Changes in muscle afferents, motoneurons and motor drive during muscle fatigue

Kinematics but not kinetics alterations to single-leg drop jump movements following a subject-tailored fatiguing protocol suggest an increased risk of ACL injury

Introduction

Neuromuscular fatigue causes a transient reduction of muscle force, and alters the mechanisms of motor control. Whether these alterations increase the risk of anterior cruciate ligament (ACL) injury is still debated. Here we compare the biomechanics of single-leg drop jumps before and after the execution of a fatiguing exercise, evaluating whether this exercise causes biomechanical alterations typically associated with an increased risk of ACL lesion. The intensity of the fatiguing protocol was tailored to the aerobic capacity of each participant, minimizing potential differential effects due to inter-individual variability in fitness.

Methods

Twenty-four healthy male volunteers performed single leg drop jumps, before and after a single-set fatiguing session on a cycle ergometer until exhaustion (cadence: 65-70 revolutions per minute). For each participant, the intensity of the fatiguing exercise was set to 110% of the power achieved at their anaerobic threshold, previously identified by means of a cardiopulmonary exercise test. Joint angles and moments, as well as ground reaction forces (GRF) before and after the fatiguing exercise were compared for both the dominant and the non-dominant leg.

Results

Following the fatiguing exercise, the hip joint was more extended (landing: Δ=-2.17°, p = 0.005; propulsion: Δ=-1.83°, p = 0.032) and more abducted (landing: Δ=-0.72°, p = 0.01; propulsion: Δ=-1.12°, p = 0.009). Similarly, the knee joint was more extended at landing (non-dominant leg: Δ=-2.67°, p < 0.001; dominant: Δ=-1.4°, p = 0.023), and more abducted at propulsion (both legs: Δ=-0.99°, p < 0.001) and stabilization (both legs: Δ=-1.71°, p < 0.001) hence increasing knee valgus. Fatigue also caused a significant reduction of vertical GRF upon landing (Δ=-0.21 N/kg, p = 0.003), but not during propulsion. Fatigue did not affect joint moments significantly.

Conclusion

The increased hip and knee extension, as well as the increased knee abduction we observed after the execution of the fatiguing exercise have been previously identified as risk factors for ACL injury. These results therefore suggest an increased risk of ACL injury after the execution of the participant-tailored fatiguing protocol proposed here. However, the reduced vertical GRF upon landing and the preservation of joint moments are intriguing, as they may suggest the adoption of protective strategies in the fatigued condition to be evaluated in future studied.

Adaptive nanotube networks enabling omnidirectionally deformable electro-driven liquid crystal elastomers towards artificial muscles

Artificial muscles that can convert electrical energy into mechanical energy promise broad scientific and technological applications. However, existing electro-driven artificial muscles have been plagued with problems that hinder their practical applications: large electro-mechanical attenuation during deformation, high-driving voltages, small actuation strain, and low power density. Here, we design and create novel electro-thermal-driven artificial muscles rationally composited by hierarchically structured carbon nanotube (HS-CNT) networks and liquid crystal elastomers (LCEs), which possess adaptive sandwiched nanotube networks with angulated-scissor-like microstructures, thus effectively addressing above problems. These HS-CNT/LCE artificial muscles demonstrate not only large strain (>40%), but also remarkable conductive robustness (R/R0 < 1.03 under actuation), excellent Joule heating efficiency (≈ 233 °C at 4 V), and high load-bearing capacity (R/R0 < 1.15 at 4000 times its weight loaded). In addition, our artificial muscles exhibit real-muscle-like morphing intelligence that enables preventing mechanical damage in response to excessively heavyweight loading. These high-performance artificial muscles uniquely combining omnidirectional stretchability, robust electrothermal actuation, low driving voltage, and powerful mechanical output would exert significant technological impacts on engineering applications such as soft robotics and wearable flexible electronics.

Perturbation Variability Does Not Influence Implicit Sensorimotor Adaptation

Implicit adaptation has been regarded as a rigid process that automatically operates in response to movement errors to keep the sensorimotor system precisely calibrated. This hypothesis has been challenged by recent evidence suggesting flexibility in this learning process. One compelling line of evidence comes from work suggesting that this form of learning is context-dependent, with the rate of learning modulated by error history. Specifically, learning was attenuated in the presence of perturbations exhibiting high variance compared to when the perturbation is fixed. However, these findings are confounded by the fact that the adaptation system corrects for errors of different magnitudes in a non-linear manner, with the adaptive response increasing in a proportional manner to small errors and saturating to large errors. Through simulations, we show that this non-linear motor correction function is sufficient to explain the effect of perturbation variance without referring to an experience-dependent change in error sensitivity. Moreover, by controlling the distribution of errors experienced during training, we provide empirical evidence showing that there is no measurable effect of perturbation variance on implicit adaptation. As such, we argue that the evidence to date remains consistent with the rigidity assumption.

Reactive postural adjustment in response to predictable and unpredictable perturbations in healthy adults: A comparison between swayback, hyperlordotic and erect postures

BACKGROUND

Promoting an erect posture in standing has been advocated to offer superior protection to the spine when compared to hyperlordotic and swayback postures.

RESEARCH QUESTION

Do postural adjustments towards external perturbation differ between erect, hyperlordotic and swayback postures? If so, which posture offers better protection to lumbar spine?

METHODS

Forty-four healthy adults received top-down perturbations under unpredictable (without visual-and-auditory input) and predictable (with visual-and-auditory input) conditions in three simulated postures: erect, hyperlordotic, and swayback. Postural adjustments namely the centre of pressure parameters, joint angle onsets, and neuromuscular responses measured by muscle onsets and co-contraction between muscle pairs upon the perturbation were compared using the two-way repeated measures ANOVA. Post-hoc analysis with Bonferroni correction was conducted to identify the between-posture differences for the respective postural adjustment parameters.

RESULTS

Path length, ellipse area and average velocity of centre of pressure were significantly greater under unpredictable condition as compared to predictable condition (p < 0.001). Significant between-posture difference was detected in centre of pressure path length (p < 0.035), pelvic tilt onset (p < 0.038) and all muscle co-contraction indexes (p < 0.001). Post-hoc analysis revealed significantly smaller centre of pressure path length in erect posture as compared to hyperlordotic and swayback postures (p < 0.01) under unpredictable conditions. Significantly greater co-contraction indexes of lumbar multifidus and erector spinae, and internal oblique and lumbar multifidus were found in hyperlordotic as compared to erect and swayback postures (p < 0.05).

SIGNIFICANCE

Compared to erect posture, adoption of hyperlordotic and swayback postures altered the contributions of the active and passive subsystems of the spine that regulates postural control upon external perturbations. Such differences in neuromuscular control may lessen the capacity of the human spine to withstand loading and shear forces. Prospective studies are required to validate if habitually adopted hyperlordotic and swayback postures contribute to an earlier/ higher prevalence of spinal dysfunctions.

Effects of auriculotherapy on muscle fatigue: A randomized crossover trial

OBJECTIVE

This study aimed investigate the effect of auriculotherapy on exercise-induced muscle fatigue, isometric torque production, and surface electromyographic activity (EMG).

METHODS

Design: Randomized Crossover Trial. The sample consisted of 18 males' volunteers who exercised at least twice a week.

THE SAMPLE WAS RANDOMLY ASSIGNED TO TWO GROUPS

Placebo Group (n = 9) and Treated Group (n = 9), and after seven days, the groups were crossed. The data analysis included 18 participants in each group.

MAIN OUTCOME MEASURE

The muscle fatigue index, force production rate, and EMG of the quadriceps were used for evaluation. The evaluation moments included baseline pre-fatigue, baseline post-fatigue, 48 h post-intervention pre-fatigue, and 48 h post-intervention post-fatigue. Mixed two-way test ANOVA was used to compare times and groups.

RESULTS

The fatigue index for peak torque and work showed no significant effect on time, groups, or interaction (p > 0.05). However, for isometric torque, force production rate, and EMG median frequency and average, the results indicate a positive change in values over time (p < 0.05) (with little practical relevance), with no differences observed between the groups or interaction (p > 0.05).

CONCLUSIONS

In conclusion, auriculotherapy had no effect on exercise-induced muscle fatigue, isometric torque production, and surface electromyographic activity.

Neuromuscular and gene signaling responses to passive whole-body heat stress in young adults

This study aimed to investigate whether acute passive heat stress 1) decreases muscle Maximal Voluntary Contraction (MVC); 2) increases peripheral muscle fatigue; 3) increases spinal cord excitability, and 4) increases key skeletal muscle gene signaling pathways in skeletal muscle. Examining the biological and physiological markers underlying passive heat stress will assist us in understanding the potential therapeutic benefits. MVCs, muscle fatigue, spinal cord excitability, and gene signaling were examined after control or whole body heat stress in an environmental chamber (heat; 82 °C, 10% humidity for 30 min). Heart Rate (HR), an indicator of stress response, was correlated to muscle fatigue in the heat group (R = 0.59; p < 0.05) but was not correlated to MVC, twitch potentiation, and H reflex suppression. Sixty-one genes were differentially expressed after heat (41 genes >1.5-fold induced; 20 < 0.667 fold repressed). A strong correlation emerged between the session type (control or heat) and principal components (PC1) (R = 0.82; p < 0.005). Cell Signal Transduction, Metabolism, Gene Expression and Transcription, Immune System, DNA Repair, and Metabolism of Proteins were pathway domains with the largest number of genes regulated after acute whole body heat stress. Acute whole-body heat stress may offer a physiological stimulus for people with a limited capacity to exercise.

Effects of trunk extensor muscle fatigue on repetitive lift (re)training using an augmented tactile feedback approach

Augmented tactile and performance feedback has been used to (re)train a modified lifting technique to reduce lumbar spine flexion, which has been associated with low back disorder development during occupational repetitive lifting tasks. However, it remains unknown if the presence of trunk extensor neuromuscular fatigue influences learning of this modified lifting technique. Therefore, we compared the effectiveness of using augmented tactile and performance feedback to reduce lumbar spine flexion during a repetitive lifting task, in both unfatigued and fatigued states. Participants completed repetitive lifting tests immediately before and after training, and 1-week later, with half of the participants completing training after fatiguing their trunk extensor muscles. Both groups demonstrated learning of the modified lifting technique as demonstrated by increased thorax-pelvis coordination variability and reduced lumbar range of motion variability; however, experiencing trunk extensor neuromuscular fatigue during lift (re)training may have slight negative influences on learning the modified lifting technique. Practitioner summary: An augmented lift (re)training paradigm using tactile cueing and performance feedback regarding key movement features (i.e. lumbar spine flexion) can effectively (re)train a modified lifting technique to reduce lumbar flexion and redistribute motion to the hips and knees. However, performing (re)training while fatigued could slightly hinder learning this lifting technique.

Fatigue as a key factor for testing knee stability with single leg drop landing for injury prevention and return to play tests

Objectives

Fatigue can decrease knee stability and increase the injury risk. However, fatigue is rarely being applied throughout movement analysis. The aim of this study was to investigate if the knee stability throughout SLDLs differ between cyclic and acyclic sports, before and after fatigue in general, and between the dominant and non-dominant leg of soccer players.

Methods

A total of 43 active male (n = 34) and female (n = 9) athletes (age: 26.5 ± 7.2) participated in this study with a pre-post-design. Subjects performed a single leg drop landing (SLDL) from a plyobox. For each leg, the two-dimensional frontal plane projection angle (FPPA) was analyzed. After pretesting the shuttle run test was performed until exhaustion, before repeating the measurements.

Results

ANOVA with repeated measures was applied and identified no significance difference for the FPPA between cyclic and acyclic sports (F = 0.98, p = 0.33), a significant difference before and after fatigue (F = 12.49, p = 0.002) and no significant difference between the dominant and non dominant leg of soccer players (F = 4.35, p = 0.26).

Discussion

Fatigue seems to be able to have a significant influence on knee stability in the frontal axis. Therefore, fatigue should be included in motion analysis for injury prevention and return to play tests because during this physical state most injuries happen.

Iron Deficiency Anemia Is Associated with Proprioceptive Deficit in Adult Women: a Cross-Sectional Case-Control Study

Proprioception is essential to several conscious and unconscious sensations and automatic control of movement in daily life activities. Iron deficiency anemia (IDA) may alter proprioception as it could induce fatigue, and affect neural processes such as myelination, and neurotransmitters synthesis and degradation. This study aimed to explore the effect of IDA on proprioception in adult women. Thirty adult women with IDA and 30 controls participated in this study. The weight discrimination test was performed to assess proprioceptive acuity. Attentional capacity and fatigue were evaluated, too. Women with IDA had a significantly (P < 0.001) lower ability to discriminate weights compared to controls in the two difficult increments, and for the second easy weight (P < 0.01). For the heaviest weight, no significant difference was found. Attentional capacity and fatigue values were significantly (P < 0.001) higher in patients with IDA compared to controls. Moreover, moderate positive correlations between the representative proprioceptive acuity values and Hb (r = 0.68) and ferritin (r = 0.69) concentrations were found. Moderate negative correlations were found between the proprioceptive acuity values and general (r =  - 0.52), physical (r =  - 0.65) and mental (r =  - 0.46) fatigue scores, and attentional capacity (r =  - 0.52). Women with IDA had impaired proprioception compared to their healthy peers. This impairment may be related to neurological deficits due to the disruption of iron bioavailability in IDA. In addition, fatigue resulting from IDA due to the poor muscle oxygenation could also explain the proprioceptive acuity decrease in women suffering from IDA.

Changes in Reaction Time, Balance and Neuroplasticity after Exercise with a Face Mask in Male Adults with Mild COVID-19 Symptoms

This study compared physiological, perceptual and neuroprotective hormone and metabolite responses and changes in coordination as an effect of aerobic exercise with and without a face mask in people with mild symptoms of COVID-19. Forty men took part in this study. Half declared mild symptoms of SARS-CoV-2 infection in the 6 months before the study (Declared) and the other half did not (Non-declared). In a random order, with a 7-day interval, they performed a 30-min walk on a treadmill at a speed of 6 km/h wearing a surgical face mask (Masked) and without it (Unmasked). The heart rate, heart rate variability, oxygen saturation, lactate concentration and rate of perceived exertion were recorded. The reaction time and balance were measured before and after the exercise. The concentrations of brain-derived neurotrophic factor, testosterone, cortisol, epinephrine and antibodies in the blood serum were determined. Physiological and perceptual responses, reaction times, and balance did not differ between the tested conditions. Three-way RM-ANOVA with post hoc Bonferroni analysis revealed lower post-exercise cortisol concentrations in the Masked and Unmasked conditions in both groups (p ≤ 0.001). Asymptomatic infection with this virus is prevalent, and mild COVID-19 causes similar responses to aerobic exercise with a surgical face mask and does not lead to impaired coordination.

Anodal tDCS over the left DLPFC but not M1 increases muscle activity and improves psychophysiological responses, cognitive function, and endurance performance in normobaric hypoxia: a randomized controlled trial

BACKGROUND

Transcranial direct current stimulation (tDCS) has been shown to have positive effects on exercise performance and cognitive function in the normal ambient condition. Hypoxia is deemed a stressful situation with detrimental effects on physiological, psychological, cognitive, and perceptual responses of the body. Nevertheless, no study has evaluated the efficacy of tDCS for counteracting the negative effects of hypoxic conditions on exercise performance and cognition so far. Hence, in the present study, we investigated the effects of anodal tDCS on endurance performance, cognitive function, and perceptual responses in hypoxia.

PARTICIPANTS AND METHODS

Fourteen endurance-trained males participated in five experimental sessions. After familiarization and measuring peak power output in hypoxia, in the first and second sessions, through the 3rd to 5th sessions, participants performed a cycling endurance task until exhaustion after 30 min hypoxic exposure at resting position followed by 20 min of anodal stimulation of the motor cortex (M1), left dorsolateral prefrontal cortex (DLPFC), or sham-tDCS. Color-word Stroop test and choice reaction time were measured at baseline and after exhaustion. Time to exhaustion, heart rate, saturated O₂, EMG amplitude of the vastus lateralis, vastus medialis, and rectus femoris muscles, RPE, affective response, and felt arousal were also measured during the task under hypoxia.

RESULTS

The results showed a longer time to exhaustion (+ 30.96%, p₌0.036), lower RPE (- 10.23%, p ₌ 0.045) and higher EMG amplitude of the vastus medialis muscle (+ 37.24%, p₌0.003), affective response (+ 260%, p₌0.035) and felt arousal (+ 28.9%, p₌0.029) in the DLPFC tDCS compared to sham. The choice reaction time was shorter in DLPFC tDCS compared to sham (- 17.55%, p₌0.029), and no differences were seen in the color-word Stroop test among the conditions under hypoxia. M1 tDCS resulted in no significant effect for any outcome measure.

CONCLUSIONS

We concluded that, as a novel finding, anodal stimulation of the left DLPFC might provide an ergogenic aid for endurance performance and cognitive function under the hypoxic condition probably via increasing neural drive to the working muscles, lowering RPE, and increasing perceptual responses.

The Neuromuscular Fatigue-Induced Loss of Muscle Force Control

Neuromuscular fatigue is characterised not only by a reduction in the capacity to generate maximal muscle force, but also in the ability to control submaximal muscle forces, i.e., to generate task-relevant and precise levels of force. This decreased ability to control force is quantified according to a greater magnitude and lower complexity (temporal structure) of force fluctuations, which are indicative of decreased force steadiness and adaptability, respectively. The “loss of force control” is affected by the type of muscle contraction used in the fatiguing exercise, potentially differing between typical laboratory tests of fatigue (e.g., isometric contractions) and the contractions typical of everyday and sporting movements (e.g., dynamic concentric and eccentric contractions), and can be attenuated through the use of ergogenic aids. The loss of force control appears to relate to a fatigue-induced increase in common synaptic input to muscle, though the extent to which various mechanisms (afferent feedback, neuromodulatory pathways, cortical/reticulospinal pathways) contribute to this remains to be determined. Importantly, this fatigue-induced loss of force control could have important implications for task performance, as force control is correlated with performance in a range of tasks that are associated with activities of daily living, occupational duties, and sporting performance.

Detection of motor-evoked potentials below the noise floor: rethinking the motor stimulation threshold

Objective. Motor-evoked potentials (MEPs) are among the most prominent responses to brain stimulation, such as supra-threshold transcranial magnetic stimulation and electrical stimulation. Understanding of the neurophysiology and the determination of the lowest stimulation strength that evokes responses requires the detection of even smaller responses, e.g. from single motor units. However, available detection and quantization methods suffer from a large noise floor. This paper develops a detection method that extracts MEPs hidden below the noise floor. With this method, we aim to estimate excitatory activations of the corticospinal pathways well below the conventional detection level.Approach. The presented MEP detection method presents a self-learning matched-filter approach for improved robustness against noise. The filter is adaptively generated per subject through iterative learning. For responses that are reliably detected by conventional detection, the new approach is fully compatible with established peak-to-peak readings and provides the same results but extends the dynamic range below the conventional noise floor.Main results. In contrast to the conventional peak-to-peak measure, the proposed method increases the signal-to-noise ratio by more than a factor of 5. The first detectable responses appear to be substantially lower than the conventional threshold definition of 50µV median peak-to-peak amplitude.Significance. The proposed method shows that stimuli well below the conventional 50µV threshold definition can consistently and repeatably evoke muscular responses and thus activate excitable neuron populations in the brain. As a consequence, the input-output (IO) curve is extended at the lower end, and the noise cut-off is shifted. Importantly, the IO curve extends so far that the 50µV point turns out to be closer to the center of the logarithmic sigmoid curve rather than close to the first detectable responses. The underlying method is applicable to a wide range of evoked potentials and other biosignals, such as in electroencephalography.

Intense Acute Swimming Induces Delayed-Onset Muscle Soreness Dependent on Spinal Cord Neuroinflammation

Unaccustomed exercise involving eccentric contractions, high intensity, or long duration are recognized to induce delayed-onset muscle soreness (DOMS). Myocyte damage and inflammation in affected peripheral tissues contribute to sensitize muscle nociceptors leading to muscle pain. However, despite the essential role of the spinal cord in the regulation of pain, spinal cord neuroinflammatory mechanisms in intense swimming-induced DOMS remain to be investigated. We hypothesized that spinal cord neuroinflammation contributes to DOMS. C57BL/6 mice swam for 2 h to induce DOMS, and nociceptive spinal cord mechanisms were evaluated. DOMS triggered the activation of astrocytes and microglia in the spinal cord 24 h after exercise compared to the sham group. DOMS and DOMS-induced spinal cord nuclear factor κB (NFκB) activation were reduced by intrathecal treatments with glial inhibitors (fluorocitrate, α-aminoadipate, and minocycline) and NFκB inhibitor [pyrrolidine dithiocarbamate (PDTC)]. Moreover, DOMS was also reduced by intrathecal treatments targeting C-X₃-C motif chemokine ligand 1 (CX₃CL1), tumor necrosis factor (TNF)-α, and interleukin (IL)-1β or with recombinant IL-10. In agreement, DOMS induced the mRNA and protein expressions of CX₃CR1, TNF-α, IL-1β, IL-10, c-Fos, and oxidative stress in the spinal cord. All these immune and cellular alterations triggered by DOMS were amenable by intrathecal treatments with glial and NFκB inhibitors. These results support a role for spinal cord glial cells, via NFκB, cytokines/chemokines, and oxidative stress, in DOMS. Thus, unveiling neuroinflammatory mechanisms by which unaccustomed exercise induces central sensitization and consequently DOMS.

"Going Backward": Effects of age and fatigue on posterior-directed falls in Parkinson disease

BACKGROUND

Nearly half of persons with Parkinson disease (PD) report fatigue as a factor in their fall history. However, it is unknown whether these self-reported falls are caused by a sensation of fatigue or performance fatigue.

OBJECTIVE

We sought to investigate the influences of performance fatigue and age on postural control in persons with PD.

METHODS

Individuals with PD (n = 14) underwent postural control assessments before (T0) and immediately after (T1) fatiguing exercise. Biomechanical data were gathered on participants completing a treadmill-induced, posterior-directed fall. Performance fatigue was produced using lower extremity resistance exercise on an isokinetic ergometer. Repeated measures ANCOVAs were used with age as a covariate to determine the effects of performance fatigue on biomechanical variables.

RESULTS

After adjustment for age, there was a statistically significant difference in peak center of pressure (COP) latency during the support phase of recovery. Pairwise comparisons demonstrated a decrease in peak ankle displacement from T0 to T1. Age was also found to be significantly related to reaction time and peak knee displacement while participants were fatigued.

CONCLUSIONS

The decreased peak COP latency, along with decreased ankle angular displacement, suggest that persons with PD adopt a stiffening strategy in response to backward directed falls. Postural stiffening is not uncommon in persons with PD and could be a risk factor for falls. Older individuals with PD demonstrate slower mobility scores and decreased reaction times in the setting of fatigue, suggesting a combined effect of the aging and fatigue processes.

Redox interactions of immune cells and muscle in the regulation of exercise-induced pain and analgesia: implications on the modulation of muscle nociceptor sensory neurons

The mechanistic interactions among redox status of leukocytes, muscle, and exercise in pain regulation are still poorly understood and limit targeted treatment. Exercise benefits are numerous, including the treatment of chronic pain. However, unaccustomed exercise may be reported as undesirable as it may contribute to pain. The aim of the present review is to evaluate the relationship between oxidative metabolism and acute exercise-induced pain, and as to whether improved antioxidant capacity underpins the analgesic effects of regular exercise. Preclinical and clinical studies addressing relevant topics on mechanisms by which exercise modulates the nociceptive activity and how redox status can outline pain and analgesia are discussed, in sense of translating into refined outcomes. Emerging evidence points to the role of oxidative stress-induced signaling in sensitizing nociceptor sensory neurons. In response to acute exercise, there is an increase in oxidative metabolism, and consequently, pain. Instead, regular exercise can modulate redox status in favor of antioxidant capacity and repair mechanisms, which have consequently increased resistance to oxidative stress, damage, and pain. Data indicate that acute sessions of unaccustomed prolonged and/or intense exercise increase oxidative metabolism and regulate exercise-induced pain in the post-exercise recovery period. Further, evidence demonstrates regular exercise improves antioxidant status, indicating its therapeutic utility for chronic pain disorders. An improved comprehension of the role of redox status in exercise can provide helpful insights into immune-muscle communication during pain modulatory effects of exercise and support new therapeutic efforts and rationale for the promotion of exercise.

Strength training in addition to neuromuscular exercise and education in individuals with knee osteoarthritis-the effects on pain and sensitization

BACKGROUND

There is a lack of evidence of the relative effects of different exercise modes on pain sensitization and pain intensity in individuals with knee osteoarthritis (KOA).

METHODS

Ninety individuals with radiographic and symptomatic KOA, ineligible for knee replacement surgery, were randomized to 12 weeks of twice-weekly strength training in addition to neuromuscular exercise and education (ST+NEMEX-EDU) or neuromuscular exercise and education alone (NEMEX-EDU). Outcomes were bilateral, lower-leg, cuff pressure pain- and tolerance thresholds (PPT, PTT), temporal summation (TS), conditioned pain modulation (CPM), self-reported knee pain intensity and number of painful body sites.

RESULTS

After 12 weeks of exercise, we found significant differences in increases in PPT (-5.01 kPa (-8.29 to -1.73, p = .0028)) and PTT (-8.02 kPa (-12.22 to -3.82, p = .0002)) in the KOA leg in favour of ST+NEMEX-EDU. We found no difference in effects between groups on TS, CPM or number of painful body sites. In contrast, there were significantly greater pain-relieving effects on VAS mean knee pain during the last week (-8.4 mm (-16.2 to -0.5, p = .0364) and during function (-16.0 mm (-24.8 to -7.3, p = .0004)) in favour of NEMEX-EDU after 12 weeks of exercise.

CONCLUSION

Additional strength training reduced pain sensitization compared to neuromuscular exercise and education alone, but also attenuated the reduction in pain intensity compared to neuromuscular exercise and education alone. The study provides the first dose- and type-specific insight into the effects of a sustained exercise period on pain sensitization in KOA. Future studies are needed to elucidate the role of different exercise modes.

SIGNIFICANCE

This study is an important step towards better understanding the effects of exercise in pain management of chronic musculoskeletal conditions. We found that strength training in addition to neuromuscular exercise and education compared with neuromuscular exercise and education only had a differential impact on pain sensitization and pain intensity, but also that regardless of the exercise mode, the positive effects on pain sensitization and pain intensity were comparable to the effects of other therapeutic interventions for individuals with knee osteoarthritis.

Accentuated Eccentric Loading and Cluster Set Configurations in the Back Squat: A Kinetic and Kinematic Analysis

ABSTRACT

Wagle, JP, Cunanan, AJ, Carroll, KM, Sams, ML, Wetmore, A, Bingham, GE, Taber, CB, DeWeese, BH, Sato, K, Stuart, CA, and Stone, MH. Accentuated eccentric loading and cluster set configurations in the back squat: a kinetic and kinematic analysis. J Strength Cond Res 35(2): 420-427, 2021-This study examined the kinetic and kinematic differences between accentuated eccentric loading (AEL) and cluster sets in trained male subjects (age = 26.1 ± 4.1 years, height = 183.5 ± 4.3 cm, body mass = 92.5 ± 10.5 kg, and back squat to body mass ratio = 1.8 ± 0.3). Four load condition sessions consisted of traditionally loaded (TL) "straight sets," TL cluster (TLC) sets, AEL cluster (AEC) sets, and AEL "straight sets" where only the first repetition had eccentric overload (AEL1). An interrepetition rest interval of 30 seconds was prescribed for both TLC and AEC. Concentric intensity for all load conditions was 80% 1 repetition maximum (1RM). Accentuated eccentric loading was applied to repetitions using weight releasers with total eccentric load equivalent to 105% of concentric 1RM. Traditionally loaded cluster had statistically greater concentric outputs than TL. Furthermore, statistically greater eccentric and concentric outputs were observed during AEC compared with TL with the exception of peak power. Statistically greater concentric characteristics were observed in TLC compared with AEL1, but statistically greater eccentric outputs were observed in AEL1. In the 2 cluster set conditions, statistically greater concentric rate of force development (RFDCON) (d = 0.470, p < 0.001) and average velocity (vavg) (d = 0.560, p < 0.001) in TLC compared with AEC were observed. However, statistically greater eccentric work (WECC) (d = 2.096, p < 0.001) and eccentric RFD (RFDECC) (d = 0.424, p < 0.001) were observed in AEC compared with TLC. Overall, eccentric overload demonstrated efficacy as a means of increasing eccentric work and RFD, but not as a means of potentiating concentric output. Finally, interrepetition rest seems to have the largest influence on concentric power output and RFD.

Interrelated hypoalgesia, creep, and muscle fatigue following a repetitive trunk flexion exposure

Repetitive trunk flexion can damage spinal tissues, however its association with low back pain in the workplace may be confounded by factors related to pain sensitivity. Muscle fatigue, exercise-induced hypoalgesia, and creep-induced neuromuscular changes following repetitive trunk flexion may all affect this assumed exposure-pain relationship. This study's purpose was to determine how mechanical pain sensitivity in the low back is affected by a repetitive trunk flexion exposure and identify factors associated with changes in low back pain sensitivity. Pressure pain thresholds, perceptions of sub-threshold stimuli, and muscle fatigue in the trunk and tibia, as well as lumbar spine creep were tracked in 37 young healthy adults before and up to 40 min after a 10-min repetitive trunk flexion exposure. Pressure pain thresholds (p = 0.033), but not perceptions of sub-threshold stimuli (p > 0.102) were associated with approximately a 12.5% reduction in pain sensitivity 10 min after completing the exposure, while creep and local muscle fatigue effects were only observed immediately following the exposure. Creep and fatigue interactions and the corresponding tibial measure co-varied with individual low back pressure pain thresholds. The net hypoalgesic effects of repetitive trunk flexion have the potential to partially mask possibly injurious loads, which could contribute to the severity or incidence of lower back injuries related to these exposures.

Cervical Electrical Neuromodulation Effectively Enhances Hand Motor Output in Healthy Subjects by Engaging a Use-Dependent Intervention

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation is a non-invasive method that can modify the functional state of the sensory-motor system. We hypothesize that eEmc delivery, together with hand training, improves hand function in healthy subjects more than either intervention alone by inducing plastic changes at spinal and cortical levels. Ten voluntary participants were included in the following three interventions: (i) hand grip training, (ii) eEmc, and (iii) eEmc with hand training. Functional evaluation included the box and blocks test (BBT) and hand grip maximum voluntary contraction (MVC), spinal and cortical motor evoked potential (sMEP and cMEP), and resting motor thresholds (RMT), short interval intracortical inhibition (SICI), and F wave in the abductor pollicis brevis muscle. eEmc combined with hand training retained MVC and increased F wave amplitude and persistency, reduced cortical RMT and facilitated cMEP amplitude. In contrast, eEmc alone only increased F wave amplitude, whereas hand training alone reduced MVC and increased cortical RMT and SICI. In conclusion, eEmc combined with hand grip training enhanced hand motor output and induced plastic changes at spinal and cortical level in healthy subjects when compared to either intervention alone. These data suggest that electrical neuromodulation changes spinal and, perhaps, supraspinal networks to a more malleable state, while a concomitant use-dependent mechanism drives these networks to a higher functional state.

Compensatory control between the legs in automatic postural responses to stance perturbations under single-leg fatigue

In response to sudden perturbations of stance stability, muscles of both legs are activated for balance recovery. In conditions that one of the legs has a reduced capacity to respond, the opposite leg is predicted to compensate by responding more powerfully to restore stable upright stance. In this investigation, we aimed to evaluate between-leg compensatory control in automatic postural responses to sudden perturbations in a situation in which plantar flexor muscles of a single leg were fatigued. Young participants were evaluated in response to a series of perturbations inducing forward body sway, with a focus on activation of plantar flexor muscles: lateral and medial gastrocnemii and soleus. Muscular responses were analyzed through activation magnitude and latency of muscular activation onset. For evaluation of balance and postural stability, we also analyzed the center of pressure and upper trunk displacement and weight-bearing asymmetry between the legs. Responses were assessed in three conditions: pre-fatigue, under single-leg fatigue, and following the recovery of muscular function. Results showed (a) compensation of the non-fatigued leg through the increased magnitude of muscular activation in the first perturbation under fatigue; (b) adaptation in the non-fatigued leg over repetitive perturbations, with a progressive decrement of muscular activation over trials; and (c) maintenance of increased muscular activation of the non-fatigued leg following fatigue dissipation. These findings suggest that the central nervous system is able to modulate the descending motor drive individually for each leg's muscles apparently based on their potential contribution for the achievement of the behavioral aim of recovering stable body balance following stance perturbations.

Function of the Distal Part of the Vastus Medialis Muscle as a Generator of Knee Extension Twitch Torque

The distal part of the vastus medialis (VM) (VM obliquus: VMO) muscle acts as the medial stabilizer of the patella. However, it has been known to facilitate VMO contraction during training of the quadriceps femoris muscle in knee joint rehabilitation. This study aimed to examine the contribution degree of VMO as a knee joint extension torque generator. Sixteen healthy male volunteers participated in this study. Electrical muscle stimulation (EMS) was performed on VMO at 60° knee angle for 20 min to induce muscle fatigue. Knee extension twitch torques (TT) at 90° and 30° knee angle evoked by femoral nerve stimulation were measured before and after EMS. Although each TT at 90° and 30° knee angle significantly decreased after EMS, the decreased TT rate in both joint angles showed no significant difference. Our results show that VMO might contribute to the generation of the knee joint torque at the same level in the range from flexion to extension. Therefore, it was suggested that the facilitating the neural drive for VMO is important during the quadriceps femoris muscle strengthening exercise.

Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom

More than half of patients who recover from COVID-19 experience fatigue. We studied fatigue using neuropsychological and neurophysiological investigations in post-COVID-19 patients and healthy subjects. Neuropsychological assessment included: Fatigue Severity Scale (FSS), Fatigue Rating Scale, Beck Depression Inventory, Apathy Evaluation Scale, cognitive tests, and computerized tasks. Neurophysiological examination was assessed before (PRE) and 2 min after (POST) a 1-min fatiguing isometric pinching task and included: maximum compound muscle action potential (CMAP) amplitude in first dorsal interosseous muscle (FDI) following ulnar nerve stimulation, resting motor threshold, motor evoked potential (MEP) amplitude and silent period (SP) duration in right FDI following transcranial magnetic stimulation of the left motor cortex. Maximum pinch strength was measured. Perceived exertion was assessed with the Borg-Category-Ratio scale. Patients manifested fatigue, apathy, executive deficits, impaired cognitive control, and reduction in global cognition. Perceived exertion was higher in patients. CMAP and MEP were smaller in patients both PRE and POST. CMAP did not change in either group from PRE to POST, while MEP amplitudes declined in controls POST. SP duration did not differ between groups PRE, increased in controls but decreased in patients POST. Patients' change of SP duration from PRE to POST was negatively correlated to FSS. Abnormal SP shortening and lack of MEP depression concur with a reduction in post-exhaustion corticomotor inhibition, suggesting a possible GABA_B-ergic dysfunction. This impairment might be related to the neuropsychological alterations. COVID-19-associated inflammation might lead to GABAergic impairment, possibly representing the basis of fatigue and explaining apathy and executive deficits.

Effects of Manual Material Handling Workload on Measures of Fall Risk

OCCUPATIONAL APPLICATIONS We found, contrary to expectations, that performing a fatiguing simulated heavy manual material handling (MMH) task did not adversely affect the risk of trip-induced falls when compared to a less-fatiguing light MMH task. However, when considering these MMH tasks together rather than in comparison, our results provide evidence for adverse effects of fatigue on both gait and the ability to recover balance after tripping. The current results provide additional evidence that physical fatigue increases fall risk, start to clarify the mechanisms by which this increase occurs, and can help in developing and evaluating fall prevention strategies targeting these mechanisms.

Age-specific modulation of intermuscular beta coherence during gait before and after experimentally induced fatigue

We examined the effects of age on intermuscular beta-band (15–35 Hz) coherence during treadmill walking before and after experimentally induced fatigue. Older (n = 12) and younger (n = 12) adults walked on a treadmill at 1.2 m/s for 3 min before and after repetitive sit-to-stand, rSTS, to induce muscle fatigability. We measured stride outcomes and coherence from 100 steps in the dominant leg for the synergistic (biceps femoris (BF)-semitendinosus, rectus femoris (RF)-vastus lateralis (VL), gastrocnemius lateralis (GL)-Soleus (SL), tibialis anterior (TA)-peroneus longus (PL)) and for the antagonistic (RF-BF and TA-GL) muscle pairs at late swing and early stance. Older vs. younger adults had 43–62% lower GL-SL, RF-VL coherence in swing and TA-PL and RF-VL coherence in stance. After rSTS, RF-BF coherence in late swing decreased by ~ 20% and TA-PL increased by 16% independent of age (p = 0.02). Also, GL-SL coherence decreased by ~ 23% and increased by ~ 23% in younger and older, respectively. Age affects the oscillatory coupling between synergistic muscle pairs, delivered presumably via corticospinal tracts, during treadmill walking. Muscle fatigability elicits age-specific changes in the common fluctuations in muscle activity, which could be interpreted as a compensation for muscle fatigability to maintain gait performance.

Sustained Isometric Wrist Flexion and Extension Maximal Voluntary Contractions Similarly Impair Hand-Tracking Accuracy in Young Adults Using a Wrist Robot

Due to their stabilizing role, the wrist extensor muscles demonstrate an earlier onset of performance fatigability and may impair movement accuracy more than the wrist flexors. However, minimal fatigue research has been conducted at the wrist. Thus, the purpose of this study was to examine how sustained isometric contractions of the wrist extensors/flexors influence hand-tracking accuracy. While gripping the handle of a three-degrees-of-freedom wrist manipulandum, 12 male participants tracked a 2:3 Lissajous curve (±32° wrist flexion/extension; ±18° radial/ulnar deviation). A blue, circular target moved about the trajectory and participants tracked the target with a yellow circle (corresponding to the handle's position). Five baseline tracking trials were performed prior to the fatiguing task. Participants then exerted either maximal wrist extension or flexion force (performed on separate days) against a force transducer until they were unable to maintain 25% of their pre-fatigue maximal voluntary contraction (MVC). Participants then performed 7 tracking trials from immediately post-fatigue to 10 min after. Performance fatigability was assessed using various metrics to account for errors in position-tracking, error tendencies, and movement smoothness. While there were no differences in tracking error between flexion/extension sessions, tracking error significantly increased immediately post-fatigue (Baseline: 1.40 ± 0.54°, Post-fatigue: 2.02 ± 0.51°, P < 0.05). However, error rapidly recovered, with no differences in error from baseline after 1-min post-fatigue. These findings demonstrate that sustained isometric extension/flexion contractions similarly impair tracking accuracy of the hand. This work serves as an important step to future research into workplace health and preventing injuries of the distal upper-limb.

The effect of soft tissue manipulation and rest on knee extensor muscles fatigue: Do torque parameters and induced perception following muscle fatigue have enough reliability?

Background:

Muscle fatigue affects the precision of the subjects’ performance and limits the range of physical and sports activities. There is limited scientific evidence to support the use of soft tissue manipulation for enhancing muscle performance and its recovery. The aim of this study is to compare the effects of soft tissue manipulation and rest on the knee extensor muscle fatigue after maximal isokinetic contractions.

Methods:

Fifteen healthy females 20–30 years of age were selected for this research. This study implemented a semi-experimental test–retest measurement method. The subjects then either rested or received soft tissue manipulation on the knee extensors for a duration of 15 min. After intervention (soft tissue manipulation or rest), the parameters were evaluated for the third time.

Results:

The stability of the average of peak torque (APT), average power (AP), and visual analog scale (VAS) before performing fatigue protocol was 85%, 83%, and 31.9%, respectively. The stability after fatigue was 43%, 50%, and 93%, respectively. After maximal fatigue and a decrease in torque output to below 50% maximal torque, 15 min of soft tissue manipulation could change the APT after fatigue from a mean of 58.3 (nm) to 91.5 (nm), the AP from 39.4 to 63.6 (nm/s), and the VAS, from 90.0 to 12 (mm). But 15 min of rest could change the APT from 52.5 to 68.1 (nm), the AP from 37.6 to 48 (nm/s), and the VAS from 90.0 to 27.3 (mm).

Conclusion:

The study showed that soft tissue manipulation was more effective than rest as a strategy to return muscles to a normal state and caused more relief in perceived fatigue.

Fatigue-related modulation of low-frequency common drive to motor units

PURPOSE

This study investigated fatigue-related modulation of common neural inputs to motor units (MUs) under 5 Hz, which determines force precision control.

METHODS

Twenty-seven adults performed a sequence of fatiguing contractions. The participants were assessed with a static isometric index abduction at 20% maximal voluntary contraction in the pre-test and post-test. Discharge characteristics of MUs of the first dorsal interosseous muscle were analyzed with decomposed EMG signals.

RESULTS

Along with increases in the mean (58.40 ± 11.76 ms → 62.55 ± 10.83 ms, P = 0.029) and coefficient of variation (0.204 ± .014 → 0.215 ± 0.017, P = 0.002) in inter-spike intervals, the fatiguing contraction caused reductions in the mean frequency (16.84 ± 3.31 Hz → 15.59 ± 3.21 Hz, P = 0.027) and spectral dispersions (67.54 ± 4.49 → 62.64 ± 6.76 Hz, P = 0.007) of common neural drive, as estimated with smoothed cumulative motor unit spike trains (SCMUSTs). Stabilogram diffusion analysis of SCMUSTs revealed significant fatigue-related reductions in the long-term effective diffusion coefficient (1.91 ± 0.77 Hz²/s → 1.61 ± 0.61 Hz²/s, P = 0.020) and long-term scaling exponent (0.480 ± 0.013 Hz²/s → 0.471 ± 0.017 Hz²/s, P = 0.014). After fatiguing contraction, mutual information of force fluctuations and SCMUSTs was augmented roughly by 12.95% (P = 0.041).

CONCLUSIONS

Muscular fatigue could compress and shift the low-frequency common drive to MUs toward lower spectral bands, thereby enhancing transmission of twitch forces through the muscle-tendon complex with a low-pass filter property. The fatigue-induced changes involve increased closed-loop control of the common modulation of MU discharge rates.

Effects of mental and physical orofacial training on pressure pain sensitivity and tongue strength: A single-blind randomized controlled trial

OBJECTIVES

The main objective of this study was to analyze differences on pain pressure thresholds, tongue strength and perceived effort between various orofacial motor exercise training dosages of mental representation training through motor imagery (MI) and action observation (AO), first in isolation and then in combination with real exercise performance.

METHODS

A single-blind randomized controlled trial was designed. 48 asymptomatic individuals were randomized into two groups: Intensive training group (IG) and Moderate training group (MG). Both groups performed a first session of MI and AO of orofacial exercises training and a second session of actual orofacial exercises combined with mental representation training, but with different dosage in terms of series and repetitions. Pain pressure thresholds (PPTs) in the masseter and temporal muscles and tongue muscle strength were the main variables.

RESULTS

Regarding the PPT, ANOVA revealed significant between-group differences, where MG showed a significantly higher PPT than IG at post-day2, with a medium effect size. Both groups showed with-in group differences between pre and post intervention measures in the first session, but only the IG showed differences in the second. Regarding tongue muscle strength, ANOVA revealed significant within-group differences only in MG between the pre-day and post-day first intervention.

CONCLUSION

The results of the present study suggest that movement representation training performed in isolation may have a positive effect on PPTs and tongue muscle strength. In addition, the combination with the actual execution of the exercises could be considered effective, but it is necessary to take into account the training dosage to avoid fatigue responses.

The effect of trunk muscle fatigue on postural control of upright stance: A systematic review

BACKGROUND

Fatigability and postural control deficits are both serious concerns in a variety of chronic musculoskeletal conditions. Research has shown that muscle fatigue may adversely affect postural control. This is while the evidence on the relevance of fatigue to postural control has never been summarized nor critically appraised.

RESEARCH QUESTION

Is there sufficient and strong enough evidence to accept trunk muscle fatigue as a contributing factor to postural control alterations during upright standing posture?.

METHODS

EMBASE, Scopus, ELSEVIER, PubMed, ProQuest, Google scholar and reference lists of the relevant articles were searched through April 2018. Studies having investigated the trunk muscle fatigue effect on postural control in asymptomatic individuals were included in the study. Only those studies having assessed postural control in terms of center of pressure driven variables were included.

RESULTS

Twelve studies (218 asymptomatic participants) matched the inclusion criteria of this systematic review. Their results supported the hypothesis that fatigue has a significant effect on postural control in terms of the time domain variables. Sway velocity was consistently found to be affected by fatigue. The results were inconsistent in the frequency domain. The only study on the structural dynamics of center of pressure displacements also confirmed such a relationship.

SIGNIFICANCE

The present review indicates that postural control is altered in asymptomatic individuals following trunk muscle fatigue. This may suggest that trunk muscle endurance training is crucial to address postural impairment in chronic spine musculoskeletal conditions.

Neuromuscular Factors Contributing to Reductions in Muscle Force After Repeated, High-Intensity Muscular Efforts

Multiple neuromuscular processes contribute to the loss of force production following repeated, high-intensity muscular efforts; however, the relative contribution of each process is unclear. In Experiment 1, 16 resistance trained men performed six sets of unilateral isometric plantar flexor contractions of the right leg (3 s contraction/2 s rest; 85% maximal voluntary contraction torque; 90-s inter-set rest) until failure with and without caffeine ingestion (3 mg kg^-1) on two separate days. Corticospinal excitability and cortical silent period (cSP) were assessed before and immediately, 10 and 20 min after the exercise. In Experiment 2, electrically evoked tetanic force and persistent inward current (PIC)-mediated facilitation of the motor neuron pool (estimated using neuromuscular electrical stimulation with tendon vibration) were assessed before and after the same exercise intervention in 17 resistance trained men. Results showed decreases in peak plantar flexion torque (Experiment 1: -12.2%, Experiment 2: -16.9%), electrically evoked torque (20 Hz -15.3%, 80 Hz -15.3%, variable-frequency train -17.9%), and cSP (-3.8%; i.e., reduced inhibition) post-exercise which did not recover by 20 min. Electromyographic activity (EMG; -6%), corticospinal excitability (-9%), and PIC facilitation (-24.8%) were also reduced post-exercise but recovered by 10 min. Caffeine ingestion increased torque and EMG but did not notably affect corticospinal excitability, PIC amplification, or electrically evoked torque. The data indicate that a decrease in muscle function largely underpins the loss of force after repeated, high-intensity muscular efforts, but that the loss is exacerbated immediately after the exercise by simultaneous decreases in corticospinal excitability and PIC amplitudes at the motor neurons.

Evaluation of 18-Week Whole-Body Vibration Training in Normobaric Hypoxia on Lower Extremity Muscle Strength in an Elderly Population

Therapeutic benefits of hypoxic training have been suggested for clinical populations, such as elderly who could suffer loss of lower limb muscle strength and higher risk of falling. This study investigated the effects of 18 weeks of whole-body vibration (WBV) training in normobaric hypoxia on the strength parameters of an elderly population. Thirty-one healthy elderly participants were randomly assigned to a hypoxic whole-body vibration group (HWBV; n = 10), normoxic whole-body vibration group (NWBV; n = 11), or control group (n = 10). The experimental groups received the same vibration treatment in a hypoxia chamber (HWBV: 16.1% fraction of inspired oxygen [FiO₂]; NWBV: 21.0% FiO₂). Isokinetic leg muscle strength was evaluated using a Biodex System-3 isokinetic dynamometer. Body composition was obtained with dual-energy X-ray absorptiometry. There were no significant differences between groups in either strength or body composition parameters. The NWBV group showed statistically significant improvements in the maximal strength of knee extensors, with a small effect size (p = 0.004; d = 0.54). No significant differences were found in any variable of the HWBV group. The combination of WBV training and exposure to normobaric cyclic hypoxia carried out in the present study did not have an effect on strength parameters in healthy elderly subjects.

The effect of IPC on central and peripheral fatiguing mechanisms in humans following maximal single limb isokinetic exercise

Ischemic preconditioning (IPC) has been suggested to preserve neural drive during fatiguing dynamic exercise, however, it remains unclear as to whether this may be the consequence of IPC-enhanced muscle oxygenation. We hypothesized that the IPC-enhanced muscle oxygenation during a dynamic exercise task would subsequently attenuate exercise-induced reductions in voluntary activation. Ten resistance trained males completed three 3 min maximal all-out tests (AOTs) via 135 isokinetic leg extensions preceded by treatments of IPC (3 × 5 min bilateral leg occlusions at 220 mmHg), SHAM (3 × 5 min at 20 mmHg) or CON (30 min passive rest). Femoral nerve stimulation was utilized to assess voluntary activation and potentiated twitch torque during maximal voluntary contractions (MVCs) performed at baseline (BL), prior to the AOT (Pre), and then 10 sec post (Post). Tissue oxygenation (via near-infrared spectroscopy) and sEMG activity was measured throughout the AOT. MVC and twitch torque levels declined (MVC: -87 ± 23 Nm, 95% CI = -67 to -107 Nm; P < 0.001, twitch: -30 ± 13 Nm; 95% CI = -25 to -35 Nm; P < 0.001) between Pre and Post without reductions in voluntary activation (P = 0.72); there were no differences between conditions (MVC: P = 0.75, twitch: P = 0.55). There were no differences in tissue saturation index (P = 0.27), deoxyhemoglobin concentrations (P = 0.86) or sEMG activity (P = 0.92) throughout the AOT. These findings demonstrate that IPC does not preserve neural drive during an all-out 3 min isokinetic leg extension task.

Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions

Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. In contrast, EIH is more variable in chronic pain populations and is more frequently impaired; with pain and pain sensitivity decreasing, remaining unchanged or, in some cases, even increasing in response to exercise. Pain exacerbation with exercise may be a major barrier to adherence, precipitating a cycle of physical inactivity that can lead to long-term worsening of both pain and disability. To optimize the therapeutic benefits of exercise, it is important to understand how EIH works, why it may be impaired in some people with chronic pain, and how this should be addressed in clinical practice. In this article, we provide an overview of EIH across different chronic pain conditions. We discuss possible biological mechanisms of EIH and the potential influence of sex and psychosocial factors, both in pain-free adults and, where possible, in individuals with chronic pain. The clinical implications of impaired EIH are discussed and recommendations are made for future research, including further exploration of individual differences in EIH, the relationship between exercise dose and EIH, the efficacy of combined treatments and the use of alternative measures to quantify EIH. PERSPECTIVE: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions. Existing findings are critically reviewed, clinical implications are discussed, and recommendations are offered for future research.

The short-term recovery of corticomotor responses in elbow flexors

Background

The recovery of neurophysiological parameters at various time intervals following fatiguing exercise has been investigated previously. However, the repetition of neuromuscular assessments during the recovery period may have interfered with the true corticomotor excitability responses. In this experiment, fatiguing contractions were combined with a single post-fatigue assessment at varying time points. Ten participants undertook 5 bouts of 60-s maximal voluntary contractions (MVC) of the elbow flexors, separated by 20 min. Before and after each 60-s fatiguing exercise (FAT), participants performed a series of 6-s contractions at 100, 75 and 50% of their MVC during which transcranial magnetic, transmastoid electrical and brachial plexus electrical stimuli were used to elicit motor evoked potentials (MEP), cervicomedullary motor evoked potentials (CMEP) and compound muscle action potentials (Mmax) in the biceps brachii muscle, respectively. Post-FAT measurements were randomly performed 0, 15, 30, 60, or 120 s after each FAT.

Results

MVC force declined to 65.1 ± 13.1% of baseline following FAT and then recovered to 82.7 ± 10.2% after 60 s. The MEP·Mmax⁻¹ ratio recorded at MVC increased to 151.1 ± 45.8% and then returned to baseline within 60 s. The supraspinal excitability (MEP·CMEP⁻¹) measured at MVC increased to 198.2 ± 47.2% and fully recovered after 30 s. The duration of post-MEP silent period recorded at MVC elongated by 23.4 ± 10.6% during FAT (all P < 0.05) but fully recovered after 15 s.

Conclusions

The current study represents the first accurate description of the time course and pattern of recovery for supraspinal and spinal excitability and inhibition following a short maximal fatiguing exercise in upper limb.

Fatigue induces long-lasting detrimental changes in motor-skill learning

Fatigue due to physical exertion is a ubiquitous phenomenon in everyday life and especially common in a range of neurological diseases. While the effect of fatigue on limiting skill execution are well known, its influence on learning new skills is unclear. This is of particular interest as it is common practice to train athletes, musicians or perform rehabilitation exercises up to and beyond a point of fatigue. In a series of experiments, we describe how muscle fatigue, defined as degradation of maximum force after exertion, impairs motor-skill learning beyond its effects on task execution. The negative effects on learning are evidenced by impaired task acquisition on subsequent practice days even in the absence of fatigue. Further, we found that this effect is in part mediated centrally and can be alleviated by altering motor cortex function. Thus, the common practice of training while, or beyond, fatigue levels should be carefully reconsidered, since this affects overall long-term skill learning.

Mastering a new movement requires practice. Intensive and repetitive training is essential for musicians, athletes, or surgeons. It is also important for people undergoing rehabilitation to help them regain normal movements after an illness or injury. Although practice is said to make perfect, there comes the point when it also causes physical fatigue. Fatigue can impair how well a person performs a movement, but its effects on learning a task are less clear.

Now, Branscheidt et al. show that being physically fatigued interferes with learning a new movement skill. In the experiments, volunteers were divided in two groups: the first group had to learn a new motor skill after their hand muscles were physically fatigued, the second group learned the same task without being worn out. The fatigued volunteers had a harder time learning a new motor task both on the day of the task and on the following days, even after they had recovered from the fatigue. The same experiment was repeated, but instead of learning a motor task, the volunteers were asked to learn a sequence of keystrokes. The volunteers in both groups learned this new thinking task easily. This suggests that learning new thinking tasks is not affected by physical fatigue.

Branscheidt et al. also disrupted memory formation in part of the brain that controls movement after volunteers finished learning the motor task using a technique called repetitive transcranial magnetic stimulation. This eliminated the motor learning deficit in the fatigued group. This may suggest that memories formed after fatigue may impair later motor learning and that physical training or rehabilitation that pushes people to work past fatigue may be counterproductive. Further study of these processes may help to develop better training regimens and rehabilitation methods.

Time Response of Photobiomodulation Therapy on Muscular Fatigue in Humans

Rossato, M, Dellagrana, RA, Sakugawa, RL, Lazzari, CD, Baroni, BM, and Diefenthaeler, F. Time response of photobiomodulation therapy on muscular fatigue in humans. J Strength Cond Res 32(11): 3285-3293, 2018-The aim of this study was to identify the effects of 2 different time responses on fatigue of knee extensor. Sixteen male volunteers (26 ± 6.0 years, 81 ± 12 kg, and 181 ± 7.4 cm) participated in the study. Participants performed the same protocol in 5 sessions {control, placebo (placebo applied both 6 hours before and immediately before the test), 6 hours before + immediately before (photobiomodulation therapy [PBMT] applied both 6 hours before and immediately before the test), 6 hours before (PBMT applied 6 hours before and placebo applied immediately before the test), and immediately before (placebo applied 6 hours before and PBMT applied immediately before the test)}. Photobiomodulation therapy was applied on knee extensor (9 sites; 30 J per site). Maximal isometric voluntary contraction (MIVC) was assessed before and after an isokinetic fatigue (45 flexion-extension concentric at 180°·s), associated with electromyography (root mean square [RMS] and median of frequency [MF]). For MIVC, there was no treatment × time interaction for all variables. Time effect was observed for peak torque (PT), RMS, and MF. Treatment effect was verified for PT, and 6 hours before + immediately before condition presented higher PT during MIVCpre than control (p = 0.004) and placebo (p = 0.044). The immediately before presented higher PT values than control (p = 0.047). Regarding MIVCpost, the PT for 6 hours before + immediately before presented higher values than control (p = 0.001) and placebo (p = 0.004). Peak torque during MIVC (pre to post) was reduced in 6 hours before + immediately before treatment (26%) compared with control (33%), placebo (29%), and immediately before (32%). The application of PBMT 6 hours + immediately before and immediately before exercise protocol is able to reduce the fatigue.

Balance problems and dizziness after neck surgery - associations with pain and health-related quality of life

Introduction: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10-13 years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness. Material and methods: Sixty-eight individuals, 10 years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life. Results: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory. Conclusions: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients' descriptions of these problems are in line with common symptoms of cervicogenic dizziness.

The use of electromyography for the assessment of sense of muscular effort: a test-retest reliability study

This study sought to examine the test-retest reliability to measure sense of muscular effort with electromyography (EMG). The EMG activity of the tibialis anterior muscle from 23 participants was recorded. Targets of EMG amplitudes produced at 10 and 20% of the maximum voluntary contraction (MVC) were calculated. Participants matched the target EMG level with and without visual feedback (FB). With NFB, the reliability was good to excellent when errors were represented as the average standard deviation (SD) of the error from the target (ICC_1,2 = 0.75 and 0.69 for 10 and 20% targets, respectively). Also, reliability was good when errors were presented as the average SD as a percentage of the MVC EMG (intraclass correlation coefficient (ICC_1,2) = 0.67 and 0.66, respectively, for 10 and 20% targets). Standard deviation around the target was the most reliable method to represent the error. This approach could be used as a simple cost-effective method to assess the sense of muscular effort.

Muscle Fatigue Does Not Change the Effects on Lower Limbs Strength Caused by Aging and Parkinson's Disease

The aim of this study was to determine the impact of aging and Parkinson’s disease (PD) on lower limb muscle strength before and after muscle fatigue. One hundred thirty-five individuals were distributed over seven groups according to their age (20, 30, 40, 50, 60, 70 years old) and disease. Participants performed maximum voluntary isometric contractions (MVIC) in a leg press device followed by the muscle fatigue protocol (repeated sit-to-stand task). Immediately after muscle fatigue (less than 2 min), the MVIC were repeated. The peak force, peak rate of force development (first 50, 100, 200 ms), and root mean square and peak values of the vastus lateralis and vastus medialis muscle activity during MVIC were calculated before and after muscle fatigue. We found more pronounced reductions in lower limb muscle strength parameters (lower limb force, RFD-100 and RFD-200 - p<0.05) in individuals over 50 years of age and with PD. In addition, there was an inverse relation between aging and lower limb muscle strength parameters. The main findings were the lack of changes in peak force, RFDs and muscle activity of the vastus lateralis and vastus medialis after muscle fatigue according to aging and PD, and similar lower limb muscle strength parameters (before and after muscle fatigue) and effect of muscle fatigue in PD compared to the aged groups (60 and 70 years old groups).

Differential effects of muscle fatigue on dynamic spine stability: Implications for injury risk

This study was designed to assess the utility of using a measure of dynamic spine stability in an unfatigued, rested state as a predictor of dynamic spine stability in a challenged, fatigued state. Participants completed three trials (Day 1: Rested, Fatigued; Day 2: Recovery) during which the dynamic stability of the spine was assessed over 30 repeated flexion/extension motions using maximum finite-cycle Lyapunov exponents. Multiple sets of dynamic trunk extensions were performed to fatigue the trunk extensor muscles. Across the sample population, an increase in dynamic spine stability when fatigued was observed, as well as a moderate correlation between the level of dynamic stability when rested and a stabilizing response when fatigued. Further analysis of the data on a person-by-person basis revealed three distinct responses in which participants either stabilized, destabilized or had no change in dynamic spine stability when fatigued. Therefore, the mean response of the sample population did not adequately represent the true, meaningful response of individuals within the population. These results illustrate the importance of considering individualized responses when examining dynamic stability measures, and provide preliminary evidence that suggests that individual injury risk cannot be completely captured by measures taken in an unchallenged, rested state.

Local high-frequency vibration therapy following eccentric exercises reduces muscle soreness perception and posture alterations in elite athletes

PURPOSE

Exercise-induced muscle damage produces painful sensations (delayed onset of muscle soreness, DOMS). DOMS causes compensatory postural adaptations, which in turn affect athletes' walking and running gait biomechanics. It is still debated whether the postural changes are due to impaired proprioception or pain perception. To disambiguate between these two contrasting hypotheses, we designed a study that tested post-exercise postural adjustments in two groups of athletes: a group who was administered a vibration therapy (VT), to attenuate pain perception, and a control group.

METHODS

Thirty professional futsal players were tested on five different occasions: baseline, eccentric exercises (EE) session day, 24, 48 and 72 h after EE. Vibration therapy (120 Hz) was applied on legs muscles for 15 min in the experimental group, while no vibration was applied in the control group. The measurements included: isokinetic evaluation, stabilometric test, perceived soreness evaluation and serum levels of creatine kinase, and lactate dehydrogenase.

RESULTS

48 h after EE, the control group showed changes in biomechanical parameters (antero-rotations of pelvis, p < 0.05). A substantial alteration in the hip kinematics was found, associated to a reduced contractile force (p < 0.01) and soreness perception. On the contrary, the VT group did not show any change in posture and pain perception. High-intensity VT decreases EE effects on muscle strength and DOMS.

CONCLUSIONS

DOMS significantly changes athletes' posture; but postural changes disappear following a VT therapy that decreases pain perception. It is concluded that soreness perception is the main cause of postural changes and that its effects can be counteracted using VT therapy.

Exercise-induced fatigue in young people: advances and future perspectives

PURPOSE

In recent decades, the interest for exercise-induced fatigue in youth has substantially increased, and the effects of growth on the peripheral (muscular) and central (neural) mechanisms underpinning differences in neuromuscular fatigue between healthy children and adults have been described more extensively. The purpose of this review is to retrieve, report, and analyse the findings of studies comparing neuromuscular fatigue between children and adults. Objective measures of the evaluation of the physiological mechanisms are discussed.

METHOD

Major databases (PubMed, Ovid, Scopus and Web of Science) were systematically searched and limited to English language from inception to September 2017.

RESULT

Collectively, the analyzed studies indicate that children experience less muscular and potentially more neural fatigue than adults. However, there are still many unknown aspects of fatigue regarding neural (supraspinal and spinal) and peripheral mechanisms that should be more thoroughly examined in children.

CONCLUSION

Suitable methods, such as transcranial magnetic stimulation, transcranial electrical stimulation, functional magnetic resonance imaging, near-infrared spectroscopy, tendon vibration, H-reflex, and ultrasound are recommended in the research field of fatigue in youth. By designing studies that test the fatigue effects in movements that replicate daily activities, new knowledge will be acquired. The linkage and interaction between physiological, cognitive, and psychological aspects of human performance remain to be resolved in young people. This can only be successful if research is based on a foundation of basic research focused on the mechanisms of fatigue while measuring all three above aspects.

Knee extensor fatigue developed during high-intensity exercise limits lower-limb power production

We investigated the association between changes in vastii electromyography (EMG) and knee extensor fatigue during high-intensity cycling, and the subsequent effect on lower-limb power and intermuscular coordination during all-out cycling. On two separate days, participants completed 30-s all-out cycling or 10-min of high-intensity cycling followed by 30-s all-out cycling. EMG for gluteus maximus (GMAX), rectus femoris (RF), vastii (VAS), hamstrings (HAM) and gastrocnemius (GAS); co-activation for GMAX/RF, VAS/HAM and VAS/GAS; isometric maximal voluntary force (IMVF) and resting twitch (RT) of the knee extensors were measured. VAS EMG increases during high-intensity cycling (6% to 14%, P < 0.05) were negatively correlated (r = -0.791, P < 0.05) with knee extensor IMVF decreases (-2% to-36%, P < 0.05) following the exercise. Knee extensor IMVF decreases were positively correlated (r = 0.757, P < 0.05) with all-out cycling power reductions (0% to -27%, P < 0.05). VAS/GAS co-activation did not change (P > 0.05) during all-out cycling while VAS and GAS EMG decreased. Larger increase in VAS EMG during high-intensity cycling was associated with greater knee extensor fatigue and larger power reduction during all-out cycling. High VAS/GAS co-activation potentially limited power reduction induced by knee extensor fatigue during all-out cycling.

Maturation-Related Differences in Neuromuscular Fatigue After a Short-Term Maximal Run

Purpose. This study investigated maturation-related differences in neuromuscular fatigue after a short-term maximal run. Methods. Eight male children, eight adolescents, and eight adults performed a maximal ca. 50-s run (300/350/400 m, respectively). Mechanisms of neuromuscular fatigue were assessed through isometric plantar flexor tests, electrical stimulation of the posterior tibial nerve, soleus electromyography, and blood tests. Results. All the groups showed a decrease in the running speed (children: -12.2 ± 6.5%; adolescents: -9.8 ± 5.1%; adults: -12.2 ± 3.1%), but only adults revealed a decline in the maximal isometric plantar flexor torque (-16.1 ± 13.0%). On the other hand, the relative pre- to post-fatigue change in the maximal isometric plantar flexor torque differed only between adults and adolescents. The peak torque in the passive twitch test decreased in adolescents (-19.2 ± 12.2%) and adults (-23.7 ± 13.7%). Moreover, post-fatigue minimum blood pH (children: 7.18 ± 0.03; adolescents: 7.14 ± 0.07; adults: 6.97 ± 0.06) differed between the groups. No changes were observed in the neural drive or mechanisms at the spinal level. Conclusions. Despite the loss of running speed, children showed no post-exercise fatigue, whereas adolescents and adults demonstrated fatigue at peripheral sites. Central fatigue could not be established for the studied groups.

Effects of fatigue on corticospinal excitability of the human knee extensors

NEW FINDINGS

What is the central question of this study? Do group III and IV muscle afferents act at the spinal or cortical level to affect the ability of the central nervous system to drive quadriceps muscles during fatiguing exercise? What is the main finding and its importance? The excitability of the motoneurone pool of vastus lateralis was unchanged by feedback from group III and IV muscle afferents. In contrast, feedback from these afferents may contribute to inhibition at the cortex. However, the excitability of the corticospinal pathway was not directly affected by feedback from these afferents. These findings are important for understanding neural processes during fatiguing exercise. In upper limb muscles, changes in afferent feedback, motoneurone excitability, and motor cortical output can contribute to failure of the central nervous system to recruit muscles fully during fatigue. It is not known whether similar changes occur with fatigue of muscles in the lower limb. We assessed the corticospinal pathway to vastus lateralis during fatiguing sustained maximal voluntary contractions (MVCs) of the knee extensors and during firing of fatigue-sensitive group III/IV muscle afferents maintained by postexercise ischaemia after fatiguing MVCs of the knee extensors and, separately, the flexors. In two experiments, subjects (n = 9) performed brief knee extensor MVCs before and after 2-min sustained MVCs of the knee extensors (experiment 1) or knee flexors (experiment 2). During MVCs, motor evoked potentials (MEPs) were elicited by transcranial magnetic stimulation over the motor cortex and thoracic motor evoked potentials (TMEPs) by electrical stimulation over the thoracic spine. During the 2-min extensor contraction, the size of vastus lateralis MEPs normalized to the maximal M-wave increased (P < 0.05), but normalized TMEPs were unchanged (P = 0.16). After the 2-min MVC, maintained firing of group III/IV muscle afferents had no effect on vastus lateralis MEPs or TMEPs (P = 0.18 and P = 0.50, respectively). Likewise, after the 2-min knee flexor MVC, maintained firing of these afferents showed no effect on vastus lateralis MEPs or TMEPs (P = 0.69 and P = 0.34, respectively). Motoneurones of vastus lateralis do not become less excitable during fatiguing isometric MVCs. Moreover, fatigue-sensitive group III/IV muscle afferents fail to affect the overall excitability of vastus lateralis motoneurones during MVCs.

The effects of fast bowling fatigue and adhesive taping on shoulder joint position sense in amateur cricket players in Victoria, Australia

The impact that muscle fatigue and taping have on proprioception in an applied sporting context remains unclear. The purpose of this study was to investigate disturbances in position sense at the shoulder joint, and asses the effectiveness of adhesive tape in preventing injury and improving performance, after a bout of cricket fast bowling. Among amateur cricket players (N = 14), shoulder position sense, maximum voluntary contraction (MVC) force and bowling accuracy was assessed before and immediately after a fatiguing exercise bout of fast bowling. Participants were tested with the shoulder taped and untapped. Shoulder extension MVC force dropped immediately and 30 min after the exercise (P < 0.05 and P < 0.05, respectively). Position sense errors increased immediately after exercise (P < 0.05), shifting in the direction of shoulder extension for all measurements. Taping had no effect on position errors before exercise, but did significantly reduce position errors after exercise at mid-range shoulder flexion angles (45° and 60°; P < 0.05 and P < 0.05, respectively). Taping had no significant effect on bowling accuracy. These findings may be explained by a body map shift towards a gravity neutral position. Added cutaneous input from the tape is proposed to contribute more to shoulder position sense when muscles are fatigued.