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Mesquita RNO, Latella C, Ruas CV, Nosaka K, Taylor JL. Contraction Velocity of the Elbow Flexors Assessed by Tensiomyography: A Comparison Between Formulas. J Strength Cond Res 2023; 37:1969-1977. [PMID: 36946988 DOI: 10.1519/jsc.0000000000004495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/15/2022] [Indexed: 03/23/2023]
Abstract
ABSTRACT Mesquita, RNO, Latella, C, Ruas, CV, Nosaka, K, and Taylor, JL. Contraction velocity of the elbow flexors assessed by tensiomyography: A comparison between formulas. J Strength Cond Res 37(10): 1969-1977, 2023-Muscle contraction velocity ( Vc ) assessed by tensiomyography is a promising measure for athlete profiling. Multiple formulas are used to estimate Vc , but the most suitable method is yet to be established. Fifteen adults (2 female subjects) underwent tensiomyography assessment of biceps brachii muscle at 10, 45 and 90° of elbow flexion on 2 separate days. Vc was calculated using 6 formulas. Formulas 1 and 2 are measures of the early phase of the twitch; Formulas 3-5 are measures over a wider time-window, with Formula 5 normalizing Vc to maximal displacement ( D m); and we proposed Formula 6 as a measure of peak Vc . Test-retest reliability, the required minimum number of trials, proportional bias, and effects of joint angle were investigated. Higher reliability (coefficient of variation: 2.8-6.9%) was found for Formula 1 (0-2 mm of displacement) and Formula 5 (normalized 10-90% of D m). Overall, a minimum of 6-7 trials was required to obtain reliable estimates. For 10° only, significant positive proportional bias ( r = 0.563-0.670) was found for all formulas except Formula 5. Vc was faster ( p < 0.001) at shorter muscle lengths for all formulas except Formula 5 ( p = 0.06). Vc in the early phase of the twitch was more reliable when calculated using absolute displacement (Formula 1) than a relative threshold (Formula 2). Over a larger time-window, Formulas 3 and 4 were similarly reliable. Because they are derived from different components of the twitch and different parameters, the different formulas should not be used interchangeably. Additionally, more precise nomenclature is required to describe the information obtained from each formula.
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Affiliation(s)
- Ricardo N O Mesquita
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Perth, Australia
- Neuroscience Research Australia, Sydney, Australia; and
| | - Christopher Latella
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Perth, Australia
| | - Cassio V Ruas
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Perth, Australia
- Brazilian Institute of Neuroscience and Neurotechnology-Institute of Physics Gleb Wataghin, University of Campinas, São Paulo, Brazil
| | - Kazunori Nosaka
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Perth, Australia
| | - Janet L Taylor
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Perth, Australia
- Neuroscience Research Australia, Sydney, Australia; and
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Langen G, Lohr C, Ueberschär O, Behringer M. Reproducibility of knee extensor and flexor contraction velocity in healthy men and women assessed using tensiomyography: A registered report. PLoS One 2023; 18:e0288806. [PMID: 37531344 PMCID: PMC10395843 DOI: 10.1371/journal.pone.0288806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Tensiomyography measures the radial displacement of a muscle during an electrically evoked twitch contraction. Different concepts to determine the rate of displacement (Vc) from the maximum twitch exist, but information on their reproducibility is scarce. Further, different inter-stimuli intervals during progressive stimulation are used, but the effect of different intervals on Vc is unclear. OBJECTIVES The first aim of this study was to investigate the within and between-day reliability of the five most frequently used Vc concepts. The second aim was to investigate the effect of different inter-stimuli intervals on Vc. METHODS On two consecutive days, we determined Vc of the biceps femoris long head and rectus femoris of twenty-four healthy subjects. The maximum displacement was determined twice within three minutes on day one and a third time 24 h later. Also, on day two, we applied three blocks of ten consecutive stimuli at a constant intensity of 50 mA, separated by 3 min each. Inter-stimuli intervals in randomly ordered blocks were 10 s, 20 s or 30 s, respectively. RESULTS All Vc concepts displayed good to excellent relative (ICC 0.87-0.99) and generally good absolute within- and between-day reliability for both muscles. Across Vc-concepts, absolute reliability was higher for the rectus femoris (CV% 1.3-7.95%) compared to the biceps femoris (CV% 6.06-15.30%). In both muscles, Vc was generally not affected by different inter-stimuli intervals. For most Vc concepts, repeated stimulation induced an increase regardless of the inter-stimuli interval, but this effect was mainly trivial and small at most. CONCLUSIONS The reproducibility of Vc concepts was generally good but varies between different muscles. A rest interval of 10 s seems preferable to longer intervals for less time required per measurement. Following this initial study, the effect of different inter-stimuli intervals on Vc should be further investigated.
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Affiliation(s)
- Georg Langen
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Strength, Power and Technical Sports, Institute for Applied Training Science, Leipzig, Germany
| | | | - Olaf Ueberschär
- Department of Engineering and Industrial Design, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany
- Department of Biomechanics and Sport Technology, Institute for Applied Training Science, Leipzig, Germany
| | - Michael Behringer
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
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Pus K, Paravlic AH, Šimunič B. The use of tensiomyography in older adults: a systematic review. Front Physiol 2023; 14:1213993. [PMID: 37398907 PMCID: PMC10311920 DOI: 10.3389/fphys.2023.1213993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction: Aging of skeletal muscles results in a cascade of events negatively affecting muscle mass, strength, and function, leading to reduced mobility, increased risk of falls, disability, and loss of independence. To date, different methods are used to assess muscle mechanical function, tensiomyography (TMG) being one of them. The aim of this review was twofold: to summarize the evidence-based usefulness of tensiomyography in older adults and to establish reference values for the main tensiomyography parameters in older adults. Methods: The PubMed, Web of Science, SPORTDiscus, and tensiomyography databases were searched from inception until 25 December 2022. Studies investigating older adults (aged 60+ years) that reported tensiomyography-derived parameters such as contraction time (Tc) and/or maximal displacement (Dm) were included. Methodological quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: In total, eight studies satisfied the inclusion criteria. Tensiomyography has been used on different groups of older adults, including asymptomatic, master athletes, patients with peripheral arterial disease, and patients with end-stage knee osteoarthritis with a mean age of 71.5 ± 5.38 (55.7% male subjects). The most evaluated were leg muscles such as vastus lateralis (VL), gastrocnemius medialis (GM), and biceps femoris (BF). The present review demonstrates that tensiomyography is used to assess neuromuscular function in asymptomatic and diseased older adults. When compared to asymptomatic individuals, power master athletes, knee osteoarthritis patients, and patients diagnosed with peripheral arterial disease have the shortest Tc in BF, VL, and GM muscles, respectively. On the other hand, endurance master athletes showed the longest Tc in all three evaluated muscles. Less mobile, nursing-home residents showed higher Dm in VL and BF, while lower Dm in GM than the asymptomatic group. The knee osteoarthritis group showed the largest Dm in BF and VL while having the smallest Dm in GM. Conclusion: Tensiomyography can serve as a valuable tool for assessing neuromuscular function in older adults. The method is sensitive to muscle composition, architecture, and (pre) atrophic changes of the skeletal muscles and might be responsive to muscle quality changes in aging and diseased populations. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=402345, identifier CRD42023402345.
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Affiliation(s)
- Katarina Pus
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Department of Health Sciences, Alma Mater Europaea—ECM, Maribor, Slovenia
| | - Armin H. Paravlic
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | - Boštjan Šimunič
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
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Langen G, Sandau I, Ueberschär O, Nosaka K, Behringer M. Methodical approaches to determine the rate of radial muscle displacement using tensiomyography: A scoping review and new reporting guideline. J Electromyogr Kinesiol 2022; 67:102702. [PMID: 36183503 DOI: 10.1016/j.jelekin.2022.102702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/30/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
Tensiomyography is a non-invasive method to assess skeletal muscle contractile properties from the stimulated radial displacement. Many studies have used the rate of displacement (Vc) as an indirect measure of muscle contraction velocity. However, no standardised methodical approach exists to measure displacement and determine Vc. This review aimed to provide an overview of concepts to determine Vc and measurement protocols to foster the development of a standardised methodical approach. This review followed the Preferred Reporting Items for Systematic Reviews and meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline. Systematic searches were performed within five electronic databases and additional sources. The included 62 studies reported 10 different concepts to determine Vc, which we summarised in three groups. The determination concepts differed mainly regarding time intervals during the contraction phase considered and criteria used to define these intervals. Essential information on the equipment and raters, measurement setup, electrical stimulation procedure, and data analysis were frequently not reported. In conclusion, no consensus on how to determine Vc existed. Incomplete reporting of measurement protocols hindered study comparison, which obstructs developing a standardised approach. Therefore, we propose a new guideline for reporting measurement protocols, which covers the 1) equipment and rater, 2) measurement setup, including positioning of the subject, sensor and electrodes, 3) electrical stimulation, including initial stimulation amplitude, increment, and endpoint, and 4) data analysis, including selection criteria and number of analysed signals and a definition of derived parameters.
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Affiliation(s)
- G Langen
- Department of Sports Medicine and Performance Physiology, Goethe University Frankfurt, Frankfurt, Germany; Department of Strength Power and Technical Sports, Institute for Applied Training Science, Leipzig, Germany.
| | - I Sandau
- Department of Strength Power and Technical Sports, Institute for Applied Training Science, Leipzig, Germany
| | - O Ueberschär
- Department of Engineering and Industrial Design, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany; Department of Biomechanics, Institute for Applied Training Science, Leipzig, Germany
| | - K Nosaka
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - M Behringer
- Department of Sports Medicine and Performance Physiology, Goethe University Frankfurt, Frankfurt, Germany
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Langen G, Lohr C, Ueberschär O, Behringer M. Reproducibility of knee extensor and flexor contraction velocity in healthy men and women assessed using tensiomyography: A study protocol. PLoS One 2022; 17:e0262156. [PMID: 34990494 PMCID: PMC8735606 DOI: 10.1371/journal.pone.0262156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022] Open
Abstract
Tensiomyography measures the radial displacement of a muscle during an electrically evoked twitch contraction. The rate of muscle displacement is increasingly reported to assess contractile properties. Several formulas currently exist to calculate the rate of displacement during the contraction phase of the maximal twitch response. However, information on the reproducibility of these formulas is scarce. Further, different rest intervals ranging from 10 s to 30 s are applied between consecutive stimuli during progressive electrical stimulation until the maximum twitch response. The effect of different rest intervals on the rate of displacement has not been investigated so far. The first aim of this study is to investigate the within and between-day reliability of the most frequently used formulas to calculate the rate of displacement. The second aim is to investigate the effect of changing the inter-stimulus interval on the rate of displacement. We will determine the rectus femoris and biceps femoris rate of displacement of twenty-four healthy subjects’ dominant leg on two consecutive days. The maximum displacement curve will be determined two times within three minutes on the first day and a third time 24 h later. On day two, we will also apply three blocks of ten consecutive stimuli at a constant intensity of 50 mA. Inter-stimuli intervals will be 10 s, 20 s or 30 s in each block, respectively, and three minutes between blocks. The order of inter-stimulus intervals will be randomized. This study will allow a direct comparison between the five most frequently used formulas to calculate the rate of displacement in terms of their reproducibility. Our data will also inform on the effect of different inter-stimulus intervals on the rate of displacement. These results will provide helpful information on methodical considerations to determine the rate of displacement and may thus contribute to a standardized approach.
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Affiliation(s)
- Georg Langen
- Department of Sports Medicine and Performance Physiology, Goethe University Frankfurt, Frankfurt, Germany
- Department of Technical-Tactical Sports, Institute for Applied Training Science, Leipzig, Germany
- * E-mail:
| | | | - Olaf Ueberschär
- Department of Engineering and Industrial Design, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany
- Department of Biomechanics, Institute for Applied Training Science, Leipzig, Germany
| | - Michael Behringer
- Department of Sports Medicine and Performance Physiology, Goethe University Frankfurt, Frankfurt, Germany
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Quantification of the Link between Timed Up-and-Go Test Subtasks and Contractile Muscle Properties. SENSORS 2021; 21:s21196539. [PMID: 34640875 PMCID: PMC8512551 DOI: 10.3390/s21196539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/12/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Frailty and falls are a major public health problem in older adults. Muscle weakness of the lower and upper extremities are risk factors for any, as well as recurrent falls including injuries and fractures. While the Timed Up-and-Go (TUG) test is often used to identify frail members and fallers, tensiomyography (TMG) can be used as a non-invasive tool to assess the function of skeletal muscles. In a clinical study, we evaluated the correlation between the TMG parameters of the skeletal muscle contraction of 23 elderly participants (22 f, age 86.74 ± 7.88) and distance-based TUG test subtask times. TUG tests were recorded with an ultrasonic-based device. The sit-up and walking phases were significantly correlated to the contraction and delay time of the muscle vastus medialis (ρ = 0.55-0.80, p < 0.01). In addition, the delay time of the muscles vastus medialis (ρ = 0.45, p = 0.03) and gastrocnemius medialis (ρ = -0.44, p = 0.04) correlated to the sit-down phase. The maximal radial displacements of the biceps femoris showed significant correlations with the walk-forward times (ρ = -0.47, p = 0.021) and back (ρ = -0.43, p = 0.04). The association of TUG subtasks to muscle contractile parameters, therefore, could be utilized as a measure to improve the monitoring of elderly people's physical ability in general and during rehabilitation after a fall in particular. TUG test subtask measurements may be used as a proxy to monitor muscle properties in rehabilitation after long hospital stays and injuries or for fall prevention.
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Test-retest reliability of elbow flexor contraction characteristics with tensiomyography for different elbow joint angles. J Electromyogr Kinesiol 2019; 45:26-32. [PMID: 30776725 DOI: 10.1016/j.jelekin.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/24/2019] [Accepted: 02/08/2019] [Indexed: 12/22/2022] Open
Abstract
Tensiomyography (TMG) has gained popularity as a tool to quantify muscle contractile properties. However, it is unclear whether joint angle and inter-stimulus interval influence the test-retest reliability of TMG. Fifteen participants (13M/2F; 29.5 ± 7.4 y) underwent TMG recording of the biceps brachii (BB) at 10°, 45° and 90° of elbow flexion with 10 and 20 s inter-stimulus rest intervals in a randomised order on two separate days. The intra-class correlation coefficient (ICC2,1) and 95% confidence interval (95%CI) were calculated for delay time (Td), contraction time (Tc), sustain time (Ts), relaxation time (Tr) and maximal displacement (Dm). Additionally, the standard error of measurement (SEM), coefficient of variation (CV) and minimal detectable change (MDC) were obtained. Across conditions the ICC2,1 varied for each parameter (Td:0.465-0.947, Tc:0.452-0.831, Ts:0.717-0.918, Tr:0.841-0.935, Dm:0.646-0.900). CV was low for Td (2.1-3.0%), Tc (4.4-7.7%) and Ts (5.5-6.9%) but greater for Tr (10.0-15.3%) and Dm (5.8-13.1%) across conditions. Ts (∼210 ms, P < 0.001) and Dm (∼17 mm, P < 0.001) were greatest at 10° and 90°, respectively, while Td was shortest (∼22.9 ms, P = 0.002) at 10° compared to other angles. No differences were observed between inter-stimulus intervals or day. The findings are expected to help shape best practice methods for TMG use in field and research based settings.
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Macgregor LJ, Hunter AM, Orizio C, Fairweather MM, Ditroilo M. Assessment of Skeletal Muscle Contractile Properties by Radial Displacement: The Case for Tensiomyography. Sports Med 2019; 48:1607-1620. [PMID: 29605838 PMCID: PMC5999145 DOI: 10.1007/s40279-018-0912-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Skeletal muscle operates as a near-constant volume system; as such muscle shortening during contraction is transversely linked to radial deformation. Therefore, to assess contractile properties of skeletal muscle, radial displacement can be evoked and measured. Mechanomyography measures muscle radial displacement and during the last 20 years, tensiomyography has become the most commonly used and widely reported technique among the various methodologies of mechanomyography. Tensiomyography has been demonstrated to reliably measure peak radial displacement during evoked muscle twitch, as well as muscle twitch speed. A number of parameters can be extracted from the tensiomyography displacement/time curve and the most commonly used and reliable appear to be peak radial displacement and contraction time. The latter has been described as a valid non-invasive means of characterising skeletal muscle, based on fibre-type composition. Over recent years, applications of tensiomyography measurement within sport and exercise have appeared, with applications relating to injury, recovery and performance. Within the present review, we evaluate the perceived strengths and weaknesses of tensiomyography with regard to its efficacy within applied sports medicine settings. We also highlight future tensiomyography areas that require further investigation. Therefore, the purpose of this review is to critically examine the existing evidence surrounding tensiomyography as a tool within the field of sports medicine.
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Affiliation(s)
- Lewis J Macgregor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Angus M Hunter
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK.
| | - Claudio Orizio
- Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy
| | | | - Massimiliano Ditroilo
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Šimunič B, Pišot R, Rittweger J, Degens H. Age-Related Slowing of Contractile Properties Differs Between Power, Endurance, and Nonathletes: A Tensiomyographic Assessment. J Gerontol A Biol Sci Med Sci 2018; 73:1602-1608. [DOI: 10.1093/gerona/gly069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Boštjan Šimunič
- Science and Research Centre Koper, Institute for Kinesiology Research, Slovenia
| | - Rado Pišot
- Science and Research Centre Koper, Institute for Kinesiology Research, Slovenia
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Germany
| | - Hans Degens
- School of Healthcare Science, Manchester Metropolitan University, UK
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
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Kim BK, Chai JH, Kim C, Kim CH, Bae SW. Analysis of Lower Extremity Contraction According to Gender Using Tensiomyography. ACTA ACUST UNITED AC 2017. [DOI: 10.5763/kjsm.2017.35.3.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bo-Kyeong Kim
- Department of Sport and Leisure Studies, Korea University, Sejong, Korea
| | - Jung-Hun Chai
- Department of Sports Medicine, Soonchunhyang University, Asan, Korea
| | - Chan Kim
- Department of Physiology and Biophysics, Eulji University School of Medicine, Daejeon, Korea
| | - Chul-Hyun Kim
- Department of Sports Medicine, Soonchunhyang University, Asan, Korea
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Analysis of the response speed of musculature of the knee in professional male and female volleyball players. BIOMED RESEARCH INTERNATIONAL 2014; 2014:239708. [PMID: 25003109 PMCID: PMC4070587 DOI: 10.1155/2014/239708] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/09/2014] [Accepted: 05/06/2014] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the normalized response speed (Vrn) of the knee musculature (flexor and extensor) in high competitive level volleyball players using tensiomyography (TMG) and to analyze the muscular response of the vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL), and biceps femoris (BF) in accordance with the specific position they play in their teams. One hundred and sixty-six players (83 women and 83 men) were evaluated. They belonged to eight teams in the Spanish women's superleague and eight in the Spanish men's superleague. The use of Vrn allows avoiding possible sample imbalances due to anatomical and functional differences and demands. We found differences between Vrn in each of the muscles responsible for extension (VM, RF, and VL) and flexion (BF) regardless of the sex. Normalized response speed differences seem to be larger in setters, liberos and outside players compared to middle blockers and larger in males when compared to females. These results of Vrn might respond to the differences in the physical and technical demands of each specific position, showing an improved balance response of the knee extensor and flexor musculature in male professional volleyball players.
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