Validation of Insole Pressure Sensor Algorithms: Implications for In-Field Detection of Initial Contact and Hamstring Muscle Pre-Activity During Side-Cutting.

Accurate detection of initial contact (IC) during side-cutting is essential for evaluating m. semitendinosus (ST) pre-activity, a protective mechanism against ACL injury in team sport athletes. This study developed two insole pressure sensor (IPS) algorithms-a body weight-based and a criteria-based algorithm-for IC detection and evaluated their agreement with force-plate-derived IC based on vertical ground reaction forces (vGRF). Twenty-six adult female athletes performed sport-specific side-cutting while IPS, vGRF, and ST electromyography were recorded. IPS-derived IC events were compared with vGRF-derived IC, and ST pre-activity within 50 ms prior to IC was compared between methods. Agreement and limits of agreement (LoA) were evaluated using Bland-Altman analysis. The body weight-based IPS algorithm showed a systematic delay in IC detection of 9.2 ms (LoA: 4.1 to 14.3 ms) and a -3.5 percentage point bias in ST pre-activity (LoA: -8.9 to 1.9% of MVC). In contrast, the criteria-based IPS algorithm, demonstrated minimal bias in IC detection (-0.1 ms; LoA: -3.5 to 3.4 ms) and ST pre-activity (-0.1% MVC; LoA: -1.9 to 1.7% of MVC). These findings suggest the criteria-based IPS algorithm enables accurate IC detection, supporting its potential for practical monitoring of ST pre-activity during sports-specific side-cutting outside laboratory environments.