Effects of fatigue on trunk stability in elite gymnasts

Paving the path for injury prevention in rugby-7s: A systematic review and meta-analysis

This review and meta-analysis aimed to describe the current rugby-7s injury epidemiological literature by examining injury data from both sexes, all levels of play, and their associated risk factors. Studies published up until March 2024 were included. These studies were retrieved from six databases using search terms related to rugby-7s or sevens, tackle, collision, collision sport, injury, athlete, incidence rate, mechanism, and risk factor. Only peer-reviewed original studies using prospective or retrospective cohort designs with a clearly defined rugby-7s sample were considered. Included studies needed to report one injury outcome variable. Non-English and qualitative studies; reviews, conference papers, and abstracts were excluded. Twenty studies were included. The meta-analysis used the DerSimonian-Laird continuous random-effects method to calculate the pooled estimated means and 95% confidence interval. The estimated mean injury incidence rate for men was 108.5/1000 player-hours (95% CI: 85.9-131.0) and 76.1/1000 player-hours (95% CI: 48.7-103.5) for women. The estimated mean severity for men was 33.9 days (95% CI: 20.7-47.0) and 44.2 days (95% CI: 32.1-56.3) for women. Significantly more match injuries occurred in the second half of matches, were acute, located at the lower limb, diagnosed as joint/ligament, and resulted from being tackled. Fatigue, player fitness, and previous injuries were associated with an increased risk of injury. There were no statistically significant differences between women's and men's injury profiles. However, the inherent cultural and gendered factors which divide the two sports should not be ignored. The findings from this review will help pave the way forward beyond the foundational stages of injury prevention research in rugby-7s.

Trunk sway changes in professional bus drivers during actual shifts on long-distance routes

Although professional bus drivers are required to perform their task while adopting a prolonged constrained sitting posture, existence of possible effects in terms of postural strategies has been scarcely investigated under actual working conditions. This study aimed to characterise modifications of trunk sway in 14 professional bus drivers during regular shifts performed on non-urban routes using a pressure-sensitive mat placed on the seat. Centre-of-pressure (COP) time series were extracted from body-seat pressure data to calculate sway parameters (i.e. sway area, COP path length, COP displacements and velocities). Results show generalised increase in trunk sway as driving progresses, which becomes statistically significant after approximately 70-100 minutes of continuous driving. This may indicate the adoption of specific strategies to cope with discomfort onset or a fatigue-induced alteration of postural features. Trunk sway monitoring of bus drivers may be useful in detecting postural behaviours potentially associated with deteriorating performance and discomfort onset. Practitioner summary: Professional bus drivers operate in sitting position for prolonged time. Such constrained posture may induce discomfort and fatigue. We investigated trunk sway during actual shifts using pressure-sensitive mats. Significant increase of sway was detected after 70 min of continuous driving. Body-seat pressure data could be used as discomfort and fatigue markers. Abbreviations: ANOVA-RM: analysis of variance with repeated measures; AP: antero-posterior; COP: center of pressure; EC: ellipse's centroid; ML: medio-lateral; SA: sway area; SP: sway path.

The Effects of Intermittent Trunk Flexion With and Without Support on Sitting Balance in Young Adults

Prolonged trunk flexion is known to affect passive and active stabilization of the trunk. Previous studies have evaluated changes in spinal range of motion, muscle activity and reflex behavior induced by prolonged trunk flexion, whereas the effect on sitting postural control is vastly underexplored. In this study, we compared the effects of supported and unsupported intermittent trunk flexion on center of pressure (CoP) motion during sitting on an unstable seat. Participants (n = 21; 11 males, 23.2 ± 2.0 years; 10 females, age 24.3 ± 4.0) were exposed to 1-h intermittent (60-s sets with 30 s of rest) trunk flexion (80% of the maximal range of motion) and CoP root mean square distance, velocity and frequency before and after the exposure were assessed. Contrary to our hypothesis, there were no main effects of exposure (pre. vs. post flexion protocol; p = 0.128–0.709), no main effects of condition (supported vs. unsupported; p = 0.134–0.931), and no interaction between exposure and condition (p = 0.163–0.912). Our results indicate that prolonged intermittent flexion does not induce any changes in CoP motion during a seated balance task, regardless of the presence of a trunk support during prolonged intermittent flexion. This suggests a successful compensation of decreased passive stiffness by increased reflex activity.

Effects of Fatigue on Postural Sway and Electromyography Modulation in Young Expert Acrobatic Gymnasts and Healthy Non-trained Controls During Unipedal Stance

This study investigated whether expert acrobatic gymnasts respond differentially than their non-trained counterparts during a single-legged stance task performed before and after a protocol designed to induce fatigue in the ankle plantarflexor muscles in terms of (a) postural steadiness and (b) electromyography (EMG) activation. We hypothesized that neuromuscular adaptation due to training would lead to different behavior of center of pressure (COP) and EMG quantifiers after fatigue. Twenty eight female volunteers (aged 11 to 24 years) formed two groups: expert acrobatic gymnastics athletes (GYN, n = 14) and age-matched non-gymnasts [control (CTRL), n = 14]. Fatigue of the ankle plantarflexors (dominant leg) was induced by a sustained posture (standing on the toes) until exhaustion. Traditional COP parameters (area, RMS, mean velocity, and power spectrum at low and high frequency ranges) were obtained with a force plate, and time and frequency-domain EMG parameters were obtained by surface electrodes positioned on the tibialis anterior, soleus, lateral gastrocnemius, medial gastrocnemius, vastus lateralis, biceps femoris, spinal erector and rectus abdominis muscles. The main results showed that fatigue induced a significant increase in postural oscillations in the ML axis (including RMS, velocity and frequency components of the power spectrum), with no significant effects in the AP axis. In terms of postural sway parameters (i.e., COP quantifiers), no superior balance stability was found for the GYN group as compared to CTRL, irrespective of the fatigue condition. On the other hand, the modulation of EMG parameters (in both time and frequency domains) indicated that expert acrobatic gymnastics athletes (as compared to healthy untrained matched controls) used different neuromuscular control strategies to keep their postures on single-legged quiet standing after the fatiguing protocol. The present results improve our knowledge of the mechanisms behind the interplay between fatigue and postural performance associated with the neuromuscular adaptations induced by sport practice. The design of gymnastics training might consider strategies aimed at improving the performance of specific muscles (i.e., tibialis anterior, soleus, biceps femoris, spinal erector) for which particular activation patterns were used by the acrobatic gymnastics to control single-legged quiet standing.

Effect of fatigue on muscle latency, muscle activation and perceived discomfort when exposed to whole-body vibration

Whole-body vibration and muscle fatigue have both been shown to delay the trunk muscle reflex response and increase trunk muscle activation, leading to an increased risk of low back injuries. However, the effects of whole-body vibration on previously fatigued trunk muscles have never been tested, despite studies showing that prolonged exposure to whole-body vibration can lead to muscle fatigue. The purpose of this research was to investigate the effects of muscle fatigue on muscle latency, muscle activation and perceived discomfort when exposed to whole-body vibration. The results showed that a fatigued muscle state resulted in increased muscle latency, muscle activation and perceived discomfort, which all escalate the risk of low back injuries. Additionally, the ISO 2631-1 comfort ratings did not increase with fatigue, showing a disconnect between these comfort ratings and the perceived discomfort ratings in a fatigued muscle state. Practitioner summary: When exposed to whole-body vibration, fatigued back muscles result in delayed muscle contraction, higher overall muscle activation and increased perceived discomfort, all of which are known to increase low back injury risk. ISO 2631-1 comfort ratings are unable to increase with fatigue, showing a disconnect with perceived discomfort ratings. Abbreviations: EMG: electromyography; EO: external oblique; IO: internal oblique; LE: lumbar erector spinae; LEO: left externaloblique; LIO: left internal oblique; LLE: left lumbar erector spinae; LTE: left thoracic erector spinae; MVC: maximum voluntarycontraction; REO: right external oblique; RIO: right internal oblique; RLE: right lumbar erector spinae; RTE: right thoracicerector spinae; SEAT: Seat Effective Amplitude Transmissibility; TE: thoracic erector spinae; WBV: whole body vibration.

The Reliability and Validity of a Novel Sport-Specific Balance Test to Differentiate Performance Levels in Elite Curling Players

Balance as a skill and task-specific capacity is considered an essential physical quality in curling, required for executing effective stone delivery. However, no testing protocols have been developed to test curling-specific balance in the delivery position. Thus, the primary aim of this study was to investigate the reliability, validity and usefulness of a newly-developed, curling-specific balance test (CSBT) which involved the delivery position. The secondary aim was to examine the differences between elite and sub-elite curlers for core strength and flexibility, which have previously been identified as important qualities in curling and determinants of balance. Twenty curling players (13 females aged 19 ± 3.1 years; 7 males aged 19.6 ± 2.3 years) from five Swedish super-league curling clubs were divided into two groups according to playing level: elite and sub-elite. Variables included body mass, body height, body mass index, age, playing experience, training frequency, plank test, sit and reach test, standing single-leg balance test (SLBT) and CSBT. The CSBT was executed on a multiaxial tilting balance plate while mimicking the curling delivery position (i.e., a deep lunge position with the front foot on the plate). The participants completed the CSBT on three separate occasions, with each test consisting of three, 20-s attempts. Both the relative and absolute reliability were good for the CSBT (ICC = 0.90; CV = 14.5%). The CSBT demonstrated good measurement usefulness, being sensitive to detect moderate changes that exceeded 0.5 times the test standard deviation. Construct validity of the CSBT was evidenced by the large discriminatory capacity to differentiate expertise level in curling players (t-test: 2.85, p < 0.01; large ES), irrespective of other physical capacities (e.g., flexibility and core strength). However, the elite and sub-elite players also differed in age, playing experience and training frequency. Content validity was confirmed by a weak correlation (r = 0.21; 95%CI: -0.26 to 0.60) between the CSBT and SLBT, which suggests that curling-specific and standing balance should be considered as independent and task-specific motor skills. In conclusion, the CSBT can be used as a reliable, valid and useful tool for the assessment of curling-specific balance performance. In addition, longer and more extensive involvement in curling training contributed to superior specific balance in elite curlers.

Trunk Muscle Activation Patterns Differ Between Those With Low and High Back Extensor Strength During a Controlled Dynamic Task

It is proposed that reduced function in one of the spinal systems (active, passive, and neural) outlined by Panjabi could increase the risk of experiencing a low back injury (LBI). Also proposed is that reduced function in any one system can be compensated for by adjusting the time-varying recruitment of trunk muscles. This study addressed whether those with reduced active system function (WEAK), measured as back extensor strength, would have different trunk muscle activation patterns than those with higher function (STRONG), and secondly whether this relationship would be modified following recovery from a LBI. Sixty men participated, 30 recently recovered from LBI (rLBI, 4–12 weeks post injury) and 30 who had not had a LBI in the last year (ASYM). ASYM and rLBI participants were separated into STRONG and WEAK sub-groups if their isometric back extensor strength was above or below their group median, respectively. Trunk electromyograms from 24 muscle sites were recorded during a highly controlled horizontal transfer task. Principal component analysis captured key muscle activation patterns (amplitude and temporal); then analysis of variance models tested for strength or group*strength effects on these patterns consistent with the two main objectives. Significant strength, or group by strength effects were found for 3/4 electromyographic comparisons. In general, the WEAK group required higher activation amplitudes of abdominal and back extensor muscles, and greater temporal responsiveness of back extensor muscles only to the changing external moments than those who were STRONG. Group by strength interactions found that participants in the rLBI group had greater differences between WEAK and STRONG participants for overall muscle activation amplitudes in both abdominal and back extensor muscles. This increase in muscle activation was interpreted as compensation for lower maximum force properties whereas the increased temporal responsiveness captured a greater need to modify the agonist back extensors muscle activation patterns only in response to changes in the dynamic moments. Interactions captured that the recent experience of pain (rLBI) modified the magnitude of adjustment in muscle activation patterns potentially adapting to an increased risk of instability (painful flare) events associated with a deficit (lower strength) of the active system.

Reducing Core Stability Influences Lower Extremity Biomechanics in Novice Runners

PURPOSE

The role of core stability in running and its influence on injury risk in runners is not well understood. The purpose of this study was to investigate the effect of core stability (and core fatigue) on running mechanics. We hypothesized that decreasing core stability in novice runners would result in altered running mechanics previously associated with increased risk for common lower extremity running injuries.

METHODS

Three-dimensional running kinematics and kinetics and seated postural sway on an unstable surface were collected on 25 healthy, novice runners before and after they performed a core stability knockdown protocol (CSKP), designed to temporarily reduce participants' core stability in a single testing session.

RESULTS

Linear mixed models demonstrated that the CSKP resulted in an increased peak knee flexion moment (0.51%BW·ht increase, effect size = 0.49, P = 0.021) and a decreased vertical average loading rate (4.5 BW·s decrease, effect size = 0.44, P = 0.037) during running, but no significant changes in peak knee adduction moment, knee adduction impulse, hip adduction moment, hip adduction impulse, or peak vertical ground reaction force (all P > 0.05). Of 25 runners, 20 demonstrated a measurable decrement in their core stability as defined by their seated postural sway center of pressure excursion changing more than the standard error of measurement of 76 mm.

CONCLUSIONS

An experimentally induced decrement in core stability in novice runners caused an increased peak knee flexion moment during stance, which has previously been associated with increased patellofemoral contact pressure during running. Therefore, these results demonstrate that insufficient core stability in novice runners may be a risk factor for developing patellofemoral pain. Other results did not support a role of core stability in other common overuse running injuries in this population.

Do Older Adults and Those Recovered from Low Back Injury Share Common Muscle Activation Adaptations?

Theoretical models suggest trunk muscle activation compensates for spinal systems impairments. The purpose of this study was to determine if two populations (older adults and those recovered from a lower back injury (rLBI)) with spinal system impairments have similar muscle activation patterns to each other, but differ from controls. Trunk electromyograms collected from 12 older adults, 16 rLBI, and 19 controls during two dynamic tasks showed that older adults and rLBI had higher activation amplitudes, sustained temporal and more synergistic activation relative to controls. However, differences found between older adults and rLBI suggest that spinal system impairments differed between groups or that recent pain (rLBI) uniquely influenced muscle activation. This sheds light on our understanding of the relationship between spinal system impairments and muscle activation.

Changes in trunk sway of quay crane operators during work shift: A possible marker for fatigue?

This study investigated changes in task-induced trunk sway of quay crane operators during a four-hour shift performed in a dedicated simulator as an indicator of postural control system effectiveness. Using a pressure sensitive mat placed on the seat pan, center-of-pressure (COP) time series were acquired and processed to calculate sway area, path length and COP displacements and velocities. The results show a well-defined linear trend for sway path and area, with significant increases starting from 65 to 155 min of work respectively. This indicates non-optimized trunk control most likely originated by the combination of physical and cognitive workload and suggests a possible role of long-term monitoring of trunk sway of crane operators as a useful tool in detecting non-optimized movements potentially associated with deteriorating performance.

Sports-related testing protocols are required to reveal trunk stability adaptations in high-level athletes

Trunk/core stability is considered a key component of training programs, because it could contribute to prevention of low-back and lower-limb injuries and to sports performance. Based on the specificity principle, sports-related trunk stability tests would be required in elite sports performance. However, there may be some generic qualities underlying trunk stability that can be assessed with nonspecific protocols, which are broadly used in sport and rehabilitation. To assess whether specific tests are needed in a high-performance context, we analyzed the influence of specialization in sports with large but qualitatively different balance control demands (judo and kayaking) on trunk stability and compared high-performance athletes with recreational athletes without a specific training history. Twenty-five judokas, sixteen kayakers and thirty-seven recreational athletes performed two trunk stability protocols: sudden loading, to assess trunk responses to external and unexpected perturbations; stable and unstable sitting, to assess the participant's ability to control trunk while sitting. Within-session test-retest reliability analyses were performed to support the between-groups comparison. Judokas showed lower angular displacement (0.199rad) against posterior loading than kayakers (0.221rad) probably because they are frequently challenged by higher sudden loads while they are pushed or pulled. Kayakers showed lower error (<6.12mm) of center of pressure displacements than judokas especially during dynamic task while sitting on an unstable seat (>7.33mm), probably because they train and compete seated on unstable surfaces. Importantly, judokas and kayakers obtained better results than recreational athletes only in those tests designed according to the specific demands of each sport (p<0.050). In conclusion, specific-sport training induces specific trunk stability adaptations, which are not revealed through nonspecific tests.

Influence of Posturographic Protocol on Postural Stability Sways During Bipedal Stance After Ankle Muscle Fatigue

The aim of this study was to analyze the persistence of exercise-induced changes in postural stability and to verify if they last long enough to be captured by two sequential posturographic tests. The study, including 12 healthy young men (M age = 20.7 year, SD = 0.7), comprised two sessions (Sessions I and II). Each session included one physical exercise, along with two posturographic measurements taken prior to and after the effort, respectively. During Session I, open-eye test was followed by closed-eye test. This order was reversed during Session II, when closed-eye test was followed by open-eye test. The physical exercise protocol included repeated standing dual-heel raise until refusal. Regardless of the test order, markedly stronger effects of exercise-induced fatigue were documented during the first posturographic measurement. Only one reliable posturographic measurement can be taken if the fatigue protocol results in a short-term disruption of postural stability. The adverse effects of exercise-induced fatigue may no longer be observed during the subsequent test. As a result, the extent of post-exercise changes in postural stability may be underestimated leading to erroneous conclusions.

Trunk Stability, Trunk Strength and Sport Performance Level in Judo

Although trunk muscle function has been suggested to be a determinant of judo performance, its contribution to high-level performance in this sport has been poorly studied. Therefore, several tests were used to assess the differences in trunk muscle function between 11 international and 14 national level judo practitioners (judokas). Trunk strength and endurance were assessed using isokinetic tests and core stability was assessed using two protocols: 1) sudden loading, to assess trunk responses to unexpected external perturbations; 2) stable and unstable sitting, to assess the participants’ ability to control trunk balance. No differences between groups were found for trunk flexor isokinetic strength, trunk responses against lateral and posterior loading and trunk control while sitting. However, international level judokas showed significantly higher trunk extensor isokinetic strength (p <0.05) and lower trunk angular displacement after anterior trunk loading (p <0.05) than national level judokas. Few and low (r < 0.512) significant correlations were found between strength, endurance and stability parameters, which suggests that trunk strength and endurance are not limiting factors for trunk stability in competitive judokas. These results support the importance of trunk extensor strength and trunk stability against forward perturbations in elite judo performance.

Effects of training on postural stability in young basketball players

BACKGROUND

in basketball, balance ability is important to reduce non-contact injuries. The purpose of the present study was to investigate the effect of training on balance.

METHODS

thirty-two healthy male volunteers were recruited from amateur basketball teams. They were asked to perform the Balance Error Scoring System BESS test in order to measure the number of stability errors in six conditions. The test was performed at the beginning of the season (T0) and after 12 weeks (T1). In both cases the test was carried out before (pre-session) and after a training session (post-session).

RESULTS

the comparison of the total BESS scores both pre- and post-session showed a statistically significant increase of stability errors at both T0 and T1 (T0: pre-session 8.6±6.1 errors, post-session 10.7±6.3 errors; t=-4.03; p=0.002) (T1: pre-session 7.2±3.8 errors, post-session 9.1±5.4 errors; t=-1.93; p=0.03). Between T0 and T1 we noticed a reduction of errors which reached a statistical significance during the pre-session time (t=2.75; p=0.0049).

CONCLUSION

stability improved after 12 weeks of training, even for those conditions for which no specific training was done to improve, such as on the soft surface and feet aligned in a tandem stance.

Longitudinal Study Evaluating Postural Balance of Young Athletes

Repeated anaerobic conditions during athletic performance may cause general and local fatigue that result in postural balance deficit. Evidence suggests that improved postural balance during athletic training may decrease the risk for fallings and traumatic injuries among athletes. Twenty athletes (12 girls, 8 boys) and 20 controls (12 girls, 8 boys) ages 10–15 years participated in the current study. All athletes were active in an 8-month physical activity program, 3 times per week for 90 min., specific to basketball, soccer, or athletic training. The control children participated in physical education at school only, with no involvement in organized extracurricular sports. All participants were evaluated for postural balance in three assessments over one year (at 4-mo intervals); the Interactive Balance System machine (Tetrax device) was used to assess balance at three test times (pre-, post-, and 10 min) after a session of a repeated sprint anaerobic test, consisting of 12 × 20 m run starting every 20 sec. The athletes had better postural balance than controls. There were different group patterns of change over the sessions; a significant interaction of session and group indicated that postural balance of the groups differed. The contribution of low sway frequencies (F1) and high sway frequencies (F6) differed between the controls and the athletes group. Results suggested that although athletes had better postural balance, improvement should be encouraged during training over the sessions and seasons, with special awareness of the balance deficit that occurs immediately after anaerobic stress and at the end of the season, to decrease the risk of injuries.