acceleration compared with without a stride.
Therefore, with a stride, the lead foot had to push harder into
the ground to slow down the forward and the downward accelerating center of mass of the body and to control the rate
of lead knee flexion, which was 45.s-1 for both with and
without stride conditions.
Like the current study, several studies have reported primarily PCL loading and not ACL loading while performing
weight-bearing closed chain exercises. Escamilla et al. (13,14)
reported PCL loading only throughout the knee range of
motion during the barbell squat and leg press using a 12RM
load. Stuart et al. (35) reported tibial posterior shear loads
only (PCL loading) throughout the knee range of motion
while performing a forward lunge exercise using a 50-N barbell, which support the results of the current study. Moreover,
the subjects in the aforementioned studies all used external resistance while performing the squat, the leg press, and
the lunge.
In contrast to PCL-only loading during closed chain exercises, Beynnon et al. (6) and Heijne et al. (22) reported a
peak ACL strain of approximately 4% (estimated to be approximately 150 N on the basis of the finding that a 150-N
Lachman test produced 3.7% strain at 30 knee flexion
angle) at knee flexion angles between 0' and 600 during
squatting with and without a low-resistance sport cord and no
ACL strain at knee flexion angles greater than 600. During the
lunge with a stride (no external resistance and step length not
reported), Heijne et al. (22) reported a mean ACL strain of
approximately 1% or less (estimated to be approximately
40 N or less) at knee flexion angles less than 600 (no ACL
strain at knee flexion angles greater than 600) and a peak ACL

Medicine & Science in Sports & Exercisev

193.9

strain of 1.8% (estimated to be approximately 75 N) between

a 00 and 300 knee flexion angle range. By comparison, the
peak ACL force in the current study was approximately 50 N
in the forward lunge short with stride between a 00 and 101
knee flexion angles. This demonstrates a remarkable similarity between the ACL lunge data in the current study, calculated by knee modeling techniques, and the ACL strain
lunge data by Heijne et al. (22), calculated by direct measurement using force sensors within the ACL. The subjects
in Heijne et al. (22) were patients that had force sensors
implanted within the anteromedial bundle of a healthy ACL
during arthroscopic surgery to repair damaged knee structures
(partial meniscectomies; capsule and patellofemoral joint debridement). Immediately after surgery, these patients performed a variety of exercises, including the lunge, with strain
measured within the anteromedial bundle of the ACL and
referenced to an instrumented Lachman test. Unfortunately,
Heijne et al. (22) did not measure PCL strain, so we cannot
compare PCL loads between studies.
What is consistent in closed chain exercise studies is that
PCL loading occurred at knee flexion angles greater than
600. Although the current study only investigated cruciate
ligament loading between 0' and 90' knee flexion angles,
it is likely, on the basis of the results of both the current study
and the previous studies (13,15), that PCL loading would
continue to increase at knee flexion angles greater than 900.
What is inconsistent in closed chain exercise studies is that
ACL loading occurred at knee flexion angles between 00 and
60' in some studies, and no ACL loading occurred throughout the knee range of motion in other studies. The conflicting findings in ACL loading among weight-bearing exercises
may be due to differences in the exercise technique used,
differences in the external resistance used, or methodological differences. For example, in Beynnon et al. (6), the
subjects appeared to have squatted using an upright trunk
with relatively little forward trunk tilt. This suggests that
these subjects may have used their quadriceps to a greater
extent than their hamstrings because it has been demonstrated during the squat that the hamstrings are recruited
more and the quadriceps are recruited less as the trunk tilts
forward (30). However, the marker set used in the current
study is unable to discriminate between pelvis and trunk
positions, and future studies are needed to investigate the
effects of pelvis and trunk positions on cruciate ligament
loading. This is important because trunk position has been
shown to affect hamstrings activity, and hamstrings force has
been shown to unload the ACL and load the PCL during the
weight-bearing squat exercise (13,26,30). For example,
Ohkoshi et al. (30) reported no ACL strain at all knee flexion
angles tested (15*, 300, 600, and 900) while maintaining a
squat position with the trunk tilted forward from 00 to 900,
with 300 or more forward trunk tilt being optimal for eliminating or minimizing ACL strain throughout the knee range
of motion. In the current study, although trunk positions
were similar among all four lunge variations, both hamstring
force and PCL force were greater in the forward lunge long

compared with the forward lunge short (Tables 1 and 2). In

fact, the estimated hamstring forces calculated in the current
study were 500/o-60% greater in the forward lunge long
compared with the forward lunge short, which helps
explain the greater PCL forces generated in the forward
lunge long.
Compared with quadriceps force (peak force near 700 N),
hamstrings force (peak force near 150 N) was relatively low
during all four lunge variations. This relatively low hamstrings force compared with quadriceps force may occur by
a relatively erect trunk position during all lunge variations.
Farrokhi et al. (17) demonstrated that compared with performing a forward lunge with a relatively erect trunk (similar
to the forward trunk tilt in the current study), performing the
lunge with the trunk tilted forward approximately 30--45'
resulted in significantly greater hip extensor impulse and
significantly greater hamstrings and gluteus maximum activity. The greater hamstrings activity during the lunge with
the excessive forward trunk tilt would likely result in an
increase in hamstrings force compared with performing the
lunge with a more erect trunk, which may result in greater
PCL loading and less ACL loading.
In addition to forward trunk tilt, increasing external resistance during weight-bearing exercise increases hamstrings
involvement. For example, Escamilla et al. (13) reported no
ACL loading throughout the knee range of motion in power
lifters who squatted with a 12RM external resistance and a
forward trunk tilt of approximately 301. Moreover, these
subjects had relatively high hamstrings activity, ranging between 40% and 80% of an MVIC for the lateral hamstrings
and between 30% and 60% of an MVIC for the medial
hamstrings. Other studies involving the forward lunge exercise have also reported relatively high hamstring activity
(1,21,31) and hip extensor torque (19), which implies hamstring involvement.
This initial lunge study examined healthy individuals
without cruciate ligament pathology because cruciate ligament forces during forward lunge variations are currently
unknown using the healthy population. Additional research
is needed using patients with cruciate ligament pathology or
reconstruction to determine if cruciate ligament forces generated during forward lunge variations are similar between
healthy individuals and patients with cruciate ligament deficiencies or reconstruction. Additional studies are also needed
using other techniques variations, such as using a lunge step
length somewhere between the forward lunge long and the
forward lunge short, to determine what optimal step length
minimizes cruciate ligament loading.
There are some limitations to the current study. First,
there is no practical way to validate our knee model against
the gold standard of measuring ACL strain (force) directly.
This is because currently in the United States, committees
that regulate and ensure the protection of human subjects in
research endeavors do not approve invasive techniques of
inserting force sensors within the ACL in normal healthy
subjects for the purposes of exercise research. However, as

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previously discussed, force sensors have been inserted

within the anteromedial bundle of the ACL in patients who
underwent arthroscopic surgery to repair damaged knee
structures, and some of these patients were asked to perform
the lunge exercise immediately after surgery (22). As previously mentioned, the ACL strain (force) that was reported
during the lunge by Heijne et al. (22) (measured directly by
force sensors within the ACL) is similar to the ACL forces in
the current study and occurred at similar knee flexion angles,
which provides some validation for our modeled data.
Another limitation is that the current study was limited to
sagittal plane motion only and only included subjects that
could perform the exercises without transverse plane rotary
motions and frontal plane valgus/varus motions. Future studies should investigate the effects of transverse plane rotary
motions and frontal plane valgus/varus motions on cruciate
ligament loading as well as investigate the effects of
performing lunging exercises in individuals with cruciate ligament deficiencies. Individuals that perform the lunge with
excessive transverse or frontal plane rotary motions may result in increased loading of the ACL, and this needs to be
investigated. During drop landing, Kemozek and Ragan (25)
reported that rotational moments were small in drop landing
and contributed little to ACL tension. These authors reported
that the factors that contributed most to ACL loading were
patellar tendon force and the tibial slope as well as joint axial
loads. Sex differences should also be examined in future
studies because knee biomechanical differences between sex
have been shown to occur during jumping and landing (20)
and likely also would occur during lunging exercises, especially in women that have poor hip and weak hip external
rotators and abductors (24,27).

CONCLUSIONS
Lunge technique variations do affect cruciate ligament
loading. All lunge variations appear appropriate and safe
during ACL rehabilitation because of minimal ACL loading,
especially the forward lunge long and lunging without a
stride. However, clinicians should be cautious in prescribing
the forward lunge exercises during the early phases of PCL
rehabilitation when the graft site is still healing because of
relatively high PCL forces, especially at higher knee flexion
angles during the forward lunge long. PCL forces were
greater in the forward lunge long compared with the forward
lunge short throughout most of the descent and ascent phases.
Relatively low ACL forces occurred during the forward lunge
short at small knee flexion angles, but no ACL loading occurred during the forward lunge long. The only difference in
PCL force between with stride and without a stride was at
00--200 knee flexion angles during the descent phase, in which
PCL forces were significantly greater without a stride. PCL
forces generally progressively increased as knee angle increased and decreased as knee angle decreased and were
greater during the ascent phase compared with the descent
phase.-

The efforts of Dr. Bonnie Raingruber and funding from the National Institute of Child Health and Human Development's Extramural
Associates Research Development Award program made this research possible. Also acknowledged are Lisa Bonacci, Toni Bumham, Juliann Busch, Kristen D'Anna, Pete Eliopoulos, and Ryan
Mowbray for their assistance in data collection and analyses.
The results of the current study do not constitute endorsement by
the American College of Sports Medicine.

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