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July 2026

Associations Between Lower Extremity Myotonic Properties, Strength, and Balance in American Football Players: An Exploratory LASSO-Based Study

Authors: Derya Azim 1, Omer Ozer 2, Ahmet Kurtoglu 3, Safaa M. Elkholi 4

Affiliations:

  1. Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bandirma Onyedi Eylul University, 10200 Balikesir, Turkey
  2. Faculty of Sport Sciences, Department of Physical Education and Sport, Bandirma Onyedi Eylul University, 10200 Balikesir, Turkey
  3. Faculty of Sport Science, Department of Coaching Education, Bandirma Onyedi Eylul University, 10200 Balikesir, Turkey
  4. Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia

Journal: Journal of Clinical Medicine - June 2026, Volume 15, Issue 12, Article no. 4842 (DOI: 10.3390/jcm15124842)

Background/Objectives: Evidence on the role of muscle mechanical (myotonic) properties in athletic performance remains limited in young adult and sub-elite populations, particularly in American football, and sex-specific patterns of association are not well understood. This study aimed to investigate the associations between lower extremity myotonic properties and performance outcomes (strength and balance) in American football athletes, with a specific focus on sex-related differences and candidate predictors.

Methods: A cross-sectional design was implemented involving 35 American football athletes (17 female, 18 male). Lower extremity muscle tone, stiffness, and elasticity were assessed using MyotonPRO. Strength parameters (lower limb, handgrip, back, and shoulder internal rotation) and balance performance (static and dynamic under eyes-open and eyes-closed conditions) were evaluated using standardized measurement protocols. Pearson correlation analysis was conducted to examine bivariate associations, followed by Least Absolute Shrinkage and Selection Operator (LASSO) regression to determine candidate predictors while addressing multicollinearity.

Results: Male athletes exhibited significantly greater height, body mass, and BMI (p < 0.001), alongside elevated myotonic values compared to females. Correlation analyses indicated distinct sex-specific association patterns between myotonic properties and performance metrics. LASSO regression revealed a distinct sex-specific divergence in strength prediction: female strength was predominantly driven by proximal musculature (quadriceps and hamstring elasticity/stiffness), whereas male strength was anchored by distal musculature (gastrocnemius tone/stiffness). Furthermore, rigorous penalization shrunk nearly all balance coefficients to zero in both sexes, indicating that resting myotonic properties do not independently predict dynamic or static postural control.

Conclusions: While lower extremity myotonic properties are candidate predictors of multi-regional strength via sex-specific proximal and distal strategies, they do not independently predict balance performance, suggesting postural control relies primarily on active motor recruitment rather than passive resting mechanics. Given the cross-sectional design of this study, causal inferences cannot be drawn, and these findings should be interpreted accordingly. The observed sex-specific differences may support consideration of individualized, sex-informed training strategies in American football athletes.

 

Keywords: myotonometry, muscle stiffness, strength, balance, sex differences, kinetic chain

In this study, the resting mechanical characteristics of the lower extremities were associated with certain strength parameters depending on sex, yet notably not predicting postural stability performance independently from other strength parameters. This difference implies that while resting myotonic characteristics could help to predict certain force-generating capacities and mechanisms used by athletes in their kinetic chain, the postural control does not depend on these characteristics but rather depends on active neuroprocessing of information in the context of American football athletes. With regard to the explorative nature of the data obtained due to a cross-sectional design and measurements under resting conditions, this finding should be replicated in large samples in prospective studies.

Moreover, the differences between males and females observed in terms of which muscles were more influential when predicting maximal strength parameters imply distinct neuromuscular structures in these groups. Such information can be used in designing further research that can include sex-specific considerations and mechanical characteristics of athletes.

From a practical perspective, myotonic profiling can be included in comprehensive athlete monitoring procedures. The procedure itself is easy to perform, fast, and does not require special equipment beyond the MyotonPRO apparatus.

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