Landing

For Medical Students

The Principle

A falling body carries energy, and landing means getting rid of it.

Energy can be absorbed over a long distance and a long time, or over a short one. The short version is what hurts.

Bending more joints, further, for longer, is how a landing is made safe.

At the Knee

On landing the ankle, knee and hip all flex to absorb the impact, and the three share the work. 3.4.8 covers energy absorption.

A stiff landing, with little flexion, forces the same energy into less movement and therefore into higher forces.

The quadriceps lengthen under tension to control the knee's flexion, which is the same braking action as in walking but far larger.

If the knee collapses inwards while landing, the ligaments take load the muscles should have taken. 3.12.7 covers dynamic valgus.

Landing from a jump is a common moment for cruciate injury, particularly on one leg. 3.7.14 covers the mechanism.

What Changes It

How far the body fell, which sets the energy.

How much the joints bend, which sets how the energy is spread.

Whether the landing is on one leg or two.

Fatigue, which makes landings stiffer and flatter. 3.15 covers sport.

Clinical Relevance

Teaching a softer landing is a real intervention with measurable effect, and it is part of most injury prevention programmes.

Watching someone land on one leg shows more than watching them walk.

A stiff landing is easier to see than to measure, which makes it useful in clinic.

Section 11 covers injury prevention.

MRCS Level

The Principle

Landing is an energy absorption problem with three joints available and a fixed quantity to dissipate.

The distribution between ankle, knee and hip is a strategy rather than a fixed property, and it is trainable.

A knee dominant strategy concentrates the work where the ligament risk is, which is the mechanical basis of landing retraining.

At the Knee

Peak vertical ground reaction force in a drop landing commonly reaches three to six times body weight, depending on height and technique. 3.4.2 covers the forces.

Peak knee flexion at landing is the single best predictor of peak force: more flexion, lower force.

The first 50 milliseconds after contact carry the ligament risk, the same window as in cutting. 3.14.6 covers that.

Single leg landings roughly double the demand on the landing limb and are where most injuries occur.

Chapter 3.3 covers the joint angles through a landing as kinematics. 3.3.13 covers them.

What Changes It

Drop height and body mass, which set the energy.

Landing strategy, meaning how the absorption is shared between the three joints.

Peak knee flexion, which is the most informative single kinematic variable.

Frontal plane control at the hip, which decides whether valgus appears. 3.12.7 covers it.

Fatigue, which reliably stiffens and flattens landing mechanics.

How It Is Measured

Drop vertical jump on force plates with motion capture, which is the standard research task.

Landing error scoring systems from two dimensional video, which are feasible in a clinic and moderately reliable.

Peak vertical force and loading rate from a force plate alone, without kinematics.

Joint energy absorption from inverse dynamics, which gives the strategy directly and requires a full laboratory. 3.16.7 covers it.

A drop landing in a laboratory is a poor model of a contested landing in a match, which limits what the screening can claim.

Clinical Relevance

Assess landing on one leg, since two legged landings conceal asymmetry and most injuries are single leg.

Read peak knee flexion as the most informative single variable available by observation.

Test under fatigue, which reliably worsens the mechanics.

Expect a laboratory drop landing to underestimate the demands of a contested landing.

FRCS Level

At the Knee

Landing is the most screened movement in knee practice and the screening has a poorer record than its popularity suggests.

Prospective studies of frontal plane landing measures predicting cruciate injury have been inconsistent, and the large single centre result that launched the field has not replicated cleanly. 3.7.14 covers the mechanism.

What has held up is the intervention rather than the screen: programmes that train landing and cutting reduce injury rates even where the screening that selected athletes did not predict them.

That is an uncomfortable combination and the honest reading is that the training works through something broader than the variable being screened.

Conventional teaching screens and trains; the evidence supports training everybody more strongly than it supports selecting whom to train. 6.1 covers the condition.

What Changes It

The task used, since laboratory and sport specific landings differ.

Anticipation and contest, which laboratory protocols remove.

Fatigue state, which is when the mechanics that matter appear.

Sex, age and maturation stage, which change both mechanics and baseline risk.

Prior injury and fear of reinjury, which alter landing strategy measurably. 3.7.20 covers the reconstructed knee.

How It Is Measured

Three dimensional capture of a drop vertical jump, which is the research reference.

Two dimensional scoring systems, which are deployable and have modest reliability.

Markerless and wearable capture, which may eventually measure landings in matches rather than in laboratories. 3.16.8 covers them.

Force plate loading rate, which is objective and says nothing about strategy.

The field's central difficulty is that the measurement is taken in a condition unlike the one in which injuries happen.

Clinical Relevance

Train landing mechanics broadly rather than screening to select whom to train, which is where the evidence is stronger.

Assess under fatigue and on one leg, since that is nearer the injury condition.

State that frontal plane screening has not predicted injury consistently.

Expect fear of reinjury to change landing strategy, and address it as part of the assessment rather than after it.

Take the athlete's age, physiology, comorbidities, knee demand, psychological state and their own ideas, concerns and expectations into return to sport decisions, because landing confidence and landing capacity diverge.