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Ryskalin L, Morucci G, Soldani P, Gesi M. Do the fasciae of the soleus have a role in plantar fasciitis? Clin Anat 2024; 37:413-424. [PMID: 37539773 DOI: 10.1002/ca.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
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Fu C, Xia Y, Wang B, Zeng Q, Pan S. MRI T2 mapping and shear wave elastography for identifying main pain generator in delayed-onset muscle soreness: muscle or fascia? Insights Imaging 2024; 15:67. [PMID: 38424366 PMCID: PMC10904698 DOI: 10.1186/s13244-024-01619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The main generator of delayed onset muscle soreness (DOMS) is still unknown. This study aimed to clarify the main generator of DOMS. METHODS Twelve participants performed eccentric exercise (EE) on lower legs. MRI and ultrasound were used to assess changes of calf muscle and deep fascia before and after EE. These results were then compared to the muscle pain level. RESULTS Compared to baseline, muscle pain peaked at 24-48 h after EE (downstairs 22.25 ± 6.196, 57.917 ± 9.298, F = 291.168, p < 0.01; resting 5.833 ± 1.899, 5.083 ± 2.429, F = 51.678, p < 0.01). Shear wave speed (SWE) of the deep fascia and T2 values of the gastrocnemius muscle and deep fascia all increased and peaked at 48 h after EE (1.960 ± 0.130, F = 22.293; 50.237 ± 2.963, F = 73.172; 66.328 ± 2.968, F = 231.719, respectively, p < 0.01). These measurements were positively correlated with DOMS (downstairs: r = 0.46, 0.76, 0.87, respectively, p < 0.001; resting: r = 0.42, 0.70, 0.77, respectively, p < 0.001). There was a significant positive correlation between SWE and T2 values of deep fascia (r = 0.54, p < 0.01). CONCLUSION DOMS is a common result of muscle and fascia injuries. Deep fascia edema and stiffness play a crucial role in DOMS, which can be effectively evaluated MR-T2 and SWE. CRITICAL RELEVANCE STATEMENT Delayed-onset muscle soreness is a common result of muscle and deep fascia injuries, in which the edema and stiffness of the deep fascia play a crucial role. Both MRI and shear wave elastography can be effectively used to evaluate soft tissue injuries. KEY POINTS • The deep fascia is the major pain generator of delayed-onset muscle soreness. • There is a significant correlation between fascia injury and delayed-onset muscle soreness. • MRI and shear wave elastography are preferred methods for assessing fascia injuries.
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Affiliation(s)
- Congcong Fu
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yu Xia
- Department of Medical Ultrasonic, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Bingshan Wang
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Qiang Zeng
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China.
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Slomka G, Schleip R, Frei P, Kurpiers N, Krämer M, Bauermeister K, Bauermeister W. The Influence of Mobility Training on the Myofascial Structures of the Back and Extremities. J Clin Med 2024; 13:329. [PMID: 38256463 PMCID: PMC10816048 DOI: 10.3390/jcm13020329] [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: 10/28/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The subject of the study was the effect of a multicomponent program (Mobility Routine) on muscular and fascial stiffness, flexibility, subjective well-being, and body perception. METHODS The assumption was that high physical stress affects myofascial structures and joint range of motion. The assessment of myofascial stiffness employed a Shear Wave Elastography. The joint flexibility, pressure pain threshold, and subjective experiences with regard to tension, pain, and general discomfort were documented. RESULTS In the CT group, a greater increase in stiffness was measured in fewer measurement areas compared to the MR group. MR demonstrated superior gains in flexibility compared to CT. Both groups experienced significant reductions in pain, tension, and discomfort. In conclusion, repetitive motion patterns akin to CT lead to increased myofascial stiffness, whereas MR yields more balanced stiffness development, compensates for asymmetries, and improves body awareness. CONCLUSIONS Hence, this study highlights the advantages of mobility training over Crosstrainer exercises and provides valuable insights for the recommendation of training regimens aiming at the enhancement of musculoskeletal functionality and overall well-being.
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Affiliation(s)
- Gunda Slomka
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department Sport and Health Sciences, Technical University of Munich, Campus D, Georg-Bauchle-Ring 60/62, 80992 München, Germany;
- Department of Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allen, Germany
| | - Peter Frei
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Nicolas Kurpiers
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Michael Krämer
- Institute for Materials Technology, Technical University Darmstadt, Grafenstrasse 2, 64283 Darmstadt, Germany;
| | - Katharina Bauermeister
- Conservative and Rehabilitative Orthopedics, Department Sport and Health Sciences, Technical University of Munich, Campus D, Georg-Bauchle-Ring 60/62, 80992 München, Germany;
| | - Wolfgang Bauermeister
- Department of Sports, Physical and Rehabilitative Medicine, Kharkiv National Medical University, 4 Nauky Avenue, 61022 Kharkiv, Ukraine;
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Pietsch S, Green B, Schache AG, Pizzari T. Epidemiology of quadriceps muscle strain injuries in elite male Australian football players. Scand J Med Sci Sports 2024; 34:e14542. [PMID: 37994173 DOI: 10.1111/sms.14542] [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] [Received: 03/30/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To describe the epidemiology of quadriceps muscle strain injury (QMSI) in elite Australian Football League (AFL) players, explore recovery milestones and determine whether recovery is impacted by factors such as injury type (index vs. re-injury), the primary muscle injured and the mechanism of injury. MEASURES All QMSI data reported to the Soft Tissue Injury Registry of the AFL from the 2014 to 2020 seasons were evaluated. Player demographic data, circumstances of injury, MRI reports and recovery outcomes following injury were extracted. Descriptive statistics and frequency distributions are presented. Recovery outcomes for injury type, primary muscle injured and the mechanism of injury were compared using univariate analyses. RESULTS There were 164 QMSIs from 122 players reported (134 index; 30 re-injuries). Almost all (91.3%) QMSIs involved the rectus femoris. Half (48.4%) of the QMSIs occurred during kicking and most commonly affected the dominant kicking leg (72%). The majority occurred at training (64.6%). All re-injuries involved the rectus femoris, most occurred from kicking (63.0%) and within 6 months of the preceding injury (70%). The mean return to play (RTP) time was 25.4 days (95%CI = 22.6-28.2) and rectus femoris injuries took around 14 days longer to RTP than vastii injuries (p = 0.001). QMSIs with a kicking mechanism took the longest to RTP of all injury mechanisms. CONCLUSION In AFL players, QMSIs occur mostly in the dominant leg from a kicking mechanism. Rectus femoris injuries are more prevalent and result in longer RTP time frames. Re-injuries exclusively involved the rectus femoris, primarily from kicking.
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Affiliation(s)
- Samuel Pietsch
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Brady Green
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Musat CL, Niculet E, Craescu M, Nechita L, Iancu L, Nechita A, Voinescu DC, Bobeica C. Pathogenesis of Musculotendinous and Fascial Injuries After Physical Exercise - Short Review. Int J Gen Med 2023; 16:5247-5254. [PMID: 38021047 PMCID: PMC10655743 DOI: 10.2147/ijgm.s432749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The identification of sports and physical exercises with injury risk is necessary to preserve the capacity of athletes and people who perform physical education and also to prevent the installation of functional deficiencies. Methods We have selected the articles related to the pathogenic mechanisms involved in musculotendinous and fascial injuries produced as a result of physical exercise. Results and Discussions The lesional pathogenesis is complex and incompletely clarified. Recent theories put in a new light the mechanisms of muscle pain and tendinopathy production. The accumulation of lactate anion, known to be a residue that induces fatigue and muscle pain, has been reconsidered by some authors. It appears that lactate anion is an excellent fuel for the myocardial fiber. Moreover, the accumulation of lactic acid after intense physical exercise could prevent the inexcitability of the sarcolemma induced by the increased concentration of interstitial K+. Most of the time, overuse injuries are not limited to muscles. They can cause myofascial, myotendinous or purely muscular injuries. The muscular fascia is more susceptible to injuries produced under the action of large external forces. Also, fascia is more sensitive to pain compared to muscle when external forces act eccentrically. Overloading the tendon and putting it under tension repeatedly is followed by ruptures of the tendon fibers. The regeneration of the degenerated tendon is defective in the context of the inflammation produced by the injury. Tendon fibers undergo a process of fibrosis, scarring, adhesion and heterogeneous calcification. Oxidative stress is responsible for inflammation, degeneration and apoptosis of tenocytes. Conclusion The benefits brought by physical education and sports are indisputable, but their practice requires a coordinated program to prevent possible traumatic and overuse injuries.
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Affiliation(s)
- Carmina Liana Musat
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Lina Iancu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Aurel Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Doina-Carina Voinescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Carmen Bobeica
- Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
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Brandl A, Wilke J, Egner C, Schmidt T, Schleip R. Effects of Maximal Eccentric Trunk Extensor Exercise on Lumbar Extramuscular Connective Tissue: A Matched-Pairs Ultrasound Study. J Sports Sci Med 2023; 22:447-454. [PMID: 37711713 PMCID: PMC10499134 DOI: 10.52082/jssm.2023.447] [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] [Received: 05/23/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
Recently, it has been shown that the extramuscular connective tissue (ECT) is likely involved in delayed onset muscle soreness (DOMS). Therefore, the aim of the present study was to investigate the effects of maximal trunk extension eccentric exercise (EE) on ECT thickness, self-reported DOMS, ECT stiffness, skin temperature, and possible correlations between these outcomes. Healthy adults (n = 16, 29.34 ± 9.87 years) performed fatiguing EE of the trunk. A group of highly active individuals (TR, n = 8, > 14 h of sport per week) was compared with a group of less active individuals (UTR, n = 8, < 2 h of sport per week). Ultrasound measurements of ECT thickness, stiffness with MyotonPro and IndentoPro, skin temperature with infrared thermography, and pain on palpation (100 mm visual analog scale, VAS) as a surrogate for DOMS were recorded before (t0), immediately (t1), 24 h (t24), and 48 h (t48) after EE. ECT thickness increased after EE from t0 to t24 (5.96 mm to 7.10 mm, p = 0.007) and from t0 to t48 (5.96 mm to 7.21 mm, p < 0.001). VAS also increased from t0 to t24 (15.6 mm to 23.8 mm, p < 0.001) and from t0 to t48 (15.6 mm to 22.8 mm, p < 0.001). Skin temperature increased from t1 to t24 (31.6° Celsius to 32.7° Celsius, p = 0.032) and t1 to t48 (31.6° Celsius to 32.9° Celsius, p = 0.003), while stiffness remained unchanged (p > 0.05). Correlation analysis revealed no linear relationship between the outcomes within the 48-hour measurement period. The results may confirm previous findings of possible ECT involvement in the genesis of DOMS in the extremities also for the paraspinal ECT of trunk extensors. Subsequent work should focus on possible interventions targeting the ECT to prevent or reduce DOMS after strenuous muscle EE.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Vienna School of Osteopathy, Vienna, Austria
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
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Medeiros F, Martins W, Behm D, Ribeiro D, Marinho E, Santos W, Viana RB. Acute effects of foam roller or stick massage on indirect markers from exercise-induced muscle damage in healthy individuals: A systematic review and meta-analysis. J Bodyw Mov Ther 2023; 35:273-283. [PMID: 37330781 DOI: 10.1016/j.jbmt.2023.04.016] [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] [Received: 06/27/2021] [Revised: 09/21/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND This systematic review and meta-analysis examined the effects of foam roller or stick massage performed after exercise-induced muscle damage protocols on indirect markers of muscle damage compared to a non-intervention control group in healthy individuals. METHODS PubMed, Biblioteca Virtual em Saúde, Scopus, Google Scholar, and Cochrane Library database were searched in August 2, 2020, with last update on February 21, 2021. Were included clinical trials involving healthy adult individuals who received foam roller/stick massage versus a non-intervention group and evaluated indirect markers of muscle damage. Risk of bias was assessed by the Cochrane Risk of Bias tools. Standardized mean differences with 95% confidence intervals were used to measure the foam roller/stick massage effect on muscle soreness. RESULTS The five included studies investigated 151 participants (136 men). Overall, the studies presented a moderate/high risk of bias. A between-groups meta-analysis showed no significant difference between massage and non-intervention control groups on muscle soreness immediately after (0.26 [95%CI: 0.14; 0.65], p = 0.20), 24 h (-0.64 [95%CI: 1.34; 0.07], p = 0.08), 48 h (-0.35 [95%CI: 0.85; 0.15], p = 0.17), 72 h (-0.40 [95%CI: 0.92; 0.12], p = 0.13), and 96 h (0.05 [95%CI: 0.40; 0.50], p = 0.82) after an exercise-induced muscle damage protocol. Moreover, the qualitative synthesis showed that foam roller or stick massage had no significant effect on range of motion, muscle swelling, and maximal voluntary isometric contraction recovery. CONCLUSION In conclusion, the current literature appears to not support the advantage of foam roller or stick massage to improve recovery of muscle damage indirect markers (muscle soreness, range of motion, muscle swelling, and maximal voluntary isometric contraction) compared to a non-intervention control group in healthy individuals. Furthermore, due to the heterogeneity of the methodological designs among the included studies, making it difficult to compare the results. In addition, there are not enough high-quality and well-designed studies on foam roller or stick massage to draw any definite conclusions. REVIEW PROTOCOL NUMBER The study was pre-registered in the International Prospective Register of Systematic Review (PROSPERO) on August 2, 2020, with last update on February 21, 2021. Protocol number: CRD2017058559.
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Affiliation(s)
- Flávia Medeiros
- College of Physical Education, University of Brasilia, Brazil.
| | | | - David Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, Canada.
| | - Deise Ribeiro
- College of Physical Education, University of Brasilia, Brazil.
| | | | - Wanderson Santos
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil.
| | - Ricardo Borges Viana
- Institute of Physical Education and Sport, Federal University of Ceará, Fortaleza, Brazil.
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Tenberg S, Nosaka K, Wilke J. The Relationship Between Acute Exercise-Induced Changes in Extramuscular Connective Tissue Thickness and Delayed Onset Muscle Soreness in Healthy Participants: A Randomized Controlled Crossover Trial. SPORTS MEDICINE - OPEN 2022; 8:57. [PMID: 35482217 PMCID: PMC9050985 DOI: 10.1186/s40798-022-00446-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022]
Abstract
Background The extramuscular connective tissue (ECT) has been shown to play a significant role in mechanical force transmission between musculoskeletal structures. Due to this and owing to its tight connection with the underlying muscle, the ECT may be vulnerable to excessive loading. The present study aimed to investigate the effect of eccentric elbow flexor exercise on the morphology of the biceps brachii ECT. In view of the high nociceptive capacity of the ECT, an additional objective was to elucidate the potential relationship between ECT damage and the occurrence of delayed onset muscle soreness (DOMS). Methods Eleven healthy participants (♂ = 7; 24 ± 2 years) performed fatiguing dumbbell elbow flexor eccentric exercise (EE) for one arm and concentric exercise (CE) for the other arm in random order and with random arm allocation. Before, immediately after and 24–96 h post-exercise, maximal voluntary isometric contraction torque of the elbow flexors (dynamometer), pressure pain (algometer), palpation pain (100 mm visual analog scale), biceps brachii ECT thickness and ECT/muscle mobility during passive movement (both high-resolution ultrasound) were examined. Results Palpation pain, suggestive of DOMS, was greater after EE than CE, and maximal voluntary isometric contraction torque decreased greater after EE than CE (p < .05). Relative to CE, EE increased ECT thickness at 48 (+ 17%), 72 (+ 14%) and 96 (+ 15%) hours post-exercise (p < .05). At 96 h post-EE, the increase in ECT thickness correlated with palpation pain (r = .68; p < .05). ECT mobility was not different between conditions, but compared to CE, muscle displacement increased at 24 (+ 31%), 72 (+ 31%) and 96 (+ 41%) hours post-EE (p < .05). Conclusion Collectively, these results suggest an involvement of the ECT changes in delayed onset muscle soreness.
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Branched-Chain Amino Acids Supplementation Does Not Accelerate Recovery after a Change of Direction Sprinting Exercise Protocol. Nutrients 2022; 14:nu14204331. [PMID: 36297014 PMCID: PMC9609908 DOI: 10.3390/nu14204331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
BCAAs supplementation has been widely used for post-exercise recovery. However, no evidence is currently available to answer the question of whether BCAAs supplementation can attenuate muscle damage and ameliorate recovery after a bout of change of direction (COD) sprinting, which is an exercise motion frequently used during team sport actions. This study aimed to assess the effect of BCAAs supplementation on muscle damage markers, subjective muscle soreness, neuromuscular performance, and the vascular health of collegiate basketball players during a 72 h recovery period after a standardized COD protocol. Participants orally received either BCAAs (0.17 g/kg BCAAs + 0.17 g/kg glucose) or placebo (0.34 g/kg glucose) supplementation before and immediately after a COD exercise protocol in a randomized, crossover, double-blind, and placebo-controlled manner. Creatine kinase increased immediately after exercise and peaked at 24 h, muscle soreness remained elevated until 72 h, whilst arterial stiffness decreased after exercise for both supplemented conditions. A negligibly lower level of interleukin-6 was found in the BCAAs supplemented condition. In conclusion, the results of this study do not support the benefits of BCAAs supplementation on mitigating muscle damage and soreness, neuromuscular performance, and arterial stiffness after COD for basketball players.
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10
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Wilke J, Schwiete C, Behringer M. Effects of Maximal Eccentric Exercise on Deep Fascia Stiffness of the Knee Flexors: A Pilot Study using Shear-Wave Elastography. J Sports Sci Med 2022; 21:419-425. [PMID: 36157390 PMCID: PMC9459765 DOI: 10.52082/jssm.2022.419] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
The deep fascia is intimately linked to skeletal muscle and may be involved in delayed onset muscle soreness (DOMS). The present study therefore explored the effect of eccentric exercise on fascia stiffness and its relation with DOMS. Healthy active male adults (n = 19, 27 ± 4 years) performed 6 x 10 maximal eccentric knee flexions using an isokinetic dynamometer. Before (baseline) as well as immediately (T0), 1 hour (T1), and each day up to 72 hours (T24 to T72) afterwards, shear wave elastography was used to measure the mechanical stiffness of the biceps femoris muscle and the overlying fascia. As a surrogate of DOMS, pain upon palpation was captured by means of a 100mm visual analogue scale. While muscle stiffness remained unchanged (p > 0.05), deep fascia stiffness increased from baseline to T24 (median: 18 kPa to 21.12 kPa, p = 0.017) and T72 (median: 18 kPa to 21.3 kPa, p = 0.001) post-exercise. Linear regression showed an association of stiffness changes at T24 and pressure pain at T72 (r2 = 0.22, p < 0.05). Maximal eccentric exercise leads to a stiffening of the fascia, which, in turn, is related to the magnitude of future DOMS. Upcoming research should therefore gauge the effectiveness of interventions modifying the mechanical properties of the connective tissue in order to accelerate recovery.
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Affiliation(s)
- Jan Wilke
- Institute of Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt/Main, Germany
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Carsten Schwiete
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt/Main, Germany
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11
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Pianese L, Bordoni B. The Use of Instrument-Assisted Soft-Tissue Mobilization for Manual Medicine: Aiding Hand Health in Clinical Practice. Cureus 2022; 14:e28623. [PMID: 36059328 PMCID: PMC9429822 DOI: 10.7759/cureus.28623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/07/2022] Open
Abstract
Instrument-assisted soft-tissue mobilization (IASTM) represents a treatment strategy for soft tissue (skin) and musculoskeletal tissue (myofascia). There are different morphologies of these tools that are used by clinicians and manual therapists for the management of scars, fibrotic formations, muscle-joint pain, and movement limitations. The literature demonstrates the effectiveness of IASTMs in different clinical areas. However, the literature does not consider the use of these tools for the protection of the clinician’s hands. The main objective of this article is to draw attention to the fact that IASTM can protect clinicians from professional joint injuries of the hands and can likely become a preventive tool for the operator. Further research is needed to fully determine the positive adaptations in operators who use IASTMs compared to those who do not use them.
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Association Between Injury Mechanisms and Magnetic Resonance Imaging Findings in Rectus Femoris Injuries in 105 Professional Football Players. Clin J Sport Med 2022; 32:e430-e435. [PMID: 34050059 DOI: 10.1097/jsm.0000000000000935] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the injury mechanism and its association with magnetic resonance imaging (MRI) injury findings in acute rectus femoris injuries. DESIGN Combined retrospective and prospective descriptive injury study. Retrospective cohort from January 2010 to October 2013 and prospective cohort from October 2013 to January 2019. SETTING Specialized sports medicine hospital. PARTICIPANTS Male professional football players older than 18 years playing in a national football league, referred for injury assessment within 7 days after an acute rectus femoris injury, with a positive finding on MRI. INDEPENDENT VARIABLES Rectus femoris muscle injury MRI findings in relation to injury mechanism in male football players. MAIN OUTCOME MEASURES Rectus femoris injury mechanism (kicking, sprinting, and others), MRI injury location, and grade. RESULTS There were 105 injuries in total, with 60 (57.1%) and 45 (42.8%) injuries from the retrospective and prospective cohorts, respectively. Kicking was the injury mechanism in 57 (54.3%) of all acute rectus femoris injuries, sprinting represented 32 (30.4%), and 16 (15.2%) were classified as others. There were 20 (19.05%) free tendon, 67 (63.8%) myotendinous junction and/or intramuscular tendon, and 18 (17.1%) peripheral myofascial located injuries. All free tendon injuries were related to kicking and graded as a complete tear of at least one of the tendons in 15/20 (75.0%) cases. CONCLUSIONS Kicking seems to be an important mechanism related to complete ruptures and injuries occurring at the proximal free tendon. Sprinting was the other most common mechanism but was never associated with injury to the proximal free tendon.
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Valle X, Mechó S, Alentorn-Geli E, Järvinen TAH, Lempainen L, Pruna R, Monllau JC, Rodas G, Isern-Kebschull J, Ghrairi M, Yanguas X, Balius R, la Torre AMD. Return to Play Prediction Accuracy of the MLG-R Classification System for Hamstring Injuries in Football Players: A Machine Learning Approach. Sports Med 2022; 52:2271-2282. [PMID: 35610405 DOI: 10.1007/s40279-022-01672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Muscle injuries are one of the main daily problems in sports medicine, football in particular. However, we do not have a reliable means to predict the outcome, i.e. return to play from severe injury. The aim of the present study was to evaluate the capability of the MLG-R classification system to grade hamstring muscle injuries by severity, offer a prognosis for the return to play, and identify injuries with a higher risk of re-injury. Furthermore, we aimed to assess the consistency of our proposed system by investigating its intra-observer and inter-observer reliability. METHODS All male professional football players from FC Barcelona, senior A and B and the two U-19 teams, with injuries that occurred between February 2010 and February 2020 were reviewed. Only players with a clinical presentation of a hamstring muscle injury, with complete clinic information and magnetic resonance images, were included. Three different statistical and machine learning approaches (linear regression, random forest, and eXtreme Gradient Boosting) were used to assess the importance of each factor of the MLG-R classification system in determining the return to play, as well as to offer a prediction of the expected return to play. We used the Cohen's kappa and the intra-class correlation coefficient to assess the intra-observer and inter-observer reliability. RESULTS Between 2010 and 2020, 76 hamstring injuries corresponding to 42 different players were identified, of which 50 (65.8%) were grade 3r, 54 (71.1%) affected the biceps femoris long head, and 33 of the 76 (43.4%) were located at the proximal myotendinous junction. The mean return to play for grades 2, 3, and 3r injuries were 14.3, 12.4, and 37 days, respectively. Injuries affecting the proximal myotendinous junction had a mean return to play of 31.7 days while those affecting the distal part of the myotendinous junction had a mean return to play of 23.9 days. The analysis of the grade 3r biceps femoris long head injuries located at the free tendon showed a median return to play time of 56 days while the injuries located at the central tendon had a shorter return to play of 24 days (p = 0.038). The statistical analysis showed an excellent predictive power of the MLG-R classification system with a mean absolute error of 9.8 days and an R-squared of 0.48. The most important factors to determine the return to play were if the injury was at the free tendon of the biceps femoris long head or if it was a grade 3r injury. For all the items of the MLG-R classification, the intra-observer and inter-observer reliability was excellent (k > 0.93) except for fibres blurring (κ = 0.68). CONCLUSIONS The main determinant for a long return to play after a hamstring injury is the injury affecting the connective tissue structures of the hamstring. We developed a reliable hamstring muscle injury classification system based on magnetic resonance imaging that showed excellent results in terms of reliability, prognosis capability and objectivity. It is easy to use in clinical daily practice, and can be further adapted to future knowledge. The adoption of this system by the medical community would allow a uniform diagnosis leading to better injury management.
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Affiliation(s)
- Xavier Valle
- FC Barcelona Medical Department, Barcelona, Spain. .,Hospital Universitari Dexeus (ICATME), Barcelona, Spain. .,PhD Student at the "Departament de Cirurgia i Ortopèdia", Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Sandra Mechó
- FC Barcelona Medical Department, Barcelona, Spain.,Department of Radiology, Hospital de Barcelona, SCIAS, Barcelona, Spain
| | - Eduard Alentorn-Geli
- Instituto Cugat, Barcelona, Spain.,Fundación García Cugat, Barcelona, Spain.,Mutualidad Española de Futbolistas, Delegación Cataluña, Federación Española de Fútbol, Barcelona, Spain
| | - Tero A H Järvinen
- Tampere University and Tampere University Hospital, Tampere, Finland
| | - Lasse Lempainen
- Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
| | - Ricard Pruna
- FC Barcelona Medical Department, Barcelona, Spain
| | - Joan C Monllau
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital del Mar I L'Esperança, Barcelona, Spain.,ICATME, Hospital Universitari Dexeus, Bellaterra, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Gil Rodas
- FC Barcelona Medical Department, Barcelona, Spain
| | - Jaime Isern-Kebschull
- Musculoskeletal Imaging Specialist, Barcelona, Spain.,Department of Radiology at Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Mourad Ghrairi
- FIFA Medical Centre of Excellence, Dubai, United Arab Emirates
| | | | - Ramon Balius
- Catalan Sports Council, Generalitat de Catalunya, Barcelona, Spain.,Department of Sports Medicine, Clínica Diagonal, Barcelona, Spain
| | - Adrian Martinez-De la Torre
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
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Is "Delayed Onset Muscle Soreness" a False Friend? The Potential Implication of the Fascial Connective Tissue in Post-Exercise Discomfort. Int J Mol Sci 2021; 22:ijms22179482. [PMID: 34502387 PMCID: PMC8431437 DOI: 10.3390/ijms22179482] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022] Open
Abstract
Strenuous and unaccustomed exercise frequently lead to what has been coined “delayed onset muscle soreness” (DOMS). As implied by this term, it has been proposed that the associated pain and stiffness stem from micro-lesions, inflammation, or metabolite accumulation within the skeletal muscle. However, recent research points towards a strong involvement of the connective tissue. First, according to anatomical studies, the deep fascia displays an intimate structural relationship with the underlying skeletal muscle and may therefore be damaged during excessive loading. Second, histological and experimental studies suggest a rich supply of algogenic nociceptors whose stimulation evokes stronger pain responses than muscle irritation. Taken together, the findings support the hypothesis that DOMS originates in the muscle-associated connective tissue rather than in the muscle itself. Sports and fitness professionals designing exercise programs should hence consider fascia-oriented methods and techniques (e.g., foam rolling, collagen supplementation) when aiming to treat or prevent DOMS.
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Kawai T, Takamoto K, Bito I. Previous hamstring muscle strain injury alters passive tissue stiffness and vibration sense. J Bodyw Mov Ther 2021; 27:573-578. [PMID: 34391289 DOI: 10.1016/j.jbmt.2021.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/16/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hamstring strain is one of the most common among sports injuries. A previous history of this injury is considered a strong predictor of recurrent hamstring strain injury. It has been suggested that fascial tissue alters after muscle strain injury. However, the association between previous hamstring strain injury and tissue stiffness and vibration sense detection has not been investigated. OBJECTIVES We aimed to determine whether a previous history of hamstring strain injury affects tissue stiffness and vibration sense in professional soccer players. METHOD The stiffness (MyotonPRO®) and vibration disappearance threshold (tuning fork) were measured in eight professional soccer players with previous history of hamstring strain and eight uninjured players. The differences between two groups' means were analyzed. Side-to-side differences between injured and uninjured legs were also analyzed. RESULTS The tissue stiffness was higher, and the vibration disappearance threshold was lower, in previously injured players when compared to uninjured players. Similar differences were found between injured and uninjured legs. No significant relationship was detected between the age or body mass index (BMI) for both tissue stiffness and vibration disappearance threshold (all P < 0.05). CONCLUSIONS Soccer players with a previous history of hamstring strain injury exhibited higher tissue stiffness and lower vibration sensitivity in the injured leg, regardless of the age and BMI. The results that players who have a previous hamstring strain injury with altered tissue stiffness and vibration sense will be useful and feasible evaluation for chronic muscle strain condition.
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Affiliation(s)
- Tomonori Kawai
- Department of Sports and Health Sciences, Faculty of Human Sciences, University of East Asia, Yamaguchi, Japan.
| | - Kouichi Takamoto
- Department of Sports and Health Sciences, Faculty of Human Sciences, University of East Asia, Yamaguchi, Japan
| | - Itsumu Bito
- Department of Sports and Health Sciences, Faculty of Human Sciences, University of East Asia, Yamaguchi, Japan.
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Purslow PP. The Structure and Role of Intramuscular Connective Tissue in Muscle Function. Front Physiol 2020; 11:495. [PMID: 32508678 PMCID: PMC7248366 DOI: 10.3389/fphys.2020.00495] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
Extracellular matrix (ECM) structures within skeletal muscle play an important, but under-appreciated, role in muscle development, function and adaptation. Each individual muscle is surrounded by epimysial connective tissue and within the muscle there are two distinct extracellular matrix (ECM) structures, the perimysium and endomysium. Together, these three ECM structures make up the intramuscular connective tissue (IMCT). There are large variations in the amount and composition of IMCT between functionally different muscles. Although IMCT acts as a scaffold for muscle fiber development and growth and acts as a carrier for blood vessels and nerves to the muscle cells, the variability in IMCT between different muscles points to a role in the variations in active and passive mechanical properties of muscles. Some traditional measures of the contribution of endomysial IMCT to passive muscle elasticity relied upon tensile measurements on single fiber preparations. These types of measurements may now be thought to be missing the important point that endomysial IMCT networks within a muscle fascicle coordinate forces and displacements between adjacent muscle cells by shear and that active contractile forces can be transmitted by this route (myofascial force transmission). The amount and geometry of the perimysial ECM network separating muscle fascicles varies more between different muscle than does the amount of endomysium. While there is some evidence for myofascial force transmission between fascicles via the perimysium, the variations in this ECM network appears to be linked to the amount of shear displacements between fascicles that must necessarily occur when the whole muscle contracts and changes shape. Fast growth of muscle by fiber hypertrophy is not always associated with a high turnover of ECM components, but slower rates of growth and muscle wasting may be associated with IMCT remodeling. A hypothesis arising from this observation is that the level of cell signaling via shear between integrin and dystroglycan linkages on the surface of the muscle cells and the overlying endomysium may be the controlling factor for IMCT turnover, although this idea is yet to be tested.
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Affiliation(s)
- Peter P Purslow
- Centro de Investigacion Veterinaria de Tandil, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
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