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Dunham CL, Frank JA. Ultrasound Pressure-Dependent Cytokine and Immune Cell Response Lost in Aged Muscle. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:494-501. [PMID: 38218683 PMCID: PMC10922560 DOI: 10.1016/j.ultrasmedbio.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Therapeutic ultrasound remains a highly discussed topic in physical therapy due to uncertainty between treatment regimens and biological benefits. Its impact on aged populations, who are vulnerable to insufficient healing after muscle injury because of sarcopenia, is understudied. Despite the coupling between muscle inflammation and regeneration, research on the immune response after therapeutic ultrasound is limited. The objective of this study was to evaluate structure, inflammatory cytokine signaling and immune cell infiltration after therapeutic ultrasound in young and aging murine muscle. METHODS Young (6-week-old) and Adult (52-week-old) male and female mouse non-injured gastrocnemii were treated with either low-intensity pulsed ultrasound at 2 W/cm2 (∼0.243 MPa) or high-intensity pulsed focused ultrasound at 554 W/cm2 (∼5.96 MPa). Cytokine expression was evaluated at 1, 8 and 24 hours, cell infiltration was measured via flow cytometry at 1 and 24 hours and immunofluorescence assessed muscle fiber area, fibrosis and satellite cells at 24 hours after sonication. RESULTS Low-intensity pulsed ultrasound induced an early, transient inflammatory response where interleukin (IL)-15 and macrophages (M2 > M1) were increased 1 hour post-sonication. High-intensity pulsed focused ultrasound caused a late, extended immune response where monocyte chemoattractant protein 1 (MCP-1), neutrophils, monocytes and macrophages (M1 > M2) were increased 24 hours post-sonication. Notably, these changes manifested solely in Young gastrocnemius. The Adult gastrocnemius exhibited decreased cytokine expression (IL-1α, IL-6, IL-15, macrophage colony-stimulating factor [M-CSF]) and no alteration in immune cell recruitment post-sonication. There was no damage to muscle structure. CONCLUSION Therapeutic ultrasound induced a pressure-dependent inflammatory response that can augment or mitigate intrinsic muscle cytokine signaling and cell recruitment in adolescent or aged muscle, respectively.
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Affiliation(s)
- Chelsey L Dunham
- Clinical Center, National Institutes of Health, Bethesda, MD, USA.
| | - Joseph A Frank
- Clinical Center, National Institutes of Health, Bethesda, MD, USA; National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
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Jankaew A, Chen JC, Chamnongkich S, Lin CF. Therapeutic Exercises and Modalities in Athletes With Acute Hamstring Injuries: A Systematic Review and Meta-analysis. Sports Health 2023; 15:497-511. [PMID: 35996322 PMCID: PMC10293564 DOI: 10.1177/19417381221118085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Hamstring strain is a common injury to the lower limbs. Early intervention in the acute phase aids with restoring hamstring function and prevents secondary related injury. OBJECTIVE To systematically review and summarize the effectiveness of exercise-based interventions combined with physical modalities currently used in athletes with acute hamstring injuries. DATA SOURCES Five databases (EMBASE, Medline, Cochrane Library, SPORTDiscus, and Web of Science) were searched from inception to July 2021. STUDY SELECTION A total of 4569 studies were screened. Nine randomized controlled trials (RCTs) on the effect of therapeutic exercise programs with and without physical agents in athletes with acute hamstring injuries were identified for meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION The studies were screened, and the evidence was rated using the PEDro scale. Nine RCTs with PEDro scores ranging between 3 and 9 were included and extracted pain intensity, time to return to play (TTRTP), and reinjury rate in the study. RESULTS Loading exercises during extensive lengthening were shown to facilitate TTRTP at P < 0.0001 but did not prevent recurrence (P = 0.17), whereas strengthening with trunk stabilization and agility exercise did not reduce the duration of injury recurrence (P = 0.16), but significantly reduced the reinjury rate (P < 0.007) at a 12-month follow-up. The results of the stretching programs and solely physical modalities could not be pooled in the statistical analysis. CONCLUSION The meta-analysis indicated that a loading program helps athletes to return to sports on a timely basis. Although strengthening with trunk stabilization and agility exercise cannot significantly reduce recovery time, the program can prevent reinjury. The clinical effects of stretching programs and pure physical modality interventions could not be concluded in this study due to limited evidence. PROSPERO REGISTRATION CRD42020183035.
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Affiliation(s)
- Amornthep Jankaew
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jih-Ching Chen
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Samatchai Chamnongkich
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng-Feng Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
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Guerrero Orozco L, Peterson L, Fhager A. Microwave Antenna System for Muscle Rupture Imaging with a Lossy Gel to Reduce Multipath Interference. SENSORS 2022; 22:s22114121. [PMID: 35684742 PMCID: PMC9185596 DOI: 10.3390/s22114121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/13/2022] [Accepted: 05/26/2022] [Indexed: 12/03/2022]
Abstract
Injuries to the hamstring muscles are an increasing problem in sports. Imaging plays a key role in diagnosing and managing athletes with muscle injuries, but there are several problems with conventional imaging modalities with respect to cost and availability. We hypothesized that microwave imaging could provide improved availability and lower costs and lead to improved and more accurate diagnostics. In this paper, a semicircular microwave imaging array with eight antennae was investigated. A key component in this system is the novel antenna design, which is based on a monopole antenna and a lossy gel. The purpose of the gel is to reduce the effects of multipath signals and improve the imaging quality. Several different gels have been manufactured and evaluated in imaging experiments. For comparison, corresponding simulations were performed. The results showed that the gels can effectively reduce the multipath signals and the imaging experiments resulted in significantly more stable and repeatable reconstructions when a lossy gel was used compared to when an almost non-lossy gel was used.
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Affiliation(s)
- Laura Guerrero Orozco
- Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden;
- MedTech West, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Correspondence:
| | - Lars Peterson
- Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden;
| | - Andreas Fhager
- Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden;
- MedTech West, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Prevalence and Characteristics of Muscle Tightness in Young Adults. Orthop Nurs 2022; 41:221-226. [PMID: 35476778 DOI: 10.1097/nor.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In young adults, muscle sprains and strains leading to muscle tightness are considered short-term and believed to have no ill effects on quality of life. However, recent advances in the science indicate that muscle tightness is an invisible condition that can limit life activities. The objective of this study was to identify the prevalence and characteristics of muscle tightness in young adults. The study used descriptive quantitative design. One hundred individuals aged between 18 and 27 years completed a survey based upon a validated muscle tightness measurement tool. Seventy-two percent of participants reported experiencing muscle tightness that limited their daily living and recreational activities. Fifty-six percent reported experiencing pain with muscle tightness. Women were more likely than men to experience muscle tightness. Awareness, prompt evaluation, and treatment of this condition are key to preventing negative consequences associated with chronic muscle tightness.
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O’ Brien J, Browne D, Earls D, Lodge C. The Efficacy of Flywheel Inertia Training to Enhance Hamstring Strength. J Funct Morphol Kinesiol 2022; 7:14. [PMID: 35225901 PMCID: PMC8883923 DOI: 10.3390/jfmk7010014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this narrative review is to examine the efficacy of flywheel inertia training to increase hamstring strength. Hamstring strain injury is common in many sports, and baseline strength deficits have been associated with a higher risk of hamstring strain injury. As a result, strength and conditioning professionals actively seek additional techniques to improve hamstring strength with the aim of minimising the incidence of hamstring strain injury. One method of strength training gaining popularity in hamstring strength development is flywheel inertia training. In this review, we provide a brief overview of flywheel inertia training and its supposed adaptions. Next, we discuss important determinants of flywheel inertia training such as familiarisation, volume prescription, inertia load, technique and specific exercise used. Thereafter, we investigate its effects on hamstring strength, fascicle length and hamstring strain injury reduction. This article proposes that hamstring specific flywheel inertia training can be utilised for strength development, but due to the low number of studies and contrary evidence, more research is needed before a definite conclusion can be made. In addition, as with any training modality, careful consideration should be given to flywheel inertia training determinants. This review provides general recommendations of flywheel inertia training determinants that have value when integrating flywheel inertia training into a hamstring strengthening program.
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Affiliation(s)
- Joey O’ Brien
- HealthCore, Department of Science and Health, Institute of Technology Carlow, R93 V960 Carlow, Ireland; (D.B.); (D.E.); (C.L.)
- High Performance Unit, WIT Arena, X91 P20H Waterford, Ireland
| | - Declan Browne
- HealthCore, Department of Science and Health, Institute of Technology Carlow, R93 V960 Carlow, Ireland; (D.B.); (D.E.); (C.L.)
| | - Des Earls
- HealthCore, Department of Science and Health, Institute of Technology Carlow, R93 V960 Carlow, Ireland; (D.B.); (D.E.); (C.L.)
| | - Clare Lodge
- HealthCore, Department of Science and Health, Institute of Technology Carlow, R93 V960 Carlow, Ireland; (D.B.); (D.E.); (C.L.)
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Mühlenfeld N, Steendahl IB, Berthold DP, Meyer T, Hauser T, Wagner N, Sander AL, Marzi I, Kaltenbach B, Yel I, Vogl T, Eichler K. Assessment of muscle volume using magnetic resonance imaging (MRI) in football players after hamstring injuries. Eur J Sport Sci 2021; 22:1436-1444. [PMID: 34110980 DOI: 10.1080/17461391.2021.1942226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Muscle injuries of the hamstrings are among the most frequent in football and a main cause for significant time away from training and competition. The purpose of this study was to prospectively evaluate the loss of muscle volume in recreational football players three and six weeks after initial trauma. We hypothesized that significant muscle volume loss occurs within 6 weeks after the initial injury event. Twenty recreational football players (mean-age=25 ± 4years; mean-height=181 ± 8cm; mean-weight=81 ± 10kg) with type3a (minor partial muscle tear) and type3b (moderate partial muscle tear) injuries were included. Muscle volume was determined using established methods for the hamstrings and the quadriceps femoris muscle within 3 days and after 3 and 6 weeks following the initial injury. The injured hamstrings lost 6.5% (mean=64 cm3(95%CI=31-98 cm3), p<0.001), the healthy hamstrings lost 2.1% (mean=21 cm3(3-44 cm3),p=0.096) of muscle volume after six weeks. The quadriceps in the injured leg lost 3.8% (mean=78 cm3(51-104 cm3), p<0.001) and 4.5% (83 cm3 (45-121 cm3), p<0.001) in the healthy leg. Muscle volume loss inversely correlated with activity levels in the healthy leg for the quadriceps (r=0.96 (0.90-0.98); R2=0.92; p<0.001) and the hamstrings (r=0.72 (0.40-0.88); R2=0.51; p<0.001), as well as the quadriceps in the injured leg (r=0.70 (0.37-0.87); R2=0.49; p<0.001), but not the injured hamstrings. Muscle volume ratio of hamstrings to quadriceps in the control limb was 0.52 ± 0.06 and 0.53 ± 0.06 in the injured leg. The rehabilitation period of six weeks did not have a relevant negative or a positive effect on ratios. Significant muscle volume loss in the upper thigh occurs in recreational soccer players within three, and within six weeks after a hamstring injury and lies between 2% and 7%.Highlights This study found that significant muscle volume loss occurs within six weeks after sustaining hamstring muscle group injuries.Additionally, most of the non-professional football players in the present study demonstrated low hamstring-to-quadriceps volume ratios in both the injured, as well as the heathy leg. Low hamstring-to-quadriceps volume ratios may provide an opportunity to focus on muscle hypertrophy strategies to help reduce the risk for muscle imbalances and thus future injury.After three weeks of resting, reduced training activity, compared to the training activity before the injury, seems to be sufficient to preserve 99% of the remaining muscle volume in the quadriceps and as well as the healthy hamstrings. The number of training-minutes correlates statistically significant inversely with the muscle volume lost in a rehabilitation period.
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Affiliation(s)
- Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ida Bo Steendahl
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany.,Deutscher Fußball-Bund (DFB), Frankfurt, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany
| | | | - Nils Wagner
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anna-Lena Sander
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Benjamin Kaltenbach
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
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Papadopoulos ES, Mani R. The Role of Ultrasound Therapy in the Management of Musculoskeletal Soft Tissue Pain. INT J LOW EXTR WOUND 2020; 19:350-358. [DOI: 10.1177/1534734620948343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ultrasound is an invaluable physical modality widely used for diagnosis and therapy in humans and animals. It is noninvasive, atraumatic, and may be used repeatedly. As a therapeutic tool, ultrasound has been in use for some 6 decades. Therapeutic ultrasound (TUS) is used for the treatment of musculoskeletal disorders, including acute soft tissue injuries, overuse syndromes, as well as chronic orthopedic and rheumatologic conditions. The aim of this review was to investigate the clinical effectiveness of TUS in musculoskeletal acute and chronic pain, mainly through the control of inflammation and the promotion of soft tissue injury healing. Based on the evidence presented, TUS is clinically effective in some musculoskeletal soft tissue pain conditions, but due to conflicting results in some studies, no specific positive recommendations can be made, nor does it permit exclusion of TUS from clinical practice. In phonophoresis, TUS plays a significant role, without reported adverse effects. There is scope for improving the evidence base with better designed studies.
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Affiliation(s)
| | - Raj Mani
- Shanghai Jiao Tong University, Shanghai, China
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8
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Volume of water added to crushed ice affects the efficacy of cryotherapy: a randomised, single-blind, crossover trial. Physiotherapy 2019; 107:81-87. [PMID: 32026839 DOI: 10.1016/j.physio.2019.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the effects of different cryotherapeutic preparations. DESIGN Randomised, single-blind, crossover trial. SETTING University laboratory. PARTICIPANTS Sixteen healthy women. INTERVENTIONS Participants were randomised to receive three cryotherapeutic preparations: pure ice (500g), watered ice (500g of ice in 500ml of water) and wetted ice (500g of ice in 50ml of water). MAIN OUTCOME MEASURES The primary outcome was skin surface temperature after cryotherapy, measured at the central point of application, and the minimum temperature of the region of interest (ROI). The secondary outcome was the surface area cooled to <13.6°C, which is the recommended temperature to achieve therapeutic effects. RESULTS After application of ice, mean skin surface temperature at the central point was 4.6 [standard deviation (SD) 1.9] °C for the pure ice preparation, 4.9 (SD 2.5) °C for the wetted ice preparation, and 9.6 (SD 1.8) °C for the watered ice preparation. When compared with the watered ice preparation, this represented a mean difference (MD) of 5.0°C for the pure ice preparation [95% confidence interval (CI) 4.0 to 6.0; P<0.001] and an MD of 4.7°C for the wetted ice preparation (95% CI 2.5 to 6.8; P<0.001). The minimum temperatures in the ROI were also lower for the pure ice preparation 3.0 (SD 0.9) °C and the wetted ice preparation 2.8 (SD 0.6) °C than the watered ice preparation 7.9 (SD 1.5) °C. This represented an MD of 4.8°C for the pure ice preparation (95% CI 4.0 to 5.7; P<0.001) and 5.1°C for the wetted ice preparation (95% CI 4.0 to 6.2; P<0.001]. CONCLUSIONS Application of pure ice or wetted ice led to a greater decrease in skin surface temperature compared with watered ice. For clinical purposes, combining equal parts of water and ice could decrease this effect. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov (NCT03414346).
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Annear A, Sole G, Devan H. What are the current practices of sports physiotherapists in integrating psychological strategies during athletes' return-to-play rehabilitation? Mixed methods systematic review. Phys Ther Sport 2019; 38:96-105. [PMID: 31077961 DOI: 10.1016/j.ptsp.2019.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The primary aim was to identify the current practices of sports physiotherapists in implementing psychological strategies during athletes' return-to-play rehabilitation and, secondly, to explore their attitudes and challenges to do so. METHODS An electronic search of the PubMed, CINAHL, Scopus, Medline, Google Scholar, Cochrane Library, AMED, and PsycINFO databases was performed. Studies were considered eligible if they explored physiotherapists' implementation of psychological strategies during athletic rehabilitation. Methodological quality of included studies was assessed using the Guidelines for Critical Review Form. Data were synthesised using thematic analysis. RESULTS AND CONCLUSIONS Eleven studies involving 1440 sports physiotherapists were included: six were quantitative, three were qualitative, and two were mixed-method studies. Most sports physiotherapists recognised the importance of implementing psychological strategies during athletes' rehabilitation but were unsure whether it is within their scope. Common psychological strategies implemented included goal setting and encouraging positive self-thoughts. Barriers to implementing psychological strategies include lack of knowledge and training at undergraduate level, lack of postgraduate psychology courses available, and perceived stigma from athletes toward seeking psychological support. Strategies for sports physiotherapists to incorporate psychological strategies during athletes' return-to-play rehabilitation could include targeted professional development opportunities to gain confidence in implementing psychological strategies.
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Affiliation(s)
- Andrew Annear
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; High Performance Sport, New Zealand.
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
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Wan X, Qu F, Garrett WE, Liu H, Yu B. The effect of hamstring flexibility on peak hamstring muscle strain in sprinting. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:283-289. [PMID: 30356628 PMCID: PMC6189015 DOI: 10.1016/j.jshs.2017.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/04/2017] [Accepted: 02/28/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND The effect of hamstring flexibility on the peak hamstring muscle strains in sprinting, until now, remained unknown, which limited our understanding of risk factors of hamstring muscle strain injury (hamstring injury). As a continuation of our previous study, this study was aimed to examine the relationship between hamstring flexibility and peak hamstring muscle strains in sprinting. METHODS Ten male and 10 female college students participated in this study. Hamstring flexibility, isokinetic strength data, three-dimensional (3D) kinematic data in a hamstring isokinetic test, and kinematic data in a sprinting test were collected for each participant. The optimal hamstring muscle lengths and peak hamstring muscle strains in sprinting were determined for each participant. RESULTS The muscle strain of each of the 3 biarticulated hamstring muscles reached a peak during the late swing phase. Peak hamstring muscle strains were negatively correlated to hamstring flexibility (0.1179 ≤ R 2 ≤ 0.4519, p = 0.001) but not to hip and knee joint positions at the time of peak hamstring muscle strains. Peak hamstring muscle strains were not different for different genders. Peak muscle strains of biceps long head (0.071 ± 0.059) and semitendinosus (0.070 ± 0.055) were significantly greater than that of semimembranosus (0.064 ± 0.054). CONCLUSION A potential for hamstring injury exists during the late swing phase of sprinting. Peak hamstring muscle strains in sprinting are negatively correlated to hamstring flexibility across individuals. The magnitude of peak muscle strains is different among hamstring muscles in sprinting, which may explain the different injury rate among hamstring muscles.
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Affiliation(s)
- Xianglin Wan
- Biomechanics Laboratory, Beijing Sport University, Beijing 100084, China
| | - Feng Qu
- Biomechanics Laboratory, Beijing Sport University, Beijing 100084, China
| | - William E. Garrett
- Duke Sports Medicine, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Hui Liu
- Biomechanics Laboratory, Beijing Sport University, Beijing 100084, China
| | - Bing Yu
- Center for Human Movement Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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