Relationship between muscular extensibility, strength and stability and the transmission of impacts during fatigued running

Correlation of ankle dorsiflexion range of motion with lower-limb kinetic chain function and hop test performance in healthy male recreational athletes

Background

The study aims to identify the correlation of ankle dorsiflexion range-of-motion (ADROM) (with its related gastrocnemius and soleus extensibility) with lower-limb kinetic chain function and hop test performance in young healthy recreational athletes.

Methods

Twenty-one young male healthy recreational athletes were tested for ADROM, gastrocnemius and soleus extensibility, lower-limb kinetic chain function with the closed kinetic chain lower extremity stability test (CKCLEST) and hop test performance with the single-leg hop for distance test (SHDT) and side hop test (SHT).

Results

There was a positive significant (rho = 0.514, 95% CI [0.092-0.779], P < 0.01) correlation between the dominant lower-limb weight-bearing/closed-chain ADROM (that represented the soleus extensibility) and the CKCLEST. There were no significant correlations between the study performance-based tests and open-chain ADROM (P > 0.05).

Conclusion

The CKCLEST is positively and significantly correlated with SHT and weight-bearing ADROM with knee flexion (and its related soleus extensibility) which suggests comparability among them. Open-chain ADROM has a negligible and non-significant correlation with the readings of this study performance-based tests suggesting that it is probably not an essential construct of their execution. To the best of our knowledge, this study is the first to investigate these correlations.

The Use of Wearable Sensors for Preventing, Assessing, and Informing Recovery from Sport-Related Musculoskeletal Injuries: A Systematic Scoping Review

Wearable technologies are often indicated as tools that can enable the in-field collection of quantitative biomechanical data, unobtrusively, for extended periods of time, and with few spatial limitations. Despite many claims about their potential for impact in the area of injury prevention and management, there seems to be little attention to grounding this potential in biomechanical research linking quantities from wearables to musculoskeletal injuries, and to assessing the readiness of these biomechanical approaches for being implemented in real practice. We performed a systematic scoping review to characterise and critically analyse the state of the art of research using wearable technologies to study musculoskeletal injuries in sport from a biomechanical perspective. A total of 4952 articles were retrieved from the Web of Science, Scopus, and PubMed databases; 165 were included. Multiple study features-such as research design, scope, experimental settings, and applied context-were summarised and assessed. We also proposed an injury-research readiness classification tool to gauge the maturity of biomechanical approaches using wearables. Five main conclusions emerged from this review, which we used as a springboard to propose guidelines and good practices for future research and dissemination in the field.

Accelerometer-Based Identification of Fatigue in the Lower Limbs during Cyclical Physical Exercise: A Systematic Review

Physical exercise (PE) is beneficial for both physical and psychological health aspects. However, excessive training can lead to physical fatigue and an increased risk of lower limb injuries. In order to tailor training loads and durations to the needs and capacities of an individual, physical fatigue must be estimated. Different measurement devices and techniques (i.e., ergospirometers, electromyography, and motion capture systems) can be used to identify physical fatigue. The field of biomechanics has succeeded in capturing changes in human movement with optical systems, as well as with accelerometers or inertial measurement units (IMUs), the latter being more user-friendly and adaptable to real-world scenarios due to its wearable nature. There is, however, still a lack of consensus regarding the possibility of using biomechanical parameters measured with accelerometers to identify physical fatigue states in PE. Nowadays, the field of biomechanics is beginning to open towards the possibility of identifying fatigue state using machine learning algorithms. Here, we selected and summarized accelerometer-based articles that either (a) performed analyses of biomechanical parameters that change due to fatigue in the lower limbs or (b) performed fatigue identification based on features including biomechanical parameters. We performed a systematic literature search and analysed 39 articles on running, jumping, walking, stair climbing, and other gym exercises. Peak tibial and sacral acceleration were the most common measured variables and were found to significantly increase with fatigue (respectively, in 6/13 running articles and 2/4 jumping articles). Fatigue classification was performed with an accuracy between 78% and 96% and Pearson's correlation with an RPE (rate of perceived exertion) between r = 0.79 and r = 0.95. We recommend future effort toward the standardization of fatigue protocols and methods across articles in order to generalize fatigue identification results and increase the use of accelerometers to quantify physical fatigue in PE.

Is This the Real Life, or Is This Just Laboratory? A Scoping Review of IMU-Based Running Gait Analysis

Inertial measurement units (IMUs) can be used to monitor running biomechanics in real-world settings, but IMUs are often used within a laboratory. The purpose of this scoping review was to describe how IMUs are used to record running biomechanics in both laboratory and real-world conditions. We included peer-reviewed journal articles that used IMUs to assess gait quality during running. We extracted data on running conditions (indoor/outdoor, surface, speed, and distance), device type and location, metrics, participants, and purpose and study design. A total of 231 studies were included. Most (72%) studies were conducted indoors; and in 67% of all studies, the analyzed distance was only one step or stride or <200 m. The most common device type and location combination was a triaxial accelerometer on the shank (18% of device and location combinations). The most common analyzed metric was vertical/axial magnitude, which was reported in 64% of all studies. Most studies (56%) included recreational runners. For the past 20 years, studies using IMUs to record running biomechanics have mainly been conducted indoors, on a treadmill, at prescribed speeds, and over small distances. We suggest that future studies should move out of the lab to less controlled and more real-world environments.

Low to moderate risk of nerve damage during peroneus longus tendon autograft harvest

PURPOSE

This study aims to evaluate the proximity of the tendon stripper to both the peroneal and sural nerves during peroneus longus tendon (PLT) autograft harvesting.

METHODS

Ten fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft using a standard closed blunt-ended tendon stripper. The distance to the sural nerve from the PLT (at 0, 1, 2 and 3 cm proximal to lateral malleolus (LM), and the distance to the peroneal nerve and its branches from the end of the tendon stripper were measured by two separate observers using ImageJ software.

RESULTS

The average distance from the PLT to the sural nerve increased significantly from 0 to 2 cm proximal to LM. The average distance to the sural nerve at the LM was 4.9 ± 1.5 mm and increased to 10.8 ± 2.4 mm (2 cm proximal to LM). The average distance from the tendon stripper to the deep peroneal nerve was 52.9 ± 11.4 mm. The average distance to the PLT branch of peroneal nerve was 29.3 ± 4.2 mm. The superficial peroneal nerve, which coursed parallel and deep to the tendon stripper, was on average 5.2 ± 0.7 mm from the end of the stripper. No transection injuries of the nerves were observed in any of the ten legs after harvesting.

CONCLUSION

This cadaver study found during a full-thickness PLT harvest, the distances between the tendon stripper and the nerves were greater than 5 mm with an initial incision at 2 cm proximal to LM which is recommended.

Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners

This current concept, narrative review provides the latest integrated evidence of the musculoskeletal injuries involved with trail running and therapeutic strategies to prevent injury and promote safe participation. Running activities that comprise any form of off-road running (trail running, orienteering, short-long distance, different terrain, and climate) are relevant to this review. Literature searches were conducted to 1) identify types and mechanisms of acute and chronic/overuse musculoskeletal injuries in trail runners, 2) injury prevention techniques most relevant to running trails, 3) safe methods of participation and rehabilitation timelines in the sport. The majority of acute and chronic trail running-related musculoskeletal injuries in trail running occur in the lower leg, primarily in the knee and ankle. More than 70% are due to overuse, and ankle sprains are the most common acute injury. Key mechanisms underlying injury and injury progression include inadequate neuromotor control-balance-coordination, running through fatigue, and abnormal kinematics on variable terrain. Complete kinetic chain prehabilitation programs consisting of dynamic flexibility, neuromotor strength and balance, and plyometrics exercise can foster stable, controlled movement on trails. Patient education about early musculoskeletal pain symptoms and training adjustment can help prevent injury from progressing to serious overuse injuries. Real-time adjustments to cadence, step length, and knee flexion on the trail may also mitigate impact-related risk for injury. After injury occurs, rehabilitation will involve similar exercise components, but it will also incorporate rest and active rest based on the type of injury. Multicomponent prehabilitation can help prevent musculoskeletal injuries in trail runners through movement control and fatigue resistance.

Rating of perceived exertion (RPE) in studies of fatigue-induced postural control alterations in healthy adults: Scoping review of quantitative evidence

BACKGROUND

Amongst the literature researching the effects of exercise-induced fatigue on postural control in healthy adults, many studies have used the Borg scales to document the rating of perceived exertion (RPE) and have shown a broad range of RPE values. Our main aim was to map fatigue-induced RPE values in included publications. Secondary aims were to summarize the preference and purpose for the use of Borg scales within the included publications and to explore the potential associations between fatigue-induced RPE values and postural control changes.

METHODS

Five databases (Ovid Medline, PubMed, CINAHL, Scopus, and SPORTDiscus) were systematically searched for synthesizing data among the publications that reported RPE values on the Borg RPE- and Category-Ratio (CR) 10 scales and also found fatigue effects on postural control in healthy adults. Spearman's rank correlations were conducted to assess potential associations between fatigue-induced RPE values and maximal postural control changes across the included publications (group data).

RESULTS

45 of 51 studies included in this review reported maximal RPE values following exercise and ranged from 10.4-20 (6-20 Borg RPE) or 0.9-10 (CR10) indicating "very light" or "very weak" to "maximal" exertions. The 6-20 Borg and CR10 scales were mainly used to assess cardiovascular and muscular exertion, respectively. The scales were used mostly to estimate fatigue levels (n = 45), and to a lesser extent to produce a specific exercise intensity (n = 5) and as the criterion for exercise termination (n = 1). In general, there was no significant association between RPE and postural control changes across studies.

CONCLUSION

The broad range of RPE values and weak correlations may suggest that various fatigue levels can lead to postural control changes. However, one should be careful in comparing the extent of fatigue from RPE values and its potential effect on postural control in the light of many confounding factors.

Distal semimembranosus tendinopathy: A narrative review

Distal semimembranosus tendinopathy is a relatively uncommon diagnosis that can be responsible for medial knee pain. The semimembranosus tendon inserts on the posteromedial knee and is surrounded by the semimembranosus bursa, with both the bursa and tendon potential sources of pain. Similar to other tendinopathies, semimembranosus tendinopathy often occurs with overuse of the musculotendinous unit and is commonly seen in runners. Diagnosis can be made clinically and may be substantiated with use of ultrasound or magnetic resonance imaging. Scant literature exists evaluating the efficacy of treatments for this condition. Consequently, best practice for treatment is inferred from other similar tendinopathies, clinical expertise, and smaller studies on semimembranosus tendinopathy. Extrapolating from other tendinopathies, rehabilitation should be the cornerstone of initial treatment, with focus on kinetic chain and gait abnormalities, hamstring strength and neuromuscular control, and progressive tendon loading. Recalcitrant cases with a coexisting bursopathy can be treated with an ultrasound-guided bursal corticosteroid injection. Future studies may help delineate the optimal treatment regimen for this relatively uncommon diagnosis.