Sandra J. Shultz

Dr. Sandra Shultz is Professor and Chair in the Department of Kinesiology. She received her B.S. in Physical Education / Athletic Training from CSU Fullerton (1984), M.S. in Kinesiology from the University of Arizona (1985), and Ph.D. in Sports Medicine from the University of Virginia (1999). Prior to her doctorate, she worked clinically for 12 years as associate director of Women’s TRACC Sports Medicine and associate director of athletic training and rehabilitation at UCLA (1991-1996). Her clinical experiences formed the foundation for her research interests, which focus on the sex-dependent factors that contribute to “high risk” knee biomechanics and ACL injury risk in women. Her primary line of research has characterized sex differences in knee laxity, and the consequences of greater magnitudes of knee laxity (both absolute and acute increases that occur during the female menstrual cycle and during exercise) on knee joint neuromechanics during sport related activity. She is currently exploring the genetic, hormone and anatomical factors (e.g. muscle mass) that precipitate high risk knee laxity profiles in an effort to develop effective intervention strategies to reduce or otherwise counteract the associated risk. This work has been supported by more than $1.6M in external funding from the National Institutes of Health, the NATA Foundation, and NFL Charities, and is the focus in 66 of her 104 peer-reviewed publications. Additionally she is primary author (1) or co-author (3) on 4 published consensus statements related to ACL injury risk and prevention in the female athlete. She has also chaired 14 PhD student dissertations and 19 MS student theses on ACL risk and prevention, with 6 of her PhD students receiving NATA foundation dissertation grants in the last 10 years. Her overarching goal is to determine the underlying factors that increase a female’s susceptibility for ACL injury, so that we can more effectively identify and address these factors in our ACL injury prevention strategies. Dr. Shultz was inducted into the NATA Hall of Fame in 2015 and is recipient of the 2014 Medal for Distinguished Athletic Training Research, the 2012 Sayer “Bud” Miller Distinguished Educator, the 2005 Most Distinguished Athletic Trainer, and the 2003 Freddie H Fu New Investigator awards from the National Athletic Trainers Association, and is a Fellow of the National Athletic Trainers' Association, the National Academy of Kinesiology and the American College of Sports Medicine. She serves as Section Editor for the Journal of Athletic Training, grant review panelist for NIH, and editorial board member for Medicine and Science in Sports and Exercise, Journal of Sports Health, and Isokinetic and Exercise Science.

There are 59 included publications by Sandra J. Shultz :

TitleDateViewsBrief Description
Absolute Serum Hormone Levels Predict the Magnitude of Change in Anterior Knee Laxity across the Menstrual Cycle 2006 442 This study aimed to determine whether absolute sex hormone concentrations predict the magnitude of knee joint laxity changes across the menstrual cycle. Twenty-two females (18–30 years, body mass index =30), who reported normal menstrual cycles for t...
Anterior Cruciate Ligament Injury in Collegiate Female Dancers 2009 942 ABOUT 80,000 to 250,000 anterior cruciate ligament (ACL) injuries of the knee occur annually, with many of these injuries affecting individuals between the ages of 15-25 years.1 The majority of ACL injuries are noncontact in nature,
Application of a Clinic-Based Algorithm as a Tool to Identify Female Athletes at Risk for Anterior Cruciate Ligament Injury: A Prospective Cohort Study With a Nested, Matched Case-Control Analysis 2012 39 Background: When landing from a jump, the production of increased intersegmental knee abduction moments and coupled valgus motions has been associated with an increased risk of suffering a noncontact anterior cruciate ligament (ACL) injury in one stu...
Assessment of neuromuscular response characteristics at the knee following a functional perturbation 2000 1728 Previous research indicates that both the extent and timing of muscular activation at the knee can be influenced by muscle activity state, joint angle, weight-bearing status and trunk position. However, little research to date has evaluated protectiv...
Changes in serum collagen markers, IGF-I, and Knee joint laxity across the menstrual cycle 2012 62 Variations in serum markers of collagen production (CICP) and degradation (ICTP), insulin-like growth factor I (IGF-I) and anterior knee laxity (AKL) were measured in 20 women [10 with spontaneous cycles (eumenorrheic), 10 using oral contraceptives] ...
Changing filtering parameters affects lower extremity pre-landing muscle activation onset times 2010 82 Surface electromyography(sEMG) is extensively used to examine muscle activation. Although raw sEMG signals are often filtered using Root-Mean-Square(RMS) algorithms, little agreement exists as to the time window over which signals should be processed...
Changing sagittal plane body position during single-leg landings influences the risk of non-contact anterior cruciate ligament injury 2013 25 Purpose. To examine the effects of different sagittal plane body positions during single-leg landings on biomechanics and muscle activation parameters associated with risk for anterior cruciate ligament (ACL) injury.Methods. Twenty participants perfo...
Clinical and Instrumented Measurements of Hip Laxity and Their Associations With Knee Laxity and General Joint Laxity 2014 19 Context: Hip-joint laxity may be a relevant anterior cruciate ligament injury risk factor. With no devices currently available to measure hip laxity, it is important to determine if clinical measurements sufficiently capture passive displacement of t...
Collagen Gene Variants Previously Associated With Anterior Cruciate Ligament Injury Risk Are Also Associated With Joint Laxity 2012 261 Background: Genetic association studies demonstrate a relationship between several collagen gene variants and anterior cruciate ligament (ACL) injury, yet the mechanism of these relationships is still unclear. Joint laxity is a heritable trait; incre...
Combined Anatomic Factors Predicting Risk of Anterior Cruciate Ligament Injury for Males and Females 2015 9 Background: Knee joint geometry has been associated with risk of suffering an anterior cruciate ligament (ACL) injury; however, few studies have utilized multivariate analysis to investigate how different aspects of knee joint geometry combine to inf...
A Comparison of Cyclic Variations in Anterior Knee Laxity, Genu Recurvatum, and General Joint Laxity across the Menstrual Cycle 2010 1068 Changes in anterior knee laxity (AKL), genu recurvatum (GR) and general joint laxity (GJL) were quantified across days of the early follicular and early luteal phases of the menstrual cycle in 66 females, and the similarity in their pattern of cyclic...
Cyclic variations in multiplanar knee laxity influence landing biomechanics. 2012 5070 Purpose: Females vary substantially in their multiplanar cyclic knee laxity changes across the menstrual cycle. The biomechanical implications of these cyclic changes are relatively unknown. Our purpose was to first cluster females based on their cyc...
A decreased volume of the medial tibial spine is associated with an increased risk of suffering an anterior cruciate ligament injury for males but not females 2014 14 Measurements of tibial plateau subchondral bone and articular cartilage slope have been associated with the risk of suffering anterior cruciate ligament (ACL) injury. Such single-plane measures of the tibial plateau may not sufficiently characterize ...
Dynamic Valgus Alignment and Functional Strength in Males and Females During Maturation 2009 1085 Context: Sex differences in dynamic measures have been established in physically mature populations. Gaining information on maturation's effect on dynamic performance measures implicated in injury risk may enable us to better design injury prevention...
Effect of axial load on anterior tibial translation when transitioning from non-weight bearing to weight bearing 2010 691 Background While the application of compressive joint loads and thigh muscle activity are associated with anterior tibial translation in vitro, less is known during early load acceptance in vivo. We investigated the effects of increasing axial loads...
Effect of coupling medium temperature on rate of intra-muscular temperature rise using continuous ultrasound 2000 1946 Objective: We determined the effects of coupling medium temperature on the rate of intramuscular temperature rise (RTR) during continuous ultrasound. Design and Setting: Ultrasound was applied in a continuous mode at a frequency of 1 MHz and intensi...
The Effects of Level of Competition, Sport, and Sex on the Incidence of First-Time Noncontact Anterior Cruciate Ligament Injury 2014 200 Background: Anterior cruciate ligament (ACL) injuries are disabling and are associated with the early onset of posttraumatic osteoarthritis. Little is known regarding the incidence rate of first-time noncontact ACL injuries sustained during athletic ...
Effects of Transverse and Frontal Plane Knee Laxity on Hip and Knee Neuromechanics During Drop Landings 2009 613 Background Varus-valgus (LAXVV) and internal-external (LAXIER) rotational knee laxity have received attention as potential contributing factors in anterior cruciate ligament injury. This study compared persons with above-and bel...
Energy absorption as a predictor of leg impedance in highly trained females 2006 1260 Although leg spring stiffness represents active muscular recruitment of the lower extremity during dynamic tasks such as hopping and running, the joint-specific characteristics comprising the damping portion of this measure, leg impedance, are uncert...
Evaluation of an Algorithm to Predict Menstrual-Cycle Phase at the Time of Injury 2016 13 Context: Women are 2 to 8 times more likely to sustain an anterior cruciate ligament (ACL) injury than men, and previous studies indicated an increased risk for injury during the preovulatory phase of the menstrual cycle (MC). However, investigation...
Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis 2015 324 Background- Anterior cruciate ligament (ACL) injury prevention programmes have shown mixed results, which may be due to differing emphasis on training components. The purpose of this study was to (1) quantify the overall and relative duration of each...
Females recruit quadriceps faster than males at multiple knee flexion angles following a weight-bearing rotary perturbation 2006 827 Objective: To compare the effect of knee angle on muscle response times and neuromuscular recruitment patterns between sexes following a perturbation in single leg stance at 10°, 20°, and 30°. We hypothesized that response times would be faster at le...
Geometric profile of the tibial plateau cartilage surface is associated with the risk of non-contact anterior cruciate ligament injury 2014 32 The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non-contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case–control analysis. S...
Hip extension, knee flexion paradox: A new mechanism for non-contact ACL injury 2011 72 Considering that an athlete performs at-risk sports activities countless times throughout the course of his or her career prior to the instance of anterior cruciate ligament (ACL) injury, one may conclude that non-contact ACL injury is a rare event. ...
Identifying Knee Laxity Profiles and Associated Physical Characteristics 2012 86 Context: A single measure of knee laxity (ie, measurement of laxity in a single plane of motion) is probably inadequate to fully describe how knee joint laxity is associated with anterior cruciate ligament injury.Objective: To characterize interparti...
Increased Slope of the Lateral Tibial Plateau Subchondral Bone Is Associated With Greater Risk of Noncontact ACL Injury in Females but Not in Males: A Prospective Cohort Study With a Nested, Matched Case-Control Analysis 2014 23 Background: There is an emerging consensus that increased posterior-inferior directed slope of the subchondral bone portion of the tibial plateau is associated with increased risk of suffering an anterior cruciate ligament (ACL) injury; however, most...
The independent and interactive effects of navicular drop and quadriceps angle on neuromuscular responses to a weight bearing perturbation 2006 997 Little is known about the effects of static alignment on neuromuscular control of the knee during dynamic motion. To evaluate the isolated and combined effects of quadriceps angle (QA) and navicular drop (ND) on neuromuscular responses to a weight-be...
The influences of sex and posture on joint energetics during drop landings 2015 13 Previous observations suggest that females utilize a more erect initial landing posture than males with sex differences in landing posture possibly related to sex-specific energy absorption (EA) strategies. However, sex-specific EA strategies have on...
Isometric Knee-Extension and Knee-Flexion Torque Production During Early Follicular and Postovulatory Phases in Recreationally Active Women 2010 53 Context: Acute decreases in strength have been associated with risky biomechanical strategies that might predispose one to injury. Whether acute changes in thigh muscle torque occur across the menstrual cycle remains equivocal.Objective: We compared ...
Joint Laxity Is Related to Lower Extremity Energetics during a Drop Jump Landing 2010 1052 Purpose: To examine the relationships between anterior knee laxity (AKL), genu recurvatum (GR), and general joint laxity (GJL) with sagittal plane energetics in males and females during a drop jump task. Methods: A total of 68 females and 50 males we...
Kinematic analysis of functional lower extremity perturbations 2004 1142 Background. Sudden changes in direction on a single weight-bearing-limb are commonly associated with injury to the lower extremity. The purposes of this study were to assess the between day reliability of hip, knee, and ankle kinematic displacements ...
Knee joint laxity affects muscle activation patterns in the healthy knee 2003 2474 This study investigated the effects of anterior knee joint laxity on muscle activation patterns prior to and following a lower extremity perturbation. Participants were subjected to a forward and either internal (IR) or external (ER) rotation perturb...
Knee Joint Laxity and Its Cyclic Variation Influence Tibiofemoral Motion during Weight Acceptance 2011 624 Purpose - To better understand how sex differences in anterior knee joint laxity (AKL) impact knee joint biomechanics, we examined the consequence of greater absolute baseline (males and females) and cyclic increases in AKL during the menstrual cycle...
Knee ligament behavior following a controlled loading protocol does not differ by menstrual cycle day 2004 1039 Background. Females experience a disproportionate number of anterior cruciate ligament injuries compared to males. Increased estradiol concentration has been suggested to alter ligament properties and strength. Determining whether the knee responds d...
Low levels of anterior tibial loading enhance knee extensor reflex response characteristics 2005 1223 We examined whether neuromuscular reflexes were altered with anterior loads applied to the tibiofemoral joint. A ligament testing device was modified by attaching a reflex hammer to a steel mounted frame to illicit a patellar tendon tap, while anteri...
Lower Extremity Energy Absorption and Biomechanics During Landing, Part II: Frontal-Plane Energy Analyses and Interplanar Relationships 2013 1 Context: Greater sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing is consistent with sagittal-plane biomechanics that likely increase anterior cruciate ligament (ACL) loading, but it does not appear to influence ...
Lower extremity energy absorption and biomechanics during landing. Part I: Sagittal plane energy analyses 2013 0 Context: Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics consider...
Neuromuscular Response Characteristics in Men and Women After Knee Perturbation in a Single-Leg, Weight-Bearing Stance. 2001 1581 Objective: We examined whether muscle response times and activation patterns in the lower extremity differed between men and women in response to a rotational knee perturbation while standing in a single-leg, weight-bearing stance. Design and Settin...
Physical rehabilitation and the challenge of anterior cruciate ligament injury in the physically active female 2005 1318 Rehabilitation professionals facilitate healthy movement and mobility in individuals seeking to engage in physically active lifestyles. The disparate rate of injury to the anterior cruciate ligament of the knee in physically active females in compari...
A Prospective Evaluation of the Landing Error Scoring System (LESS) as a Screening Tool for Anterior Cruciate Ligament Injury Risk 2012 100 Background: Anterior cruciate ligament (ACL) injuries are immediately disabling, costly, take a significant amount of time to rehabilitate, and are associated with an increased risk of developing posttraumatic osteoarthritis of the knee. Specific mul...
Relationship Between the Risk of Suffering a First-Time Noncontact ACL Injury and Geometry of the Femoral Notch and ACL: A Prospective Cohort Study With a Nested Case-Control Analysis 2014 136 Background: The morphometric characteristics of the anterior cruciate ligament (ACL) and the femoral intercondylar notch within which it resides have been implicated as risk factors for injuries to this important stabilizer of the knee. Prior researc...
Relationship between sex hormones and anterior knee laxity across the menstrual cycle 2004 926 Purpose: To comprehensively quantify through daily, serial measures changes in knee laxity as a function of changing sex-hormone levels across one complete menstrual cycle. Methods: Twenty-five females, 18–30 yr, body mass index <= 30, who reported ...
Relationships Between Lower Extremity Alignment and the Quadriceps Angle 2009 1618 Objective: To determine the extent to which select lower extremity alignment characteristics of the pelvis, hip, knee, and foot are related to the Q angle.

Design: Descriptive cohort study design. Setting: Applied Neuromechanics Research L...
The Reliability and Validity of Ankle Inversion and Eversion Torque Measurements From the Kin Com II Isokinetic Dynamometer 1995 2607 This study examined the test—retest reliability of a prototype device used to measure ankle inversion and eversion isokinetic average torque values. The purpose of this paper was to illustrate a situation where common isokinetic measures were reliabl...
Reliability and validity of the Biodex System 3 Pro Isokinetic Dynamometer velocity, torque and position measurements 2004 11729 This study quantitatively assessed the mechanical reliability and validity of position, torque and velocity measurements of the Biodex System 3 isokinetic dynamometer. Trial-to-trial and day-to-day reliability were assessed during three trials on two...
Reliability of a New Stabilized Dynamometer System for the Evaluation of Hip Strength 2013 29 Background: Hip strength is associated with numerous orthopaedic and neuromuscular injuries and/or pathologies and may be assessed with a variety of anatomic testing positions and techniques. Isokinetic dynamometers are generally too cumbersome and i...
Research Retreat IV: ACL Injuries–The Gender Bias, April 3-5, 2008, Greensboro, NC 2008 1 In April 2008, more than 80 attendees from across the United States and Canada participated in the fourth research retreat focused on the gender bias in anterior cruciate ligament (ACL) injury. The retreat was cofounded by Irene Davis, PhD, PT, and M...
Risk Factors for Anterior Cruciate Ligament Injury: A Review of the Literature — Part 1: Neuromuscular and Anatomic Risk 2012 82 Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possibl...
Risk Factors for Anterior Cruciate Ligament Injury: A Review of the Literature—Part 2: Hormonal, Genetic, Cognitive Function, Previous Injury, and Extrinsic Risk Factors 2012 70 Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk facto...
Serial administration of clinical concussion assessments and learning effects in healthy young athletes 2004 2119 Objective: To determine if serial administration of the Standardized Assessment of Concussion (SAC) and Balance Error Scoring System (BESS) would elicit a learning effect in young athletes and to determine the intratester reliability of scoring the B...
Sex Differences in Coupled Knee Motions during the Transition from Non-Weight Bearing to Weight Bearing 2009 536 Knee ligament injuries frequently happen when the joint transitions from non-weight bearing (NWB) to weight bearing (WB). To gain insight into the mechanism that produces these injuries, physically active females (N = 41) and males (N = 39) underwent...
Sex differences in lower extremity biomechanics during single leg landings 2007 4155 Background. Females have an increased incident rate of anterior cruciate ligament tears compared to males. Biomechanical strategies to decelerate the body in the vertical direction have been implicated as a contributing cause. This study determined i...
Sex specific abdominal activation strategies during landing 2007 1237 Control of the trunk segment in landing has been implicated as a contributing factor to the higher incidence of anterior cruciate ligament injuries in females than in males. Investigating the sex-specific abdominal activation strategies during landin...
A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury 2015 22 Anterior cruciate ligament (ACL) injuries produce significant joint trauma and have been implicated as the inciting event for both short-term and long-term changes within the articular structures of the knee.[1–8] Regardless of whether a patient choo...
Some Sex Hormone Profiles are Consistent over Time in Normal Menstruating Women: Implications for Sports Injury Epidemiology 2011 631 Purpose-It is unclear whether sex hormone profiles obtained in two consecutive months are consistent within women. Month-to-month consistency in daily, nadir, peak and mean hormone concentrations during the early follicular and luteal phases in recre...
Thigh Strength and Activation as Predictors of Knee Biomechanics during a Drop Jump Task 2009 823 Purpose: To examine whether normalized quadriceps and hamstring strength would predict quadriceps and hamstring muscle activation amplitudes and whether these neuromuscular factors would predict knee kinematics and kinetics during a drop jump task. M...
Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury 2014 19 Tibial plateau subchondral bone geometry has been associated with the risk of sustaining a non-contact ACL injury; however, little is known regarding the influence of the meniscus and articular cartilage interface geometry on risk. We hypothesized th...
Using Surface Electromyography To Assess Sex Differences in Neuromuscular Response Characteristics 1999 955 Objective: To provide an overview of the continuum of muscular responses that typically occur with joint perturbation. The applications and limitations of surface electromyography (sEMG) in evaluating these responses are also addressed. Research appl...
Variations in Varus/Valgus and Internal/External Rotational Knee Laxity and Stiffness Across the Menstrual Cycle 2011 829 Cyclic variations in genu recurvatum (GR), general joint laxity (GJL), varus–valgus (VV), and internal–external (IER) rotational laxities and stiffnesses were examined in 64 females and 43 males at two time points during the females' menstrual cycle ...