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Medeiros DM, Lima-E-Silva FXD, Aimi M, Vaz MA, Baroni BM. Do athletes with hamstring strain injury have shorter muscle fascicles in the injured limb? J Bodyw Mov Ther 2024; 38:269-273. [PMID: 38763569 DOI: 10.1016/j.jbmt.2024.01.030] [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: 04/27/2023] [Revised: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Previous studies have suggested that a reduced length of the biceps femoris long head (BFlh) fascicles may increase the risk of hamstring strain injury (HSI). However, it remains unclear whether the BFlh fascicles of the injured limb are shorter than those of the contralateral limb in athletes with an acute HSI. OBJECTIVE To investigate the between-limb asymmetry of BFlh fascicle length in amateur athletes with an acute HSI. METHODS Male amateur athletes were evaluated using ultrasound scans within five days following an HSI. The BFlh fascicle length was estimated using a validated equation. RESULTS Eighteen injured athletes participated in this study. There was no significant difference (p = 0.27) in the length of BFlh fascicles between the injured limb (9.53 ± 2.55 cm; 95%CI 8.26 to 10.80 cm) and the uninjured limb (10.54 ± 2.87 cm; 95%CI 9.11 to 11.97 cm). Individual analysis revealed high heterogeneity, with between-limb asymmetries (percentage difference of the injured limb compared to the uninjured limb) ranging from -42% to 25%. Nine out of the 18 athletes had a fascicle length that was more than 10% shorter in the injured limb compared to the uninjured limb, five athletes had a difference of less than 10%, and four athletes had a fascicle length that was more than 10% longer in the injured limb compared to the uninjured limb. CONCLUSION The architecture characteristics of injured and uninjured muscles is not consistent among athletes with HSI. Therefore, rehabilitation programs focused on fascicle lengthening should be evaluated on a case-by-case basis.
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Affiliation(s)
| | | | - Mateus Aimi
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Hjaltadóttir AÞ, Hafsteinsson D, Árnason Á, Briem K. Musculoskeletal ultrasound imaging of proximal and distal hamstrings cross sectional area in individuals with history of anterior cruciate ligament reconstruction. Physiother Theory Pract 2024; 40:487-493. [PMID: 36263941 DOI: 10.1080/09593985.2022.2135980] [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: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ultrasound (US) imaging is used by physical therapists for diagnosis and assessment of musculoskeletal injury and follow-up. PURPOSE The aim was to identify long-term effects of graft harvesting on hamstrings muscle mass among athletes who had undergone anterior cruciate ligament reconstruction (ACLR). METHODS Twenty-eight participants (ages 18-55) were recruited: 18 with history of ACLR using semitendinosus (ST) autograft and 10 healthy controls. Images of the cross-sectional area (CSA) of ST and biceps femoris (BF) were captured at 30% and 70% of the distance from the ischial tuberosity to the popliteal crease. A mixed model ANOVA was used to identify inter-limb differences in the CSA of ST and BF at each location, for each group. RESULTS Inter-limb differences were found for the CSA of ST but not BF across both locations for the ACLR group, not controls (p < .001). Within the ACLR group, ST atrophy of the injured limb was relatively greater at the distal vs. proximal location (p < .001). CONCLUSION US imaging identified selective atrophy of ST on the injured side with no compensatory hypertrophy of BF. Specific rehabilitation may influence muscle mass of medial vs. lateral hamstrings muscle groups after ACLR using a ST graft, and monitored with US imaging.
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Affiliation(s)
- Andrea Þórey Hjaltadóttir
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Physiotherapy Garðabær, Garðaflöt 16-18, 210 Garðabær, Iceland
- Department of orthopaedics, Landspitali University Hospital, Fossvogur, 103 Reykjavík, Iceland
| | - Daði Hafsteinsson
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Gáski Physiotherapy, Bolholt 8, 105 Reykjavik, Iceland
| | - Árni Árnason
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
- Gáski Physiotherapy, Bolholt 8, 105 Reykjavik, Iceland
| | - Kristín Briem
- Department of Physical Therapy, University of Iceland, Saemundargata 2, 101 Reykjavík, Iceland
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Högberg J, Piussi R, Simonsson R, Wernbom M, Samuelsson K, Thomeé R, Hamrin Senorski E. The NordBord test reveals persistent knee flexor strength asymmetry when assessed two and five years after ACL reconstruction with hamstring tendon autograft. Phys Ther Sport 2024; 66:53-60. [PMID: 38330681 DOI: 10.1016/j.ptsp.2024.01.008] [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: 11/06/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Comparison of knee flexor strength limb symmetry index (LSI) between the NordBord-test and the Biodex-test, and to determine the relationship between knee flexor strength and function in patients 2 and 5 years after anterior cruciate ligament reconstruction (ACL-R) with hamstring tendon (HT) autografts. DESIGN Observational registry study. SETTING Primary care. PATIENTS Cross-sectional data from 96 patients (55% women) participating in a rehabilitation-registry after ACL-R with HT autografts. MAIN OUTCOME MEASURES Comparison of knee flexor strength symmetry between the Biodex-test and the NordBord-test. Secondly, the relationship between knee flexor strength test and perceived knee function, activity level, and hop performance. RESULTS The NordBord-test demonstrated greater strength deficits compared to the Biodex-test with a mean difference of 12.5% ± 15.1% 95 % CI [8.1; 16.9%] at 2 years, and 11.1% ± 11.9% 95 % CI [7.7; 14.6 %] at 5 years after ACL-R. Relative concentric knee flexor strength (Nm/kg) in the Biodex demonstrated significant weak-to-moderate correlations with activity level and hop performance (r = 0.33-0.67) at 2 and 5 years. CONCLUSION The NordBord-test identified deficits in knee flexor strength LSI not seen with the Biodex-test at 2 and 5 years after ACL-R. No significant correlations were found between the persistent knee flexor strength asymmetry and perceived function, activity level or hop performance.
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Affiliation(s)
- Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden.
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Mathias Wernbom
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; Swedish Olympic Committee, Stockholm, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01 Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30 Gothenburg, Sweden; Swedish Olympic Committee, Stockholm, Sweden
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Timmins RG, Filopoulos D, Giannakis J, Nguyen V, Ruddy JD, Hickey JT, Maniar N, Pollard CW, Morgan N, Weakley J, Opar DA. The Effect of Eccentric or Isometric Training on Strength, Architecture, and Sprinting across an Australian Football Season. Med Sci Sports Exerc 2024; 56:564-574. [PMID: 38051129 DOI: 10.1249/mss.0000000000003326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE This study aimed to investigate the effect of an isometric (ISO) or Nordic hamstring exercise (NHE) intervention, alongside a sprint training program on hamstring strength, architecture, and sprinting performance in Australian footballers. METHODS Twenty-five male athletes undertook NHE ( n = 13) or ISO ( n = 12) training across a 38-wk period (including preseason and in season). Biceps femoris long head (BFlh) architecture, ISO, and eccentric knee flexor strength were assessed at baseline, at the end of preseason (14 wk), and at the conclusion of the intervention. Sprint times and force-velocity profiles were determined at baseline and at the end of preseason. RESULTS After the intervention, both groups had significant improvements in BFlh fascicle length (NHE: 1.16 cm, 95% CI = 0.68 to 1.63 cm, d = 1.88, P < 0.001; ISO: 0.82 cm, 95% CI = 0.57 to 1.06 cm, d = 1.70, P < 0.001), muscle thickness (NHE: 0.11 cm, 95% CI = 0.01 to 0.21 cm, d = 0.51, P = 0.032; ISO: 0.21 cm, 95% CI = 0.10 to 0.32 cm, d = 0.86, P = 0.002), and eccentric strength (NHE: 83 N, 95% CI = 53 to 114 N, d = 1.79, P < 0.001; ISO: 83 N, 95% CI = 17 to 151 N, d = 1.17, P = 0.018). Both groups also finished the intervention weaker isometrically than they started (NHE: -45 N, 95% CI = -81 to -8 N, d = -1.03, P = 0.022; ISO: -80 N, 95% CI = -104 to -56 N, d = -3.35, P < 0.001). At the end of preseason, the NHE group had improved their 5-m sprint time by 3.3% ± 2.0%), and their maximum horizontal velocity was 3% ± 2.1% greater than the ISO group who saw no changes. CONCLUSIONS Both ISO and NHE training with a periodized sprinting program can increase BFlh fascicle length, thickness, and eccentric strength in Australian footballers. NHE training also improves 5-m sprint time and maximum velocity. However, both interventions reduced ISO strength. These findings provide unique, contextually relevant insights into the adaptations possible in semiprofessional athletes.
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Affiliation(s)
| | - Dean Filopoulos
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Victoria, AUSTRALIA
| | - Jake Giannakis
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Victoria, AUSTRALIA
| | - Victor Nguyen
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Victoria, AUSTRALIA
| | - Joshua D Ruddy
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, AUSTRALIA
| | | | | | - Christopher W Pollard
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, AUSTRALIA
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Buckthorpe M, Gokeler A, Herrington L, Hughes M, Grassi A, Wadey R, Patterson S, Compagnin A, La Rosa G, Della Villa F. Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction. Sports Med 2024; 54:49-72. [PMID: 37787846 DOI: 10.1007/s40279-023-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK.
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
| | - Alli Gokeler
- Exercise Science and Neuroscience, Department Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany
| | - Lee Herrington
- Centre for Human Sciences Research, University of Salford, Salford, UK
| | - Mick Hughes
- North Queensland Physiotherapy Centre, Townsville, QLD, Australia
| | - Alberto Grassi
- II Clinica Ortopedica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ross Wadey
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Stephen Patterson
- Faculty of Sport, Technology and Health Sciences, St Mary's University, London, TW1 4SX, Twickenham, UK
| | - Alessandro Compagnin
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Giovanni La Rosa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
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Murakami Y, Nishida S, Kasahara K, Yoshida R, Hayakawa R, Nakamura M. Eccentric force and electromyogram comparison between the eccentric phase of the Nordic hamstring exercise and the razor hamstring curl. PLoS One 2023; 18:e0293938. [PMID: 38100489 PMCID: PMC10723670 DOI: 10.1371/journal.pone.0293938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/23/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Nordic hamstring exercise (NHE) and razor hamstring curl (RHC) are usually performed to train hamstring eccentric contraction strength. However, it is unclear whether there are differences in the intensity of the two methods and the amount of loading on each muscle. Therefore, this study was conducted using peak eccentric force and each muscle surface electromyogram (s-EMG) to provide useful information to decide whether NHE or RHC should be prescribed for training and rehabilitation. METHODS s-EMG electrodes were placed in the medial gastrocnemius, lateral gastrocnemius, biceps femoris, semitendinosus, gluteus maximus, and erector spinae of the dominant leg of the fifteen healthy male university students with exercise habits. Maximum voluntary isometric contractions of 3 seconds were performed on each muscle followed by NHE and RHC in random order. The outcome variables included peak eccentric force and s-EMG of each muscle calculated by means amplitude during the NHE and RHC. RESULTS Peak eccentric force was significantly higher in RHC than in NHE (p = 0.001, r = 0.73). However, NHE was significantly higher in s-EMG of semitendinosus (p = 0.04, r = -0.52) than RHC. However, there were no significant differences in EMG of the medial gastrocnemius (p = 0.202, r = -0.34), lateral gastrocnemius (p = 0.496, r = 0.18), biceps femoris (p = 0.061, r = -0.48), gluteus maximus (p = 0.112, r = -0.41), erector spinae (p = 0.45, r = 0.20) between NHE and RHC. CONCLUSIONS For NHE and RHC, the peak eccentric force exerted during the exercise was significantly higher for RHC, and the s-EMG of semitendinosus was significantly higher for NHE.
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Affiliation(s)
- Yuta Murakami
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Satoru Nishida
- Faculty of Sports and Health Science, Ryutsu Keizai University, Ibaraki, Japan
| | - Kaziki Kasahara
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Riku Yoshida
- Department of Rehabilitation, Medical Corporation, Maniwa Orthopedic Clinic, Niigata, Japan
| | - Ryo Hayakawa
- Department of Rehabilitation, Medical Corporation Sansuikai, Kitachiba Orthopedic, Makuhari Clinic, Chiba, Japan
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, Saga, Japan
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Differences in Peak Knee Flexor Force between Eccentric-Only and Combined Eccentric-Concentric Nordic Hamstring Exercise. Sports (Basel) 2023; 11:sports11020041. [PMID: 36828326 PMCID: PMC9961423 DOI: 10.3390/sports11020041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In many sports, the hamstring strain injury is a common injury. There is evidence that the Nordic hamstring exercise (NHE), a knee flexor exercise, can reduce hamstring injury risk in athletes. In research on hamstring injury prevention, eccentric-only NHE is typically performed, whereas in sports, it is relatively common for athletes to perform NHE eccentrically-concentrically. Further, NHE strength is generally assessed by measuring knee flexor force through an ankle brace, attached atop of a load cell. An alternative method might be to assess knee flexor force about the knee joint using a force plate. The aim of the study was to investigate differences in peak knee flexor force between eccentric-only and combined eccentric-concentric NHE. The purpose was also to determine the correlation between hamstring force measured at the ankle using a load cell (current gold standard) and force assessed about the knee joint using a force plate during NHE. Fifteen junior and senior elite soccer and track and field athletes (3 women and 12 men aged 17-27 years) performed eccentric NHE (ENHE) in which they leaned forward as far as possible until breakpoint and eccentric-concentric NHE (ECNHE) where they returned to the starting position. A linear encoder measured the position at which peak force occurred during the NHEs. Force assessed at the ankle differed significantly (678 vs. 600 N, p < 0.05), whereas force about the knee joint did not (640 vs. 607 N, p > 0.05) between ENHE and ECNHE (12 and 5% difference, respectively). The forward distance achieved by the participants in cm at breakpoint for ENHE was 37% higher than at the coupling phase for ECNHE (74 vs. 54 cm, p < 0.001). Very strong significant (p < 0.01) correlations were noted between peak force assessed at the ankle and about the knee joint for ENHE and ECNHE, r = 0.96 and r = 0.99, respectively. Our results suggest that ECNHE, where peak knee flexor force was reached with 37% less forward movement, may complement ENHE, i.e., during hamstring injury rehabilitation, where a position of great knee extension may not be well tolerated by the athlete. Further, assessing knee flexor force about the knee joint using a force plate may provide an alternative to measuring force at the ankle using a load cell when testing NHE strength.
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San Jose AT, Maniar N, Timmins RG, Beerworth K, Hampel C, Tyson N, Williams MD, Opar DA. Explosive hamstrings strength asymmetry persists despite maximal hamstring strength recovery following anterior cruciate ligament reconstruction using hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2023; 31:299-307. [PMID: 35999280 PMCID: PMC9859849 DOI: 10.1007/s00167-022-07096-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the differences in maximal (isometric and concentric peak torque) and explosive (rate of torque development (RTD)) hamstring and quadriceps strength symmetry between males and females during early- and late-phase rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts and to determine the interaction of time and sex on maximal and explosive strength symmetry. METHODS A total of 38 female and 51 male participants were assessed during early (3-6 months post-operative) and late (7-12 months post-operative) phases of rehabilitation following ACLR. Maximal (concentric and isometric peak torque) and explosive (isometric RTD) hamstring and quadriceps strength were assessed and presented as limb symmetry index (LSI). RESULTS Maximal concentric hamstrings asymmetry (Early: 86 ± 14; Late 92 ± 13; p = 0.005) as well as maximal concentric (Early, 73 ± 15; Late 91 ± 12; p < 0.001) and explosive (Early: 82 ± 30; Late: 92 ± 25; p = 0.03) quadriceps asymmetry decreased from early to late rehabilitation. However, there were no significant changes in maximal isometric quadriceps strength and explosive isometric hamstring strength in the same time period. Females had a larger asymmetry in maximal concentric (Females: 75 ± 17; Males: 81 ± 15; p = 0.001) and explosive (Females: 81 ± 32; Males: 89 ± 25; p = 0.01) quadriceps strength than males throughout rehabilitation. There were no sex differences in maximal and explosive hamstring strength. There were no sex by time interactions for any variables. CONCLUSION Explosive hamstring strength asymmetry did not improve despite recovery of maximal hamstring strength during rehabilitation following ACLR with HT autografts. While sex did not influence strength recovery, females had larger maximal and explosive quadriceps strength asymmetry compared to males throughout rehabilitation following ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Argell T. San Jose
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
| | - Ryan G. Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
| | - Kate Beerworth
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia ,Cricket Australia, Albion, QLD Australia
| | - Chris Hampel
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia
| | - Natalie Tyson
- Wakefield Sports and Exercise Medicine Clinic, Adelaide, SA Australia
| | - Morgan D. Williams
- School of Health, Sport and Professional Practice, University of South Wales, Pontypridd, Wales UK
| | - David A. Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC Australia ,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC Australia
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Haller N, Blumkaitis JC, Strepp T, Schmuttermair A, Aglas L, Simon P, Neuberger E, Kranzinger C, Kranzinger S, O’Brien J, Ergoth B, Raffetseder S, Fail C, Düring M, Stöggl T. Comprehensive training load monitoring with biomarkers, performance testing, local positioning data, and questionnaires - first results from elite youth soccer. Front Physiol 2022; 13:1000898. [PMID: 36262260 PMCID: PMC9573975 DOI: 10.3389/fphys.2022.1000898] [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] [Received: 07/22/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Load management, i.e., prescribing, monitoring, and adjusting training load, is primarily aimed at preventing injury and maximizing performance. The search for objective monitoring tools to assess the external and internal load of athletes is of great interest for sports science research. In this 4-week pilot study, we assessed the feasibility and acceptance of an extensive monitoring approach using biomarkers, neuromuscular performance, and questionnaires in an elite youth soccer setting. Eight male players (mean ± SD: age: 17.0 ± 0.6 years, weight: 69.6 ± 8.2 kg, height: 177 ± 7 cm, VO2max: 62.2 ± 3.8 ml/min/kg) were monitored with a local positioning system (e.g., distance covered, sprints), biomarkers (cell-free DNA, creatine kinase), questionnaires, neuromuscular performance testing (counter-movement jump) and further strength testing (Nordic hamstring exercise, hip abduction and adduction). Feasibility was high with no substantial impact on the training routine and no adverse events such as injuries during monitoring. Adherence to the performance tests was high, but adherence to the daily questionnaires was low, and decreased across the study period. Occasional significant correlations were observed between questionnaire scores and training load data, as well as between questionnaire scores and neuromuscular performance. However, due to the small sample size, these findings should be treated with caution. These preliminary results highlight the feasibility of the approach in elite soccer, but also indicate that modifications are needed in further large-scale studies, particularly in relation to the length of the questionnaire.
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Affiliation(s)
- Nils Haller
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
- Department of Sports Medicine, Rehabilitation and Disease Prevention, University of Mainz, Mainz, Germany
| | - Julia C. Blumkaitis
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Tilmann Strepp
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | | | - Lorenz Aglas
- Department of Biosciences and Medical Biology, University of Salzburg, Salzburg, Austria
| | | | | | | | | | - James O’Brien
- Red Bull Athlete Performance Center, Salzburg, Austria
| | - Bernd Ergoth
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Stefan Raffetseder
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | | | | | - Thomas Stöggl
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
- Red Bull Athlete Performance Center, Salzburg, Austria
- *Correspondence: Thomas Stöggl,
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Alt T, Severin J, Schmidt M. Quo Vadis Nordic Hamstring Exercise-Related Research?-A Scoping Review Revealing the Need for Improved Methodology and Reporting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11225. [PMID: 36141503 PMCID: PMC9517005 DOI: 10.3390/ijerph191811225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
The objective of this scoping review is to assess Nordic Hamstring Exercise quality (ANHEQ) of assessments and interventions according to the ANHEQ rating scales and to present practical recommendations for the expedient design and reporting of future studies. A total of 71 Nordic Hamstring Exercise (NHE) assessments and 83 NHE interventions were selected from the data sources PubMed, Scopus, and SPORTDiscus. Research studies which were presented in peer-reviewed academic journals and implemented the NHE during laboratory-based assessments or multi-week interventions met the eligibility criteria. NHE assessments analyzed force (51%), muscle activation (41%), knee angle kinematics (38%), and bilateral symmetry (37%). NHE interventions lasted 4-8 weeks (56%) and implied an exercise volume of two sessions per week (66%) with two sets per session (41%) and ≥8 repetitions per set (39%). The total ANHEQ scores of the included NHE assessments and interventions were 5.0 ± 2.0 and 2.0 ± 2.0 (median ± interquartile range), respectively. The largest deficits became apparent for consequences of impaired technique (87% 0-point-scores for assessments) and kneeling height (94% 0-point-scores for interventions). The 0-point-scores were generally higher for interventions compared to assessments for rigid fixation (87% vs. 34%), knee position (83% vs. 48%), kneeling height (94% vs. 63%), and separate familiarization (75% vs. 61%). The single ANHEQ criteria, which received the highest score most frequently, were rigid fixation (66% of assessments) and compliance (33% of interventions). The quality of NHE assessments and interventions was generally 'below average' or rather 'poor'. Both NHE assessments and interventions suffered from imprecise reporting or lacking information regarding NHE execution modalities and subsequent analyses. Based on the findings, this scoping review aggregates practical guidelines how to improve the design and reporting of future NHE-related research.
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Affiliation(s)
- Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength & Conditioning, Olympic Training and Testing Centre Westphalia, 44139 Dortmund, Germany
| | - Jannik Severin
- Institute of Movement and Neuroscience, German Sport University, 50933 Cologne, Germany
| | - Marcus Schmidt
- Institute for Sport and Sport Science, TU Dortmund University, 44227 Dortmund, Germany
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11
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Persistent knee flexor strength deficits identified through the NordBord eccentric test compared with “gold standard” isokinetic concentric testing during the first year after anterior cruciate ligament reconstruction with a hamstring tendon autograft. Phys Ther Sport 2022; 55:119-124. [DOI: 10.1016/j.ptsp.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 11/22/2022]
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12
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Augustsson J, Augustsson SR. Development of a Novel Nordic Hamstring Exercise Performance Test Device: A Reliability and Intervention Study. Sports (Basel) 2022; 10:sports10020026. [PMID: 35202065 PMCID: PMC8875831 DOI: 10.3390/sports10020026] [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] [Received: 12/03/2021] [Revised: 01/10/2022] [Accepted: 02/18/2022] [Indexed: 12/10/2022] Open
Abstract
There is evidence that a knee flexor exercise, the Nordic hamstring exercise (NHE), prevents hamstring injuries. The purpose of this study was therefore to develop, and to determine the reliability of, a novel NHE test device and, further, to determine the effectiveness of a 10-week low volume NHE program on NHE performance. Twenty female football (soccer) players, aged 16–30 years, participated in this study. From a kneeling position on the device, with the ankles secured under a heavy lifting sling, participants leaned forward in a controlled manner as far as possible (eccentric phase) and then returned to the starting position (concentric phase). A tape measure documented the forward distance achieved by the participants in cm. Participants completed three separate occasions to evaluate test-retest reliability. Additionally, 14 players performed a low volume (1 set of 5 repetitions) NHE program once weekly for 10 weeks. No significant test-retest differences in NHE performance were observed. The intra-class correlation coefficient was 0.95 and the coefficient of variation was 3.54% between tests. Mean improvement in the NHE performance test by the players following training was 22% (8.7 cm), p = 0.005. Our test device reliably measured NHE performance and is easy to perform in any setting. Further, NHE performance was improved by a 10-week low volume NHE program. This suggests that even a small dose (1 set of 5 repetitions once weekly) of the NHE may enhance NHE performance.
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13
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Messer DJ, Williams MD, Bourne MN, Opar DA, Timmins RG, Shield AJ. Anterior Cruciate Ligament Reconstruction Increases the Risk of Hamstring Strain Injury Across Football Codes in Australia. Sports Med 2021; 52:923-932. [PMID: 34709603 DOI: 10.1007/s40279-021-01567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the impacts of anterior cruciate ligament reconstruction (ACLR) and recent (< 12 months) hamstring strain injury (HSI) on (1) future HSI risk, and (2) eccentric knee flexor strength and between-limb imbalance during the Nordic hamstring exercise. A secondary goal was to examine whether eccentric knee flexor strength was a risk factor for future HSI in athletes with prior ACLR and/or HSI. METHODS In this prospective cohort study, 531 male athletes had preseason eccentric knee flexor strength tests. Injury history was also collected. The main outcome was HSI occurrence in the subsequent competitive season. RESULTS Overall, 74 athletes suffered at least one prospective HSI. Compared with control athletes, those with a lifetime history of ACLR and no recent HSI had 2.2 (95% confidence interval [CI] 1.1-4.4; p = 0.029) times greater odds of subsequent HSI while those with at least one HSI in the previous 12 months and no history of ACLR had 3.1 (95% CI 1.8-5.4; p < 0.001) times greater odds for subsequent HSI. Only athletes with a combined history of ACLR and recent HSI had weaker injured limbs (p = 0.001) and larger between-limb imbalances (p < 0.001) than uninjured players. An exploratory decision tree analysis suggested eccentric strength may protect against HSI after ACLR. CONCLUSION ACLR and recent HSI were similarly predictive of future HSI. Lower levels of eccentric knee flexor strength and larger between-limb imbalances were found in athletes with combined histories of ACLR and recent HSI. These findings may have implications for injury rehabilitation.
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Affiliation(s)
- Daniel J Messer
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove 4059, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Morgan D Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Griffith University, Gold Coast campus, Gold Coast, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove 4059, Brisbane, QLD, Australia.
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
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Ogborn D, McRae S, Larose G, Leiter J, Brown H, MacDonald P. Knee flexor strength and symmetry vary by device, body position and angle of assessment following ACL reconstruction with hamstring grafts at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 31:1658-1664. [PMID: 34477895 DOI: 10.1007/s00167-021-06712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Persistent deficits in knee flexor strength following harvest of semitendinosus and gracilis for anterior cruciate ligament reconstruction are inconsistent in the literature. Variation in methodology, including measuring torque at higher knee flexion angles may partially explain these discrepant findings. The objective of this study was to determine whether positioning (seated vs supine), consideration of peak or joint-angle-specific torque or device (Isokinetic Dynamometer vs NordBord Hamstring Dynamometer) impact the magnitude of knee flexor strength differences between limbs. METHODS Participants (n = 31, 44.2 ± 10.7 years,) who were at 14 ± 4.4 years follow-up for unilateral ACL reconstruction with semitendinosus/gracilis grafts completed the ACL Quality of Life outcome and an assessment including isokinetic concentric knee extensor and flexor strength in seated and supine with peak torque and torque at 60° (T60) and 75° (T75) knee flexion measured, followed by an eccentric Nordic Hamstring Curl. RESULTS Isokinetic concentric knee flexor torque was reduced in supine relative to seated, on the reconstructed limb against the unaffected, and at higher degrees of knee flexion relative to peak torque (T60 and T75 against peak torque). Limb symmetry varied by methodology (F(6,204) = 8.506, p = 0.001) with reduced symmetry in supine T75 against all measures (71.1 ± 16.5%, p < 0.05), supine T60 against seated peak torque (82.7 ± 14.2%, p < 0.05), and the NordBord was lower than seated peak torque that was not statistically significant (83.9 ± 12.8%, n.s.). Knee extensor peak (r2 = 0.167 (F(1,27) = 5.3, p = 0.03) and Nordic curl eccentric torque (r2 = 0.267, F(2,26) = 4.736, p = 0.02) were predictors of ACL-QoL score, although a combined model did not improve over Nordic torque alone. CONCLUSION Limb symmetry cannot be assumed in clinical practice across differing assessment methods for knee flexor strength as deficits are greatest in the supine position with torque measured at 75° knee flexion. Isokinetic knee extensor and eccentric knee flexor torque during the Nordic hamstring curl were predictors of ACL-QoL scoring and should be considered alongside patient-reported outcomes for patients following ACL reconstruction with hamstring grafts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Dan Ogborn
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada. .,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.
| | - Sheila McRae
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,College of Rehabilitation Sciences, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Gabriel Larose
- Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
| | - Jeff Leiter
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Holly Brown
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada
| | - Pete MacDonald
- Pan Am Clinic Foundation, 75 Poseidon Bay, Office 307, Winnipeg, MB, R3M 3E4, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Winnipeg, MB, Canada
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15
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Timmins RG, Filopoulos D, Nguyen V, Giannakis J, Ruddy JD, Hickey JT, Maniar N, Opar DA. Sprinting, Strength, and Architectural Adaptations Following Hamstring Training in Australian Footballers. Scand J Med Sci Sports 2021; 31:1276-1289. [PMID: 33617061 DOI: 10.1111/sms.13941] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to determine the sprinting, strength, and architectural adaptations following a hip-dominant flywheel (FLY) or Nordic hamstring exercise (NHE) intervention in Australian footballers. Twenty-seven male athletes were randomized to FLY (n = 13) or NHE (n = 14) training across a 39-week period (inclusive of pre-season and in-season). Biceps femoris long head (BFlh) architecture was assessed throughout. Eccentric hamstring strength and 40 m sprint times (with force-velocity profiling) were assessed at baseline, end of pre-season, and following the intervention. After the intervention, BFlh fascicle length was longer in both groups compared to baseline (FLY: 1.16 cm, 95%CI: 0.66 to 1.66 cm, d = 1.99, p < 0.001; NHE: 1.08 cm, 95%CI: 95%CI 0.54 to 1.61 cm, d = 1.73, p < 0.001). Both groups also increased their eccentric strength (FLY: mean change 82 N, 95%CI 12 to 152 N, d = 1.34, p = 0.026; NHE: mean change 97 N, 95%CI 47 to 146 N, d = 1.77, p = 0.001). After pre-season, the NHE group improved their 5 m sprint time by 3.5% (±1.2%) and were 3.7% (±1.4%) and 2.0% (±0.5%) faster than the FLY group across 5 m and 10 m, respectively. At the end of pre-season, the FLY group improved maximal velocity by 3.4% (±1.4%) and improved horizontal force production by 9.7% in-season (±2.2%). Both a FLY and NHE intervention increase BFlh fascicle length and eccentric strength in Australian Footballers. An NHE intervention led to enhanced acceleration capacity. A FLY intervention was suggested to improve maximal sprint velocity and horizontal force production, without changes in sprint times. These findings have implications for hamstring injury prevention but also programs aimed at improving sprint performance.
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Affiliation(s)
- Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic., Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Vic., Australia
| | - Dean Filopoulos
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Vic., Australia
| | - Victor Nguyen
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Vic., Australia
| | - Jake Giannakis
- Strength and Conditioning Department, Collingwood Football Club, Melbourne, Vic., Australia
| | - Joshua D Ruddy
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic., Australia
| | - Jack T Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic., Australia
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic., Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Vic., Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Vic., Australia
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16
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Buckthorpe M. Recommendations for Movement Re-training After ACL Reconstruction. Sports Med 2021; 51:1601-1618. [PMID: 33840081 DOI: 10.1007/s40279-021-01454-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/18/2022]
Abstract
It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). Restoring movement quality during sporting-type movements is important prior to return-to-sport (RTS) after ACLR. Alterations in movement quality during an array of functional tasks are common amongst ACLR patients at or near the time of RTS and are associated with worse outcomes after ACLR. The inability to correct movement issues prior to RTS is likely due to the use of incomplete programmes or a lack of volume and intensity of movement re-training programmes. Although most clinicians and researchers understand that re-training movement after ACLR is important (e.g., the 'why'), there is often a disconnect with understanding the 'how' and 'what' of movement re-training post ACLR. The aim of this paper was to discuss factors relevant to movement dysfunction and re-training after ACLR and provide recommendations for clinicians to restore movement quality of patients after ACLR, prior to RTS. The paper recommends: (i) considering the factors which influence the expression of movement quality, which revolve around individual (e.g., neuromuscular, biomechanical, sensorimotor and neurocognitive factors), task-specific and environmental constraints; (ii) incorporating a three-staged movement re-training approach aligned to the ACLR functional recovery process: (1) addressing the neuromuscular and biomechanical and sensorimotor control factors which affect movement quality and motor learning, (2) including a progressive movement re-training approach to re-learn an array of functional tasks optimising coordination and motor learning (3) performing the final aspect of rehabilitation and movement training on the field, in realistic environments progressively simulating the sporting movement demands and environmental constraints; and (iii) effectively designing the movement programme for optimal load management, employing effective coach and feedback techniques and utilising qualitative movement analysis for transition between exercises, stages and for RTS.
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Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Health and Applied Science, St Marys University, Twickenham, London, TW1 4SX, UK.
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17
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Abstract
Outcomes following anterior cruciate ligament (ACL) reconstruction need improving, with poor return-to-sport rates and high risk of secondary re-injury. There is a need to improve rehabilitation strategies after ACL reconstruction, if we can support enhanced patient outcomes. This paper discusses how to optimise the mid-stage rehabilitation process after ACL reconstruction. Mid-stage is a difficult and vitally important stage of the functional recovery process and provides the foundation on which to commence late-stage rehabilitation training. Often many aspects of mid-stage rehabilitation (e.g. knee extensors isolated muscle strength) are not actually restored prior to return-to-sport. In addition, if we are to allow time for optimal late-stage rehabilitation and return-to-sport training, we need to optimise the mid-stage rehabilitation approach and complete it in a timely manner. This paper forms a key part of a strategy to optimise the ACL rehabilitation approach and considers factors more specific to mid-stage rehabilitation characterised in 3 areas: (1) muscle strength: muscle and joint specific, in particular at the knee level, with the knee extensors and flexors and distally with the triceps surae and proximally with the lumbo-pelvic-hip complex, as well as closed kinetic chain strength; (2) altered basic motor patterning (movement quality) and (3) fitness re-conditioning. In addition, the paper provides recommendations on how to implement these into practice, discussing training planning and programming and suggests specific screening to monitor work and when the athlete is able to progress to the next stage (e.g. late-stage rehabilitation criteria).
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18
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Static Stretching Intensity Does Not Influence Acute Range of Motion, Passive Torque, and Muscle Architecture. J Sport Rehabil 2021; 29:1-6. [PMID: 30300070 DOI: 10.1123/jsr.2018-0178] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/27/2018] [Accepted: 09/23/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Although stretching exercises are commonly used in clinical and athletic practice, there is a lack of evidence regarding the methodological variables that guide the prescription of stretching programs, such as intensity. OBJECTIVE To investigate the acute effects of different stretching intensities on the range of motion (ROM), passive torque, and muscle architecture. DESIGN Two-group pretest-posttest design. SETTING Laboratory. PARTICIPANTS Twenty untrained men were allocated into the low- or high-intensity group. MAIN OUTCOME MEASURES Subjects were evaluated for initial (ROMinitial) and maximum (ROMmax) discomfort angle, stiffness, viscoelastic stress relaxation, muscle fascicle length, and pennation angle. RESULTS The ROM assessments showed significant changes, in both groups, in the preintervention and postintervention measures both for the ROMinitial (P < .01) and ROMmax angle (P = .02). There were no significant differences for stiffness and viscoelastic stress relaxation variables. The pennation angle and muscle fascicle length were different between the groups, but there was no significant interaction. CONCLUSION Performing stretching exercises at high or low intensity acutely promotes similar gains in flexibility, that is, there are short-term/immediate gains in ROM but does not modify passive torque and muscle architecture.
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Hamstrings Muscle Morphology After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Sports Med 2021; 51:1733-1750. [PMID: 33638795 DOI: 10.1007/s40279-021-01431-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hamstrings muscle morphology is determinant of muscle function (i.e. strength). Among individuals with ACL reconstruction (ACLR), less cross-sectional area (CSA) and volume in the ACLR-limb are associated with muscle weakness, and may contribute to lower rates of return to preinjury activity level and an increased risk for long-term sequelae. OBJECTIVES To effectively treat muscular impairments, an accurate understanding of differences in hamstrings morphology following ACLR is needed. A systematic review and meta-analysis were undertaken to describe the morphology of the hamstring muscle complex after ACLR. METHODS We searched five databases for studies evaluating the difference between hamstrings size and architecture in individuals with ACLR. Two independent reviewers assessed each paper for inclusion and quality. Means and standard deviations were extracted from each included study to allow fixed-effect size meta-analysis calculations for comparison of results. RESULTS Twenty-four studies were included for final review. Eight categories of morphological outcomes were identified, and studies were grouped accordingly: (1) volume, (2) cross-sectional area (CSA), (3) muscle length, (4) muscle thickness, (5) fascicle length, (6) pennation angle, (7) fiber area, and (8) fiber type. Meta-analysis demonstrated lower hamstrings volume in the ACLR-limb in both contralateral and control group comparisons, and lower CSA, length, and thickness in the ACLR-limb in contralateral comparisons. The semitendinosus and gracilis were most profoundly impacted. Limited moderate evidence demonstrated greater biceps femoris pennation angle in the ACLR-limb. CONCLUSIONS Individuals with ACLR demonstrated large deficits in semitendinosus and gracilis muscle CSA and volume in the ACLR-limb compared contralaterally, with no differences observed in the biceps femoris or semimembranosus. Clinical implications regarding assessment and treatment of individuals with ACLR are discussed.
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20
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Dutaillis B, Maniar N, Opar DA, Hickey JT, Timmins RG. Lower Limb Muscle Size after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis. Sports Med 2021; 51:1209-1226. [PMID: 33492623 DOI: 10.1007/s40279-020-01419-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is known to have a number of deleterious effects on lower limb muscle function. Alterations in muscle size are one such effect that have implications towards reductions in strength and functioning of the lower limbs. However, a comprehensive analysis of alterations in muscle size has yet to be undertaken. OBJECTIVE To systematically review the evidence investigating lower limb muscle size in ACL injured limbs. DESIGN Systematic review DATA SOURCES: Database searches of Medline, SPORTDiscus, Embase, Cinahl and Web of Science as well as citation tracking and manual reference list searching. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Individuals with ACL deficient or reconstructed limbs with an assessment of lower limb muscle size and control limb data (contralateral or uninjured control group) METHODS: Risk of bias assessment was completed on included studies. Data were extracted and where possible meta-analyses performed. Best evidence synthesis was also undertaken. RESULTS 49 articles were included in this review, with 37 articles included in the meta-analyses. 66 separate meta-analyses were performed using various measures of lower limb muscle size. Across all measures, ACL deficient limbs showed lesser quadriceps femoris muscle size (d range = - 0.35 to - 0.40), whereas ACL reconstructed limbs showed lesser muscle size in the quadriceps femoris (d range = - 0.41 to - 0.69), vastus medialis (d = - 0.25), vastus lateralis (d = - 0.31), hamstrings (d = - 0.28), semitendinosus (d range = - 1.02 to - 1.14) and gracilis (d range = - 0.78 to - 0.99) when compared to uninjured limbs. CONCLUSION This review highlights the effect ACL injury has on lower limb muscle size. Regardless of whether an individual chooses a conservative or surgical approach, the quadriceps of the injured limb appear to have lesser muscle size compared to an uninjured limb. When undertaking reconstructive surgery with a semitendinosus/gracilis tendon graft, the harvested muscle shows lesser muscle size compared to the uninjured limb.
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Affiliation(s)
- Benjamin Dutaillis
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia.
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - Jack T Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia
| | - Ryan G Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, 17 Young Street, Fitzroy, VIC, 3065, Australia.,Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, VIC, 3065, Australia
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21
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Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction. Phys Ther Sport 2021; 48:209-218. [PMID: 33529930 DOI: 10.1016/j.ptsp.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction has a detrimental impact on athletic performance. Despite rehabilitation guidelines and criterion-based progressions to ensure safe restoration of fundamental physical capacities and maladaptive movement strategies, residual deficits in maximal strength, rate of force development (RFD), power and reactive strength are commonly reported. These combined with associated compensatory inter and intra-limb strategies increase the risk of re-injury. OBJECTIVE The aim of this article is to examine the relationships between fundamental physical capacities and biomechanical variables during dynamic movement tasks. DESIGN Narrative review. RESULTS The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS CONCLUSION: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS.
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Strength, rate of force development, power and reactive strength in adult male athletic populations post anterior cruciate ligament reconstruction - A systematic review and meta-analysis. Phys Ther Sport 2021; 47:91-104. [DOI: 10.1016/j.ptsp.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022]
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Recommendations for Hamstring Function Recovery After ACL Reconstruction. Sports Med 2020; 51:607-624. [PMID: 33332017 DOI: 10.1007/s40279-020-01400-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/09/2023]
Abstract
It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor function after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR.
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Ribeiro-Alvares JB, Oliveira GDS, De Lima-E-Silva FX, Baroni BM. Eccentric knee flexor strength of professional football players with and without hamstring injury in the prior season. Eur J Sport Sci 2020; 21:131-139. [DOI: 10.1080/17461391.2020.1743766] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- João Breno Ribeiro-Alvares
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gabriel Dos Santos Oliveira
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Felipe Xavier De Lima-E-Silva
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Messer DJ, Shield AJ, Williams MD, Timmins RG, Bourne MN. Hamstring muscle activation and morphology are significantly altered 1-6 years after anterior cruciate ligament reconstruction with semitendinosus graft. Knee Surg Sports Traumatol Arthrosc 2020; 28:733-741. [PMID: 31030253 DOI: 10.1007/s00167-019-05374-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/24/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Harvest of the semitendinosus (ST) tendon for anterior cruciate ligament reconstruction (ACLR) causes persistent hypotrophy of this muscle even after a return to sport, although it is unclear if hamstring activation patterns are altered during eccentric exercise. It was hypothesised that in comparison with contralateral control limbs, limbs with previous ACLR involving ST grafts would display (i) deficits in ST activation during maximal eccentric exercise; (ii) smaller ST muscle volumes and anatomical cross-sectional areas (ACSAs); and (iii) lower eccentric knee flexor strength. METHODS Fourteen athletes who had successfully returned to sport after unilateral ACLR involving ST tendon graft were recruited. Median time since surgery was 49 months (range 12-78 months). Participants underwent functional magnetic resonance imaging (MRI) of their thighs before and after the Nordic hamstring exercise (NHE) and percentage change in transverse (T2) relaxation time was used as an index of hamstring activation. Muscle volumes and ACSAs were determined from MRI and distal ST tendons were evaluated via ultrasound. Eccentric knee flexor strength was determined during the NHE. RESULTS Exercise-induced T2 change was lower for ST muscles in surgical than control limbs (95% CI - 3.8 to - 16.0%). Both ST muscle volume (95% CI - 57.1 to - 104.7 cm3) and ACSA (95% CI - 1.9 to - 5.0 cm2) were markedly lower in surgical limbs. Semimembranosus (95% CI 5.5-14.0 cm3) and biceps femoris short head (95% CI 0.6-11.0 cm3) volumes were slightly higher in surgical limbs. No between-limb difference in eccentric knee flexor strength was observed (95% CI 33 N to - 74 N). CONCLUSION ST activation is significantly lower in surgical than control limbs during eccentric knee flexor exercise 1-6 years after ACLR with ST graft. Lower levels of ST activation may partially explain this muscle's persistent hypotrophy post ACLR and have implications for the design of more effective rehabilitation programs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Daniel J Messer
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD, Australia.
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Morgan D Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
| | - Ryan G Timmins
- School of Exercise Sciences, Australian Catholic University, Melbourne, Australia
| | - Matthew N Bourne
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Wiesinger H, Gressenbauer C, Kösters A, Scharinger M, Müller E. Device and method matter: A critical evaluation of eccentric hamstring muscle strength assessments. Scand J Med Sci Sports 2020; 30:217-226. [PMID: 31593621 PMCID: PMC7003788 DOI: 10.1111/sms.13569] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/10/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022]
Abstract
Equivocal findings exist on isokinetic and Nordic hamstring exercise testing of eccentric hamstring strength capacity. Here, we propose a critical comparison of the mechanical output of hamstring muscles as assessed with either a dynamometer (IKD) or a Nordic hamstring device (NHD). Twenty-five volunteers (26 ± 3 years) took part in a counterbalanced repeated-measures protocol on both devices. Eccentric peak torque, work, angle of peak torque, bilateral strength ratios, and electromyography activity of the biceps femoris long head, semitendinosus and gastrocnemius muscles were assessed. There was a very poor correlation in eccentric peak torque between the devices (r < 0.58), with a systematic and proportional bias toward lower torque values on the IKD (~28%) and a high typical error (~19%) in IKD and NHD measurements comparison. Furthermore, participants performed a higher total eccentric work on IKD, reached peak torques at greater knee extension angles, and showed a greater side-to-side strength difference compared to the Nordic hamstring exercise. Gastrocnemius muscle activity was lower during the Nordic hamstring exercise. Reliability was low for work on NHD and for angle of peak torque and bilateral strength ratios on either device. We conclude that the evaluation of eccentric knee flexor strength depends on the testing conditions and even under standardized procedures, the IKD and NHD measure a different trait. Both tests have limitations in terms of assessing strength differences within an individual, and measurements of the angle of peak torque or side-to-side differences in eccentric knee flexor strength revealed low reliability and should be considered with caution.
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Affiliation(s)
| | | | - Alexander Kösters
- Department of Sport and Exercise ScienceUniversity of SalzburgSalzburgAustria
| | - Manuel Scharinger
- Department of Sport and Exercise ScienceUniversity of SalzburgSalzburgAustria
| | - Erich Müller
- Department of Sport and Exercise ScienceUniversity of SalzburgSalzburgAustria
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Nelson CM, Marchese V, Rock K, Henshaw RM, Addison O. Alterations in Muscle Architecture: A Review of the Relevance to Individuals After Limb Salvage Surgery for Bone Sarcoma. Front Pediatr 2020; 8:292. [PMID: 32612962 PMCID: PMC7308581 DOI: 10.3389/fped.2020.00292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
Osteosarcoma and Ewing's sarcoma are the most common primary bone malignancies affecting children and adolescents. Optimal treatment requires a combination of chemotherapy and/or radiation along with surgical removal when feasible. Advances in multiple aspects of surgical management have allowed limb salvage surgery (LSS) to supplant amputation as the most common procedure for these tumors. However, individuals may experience significant impairment after LSS, including deficits in range of motion and strength that limit function and impact participation in work, school, and the community, ultimately affecting quality of life. Muscle force and speed of contraction are important contributors to normal function during activities such as gait, stairs, and other functional tasks. Muscle architecture is the primary contributor to muscle function and adapts to various stimuli, including periods of immobilization-protected weightbearing after surgery. The impacts of LSS on muscle architecture and how adaptations may impact deficits within the rehabilitation period and into long-term survivorship is not well-studied. The purpose of this paper is to [1] provide relevant background on bone sarcomas and LSS, [2] highlight the importance of muscle architecture, its measurement, and alterations as seen in other relevant populations and [3] discuss the clinical relevance of muscle architectural changes and the impact on muscle dysfunction in this population. Understanding the changes that occur in muscle architecture and its impact on long-term impairments in bone sarcoma survivors is important in developing new rehabilitation treatments that optimize functional outcomes.
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Affiliation(s)
- Christa M Nelson
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kelly Rock
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Robert M Henshaw
- Department of Orthopedic Oncology, MedStar Georgetown Orthopedic Institute, Washington, DC, United States.,Department of Orthopedic Oncology, Children's National Medical Center, Washington, DC, United States
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States.,Baltimore VA GRECC, Baltimore, MD, United States
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Effects of a 12-Week Chronic Stretch Training Program at Different Intensities on Joint and Muscle Mechanical Responses: A Randomized Clinical Trial. J Sport Rehabil 2019; 29:904-912. [PMID: 31648203 DOI: 10.1123/jsr.2018-0443] [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: 11/27/2018] [Revised: 05/27/2019] [Accepted: 08/18/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Stretching intensity is an important variable that can be manipulated with flexibility training. However, there is a lack of evidence regarding this variable and its prescription in stretching programs. OBJECTIVE To investigate the effects of 12 weeks of knee flexor static stretching at different intensities on joint and muscle mechanical properties. DESIGN A randomized clinical trial. SETTING Laboratory. PARTICIPANTS A total of 14 untrained men were allocated into the low- or high-intensity group. MAIN OUTCOME MEASURES Assessments were performed before, at 6 week, and after intervention (12 wk) for biceps femoris long head architecture (resting fascicle length and angle), knee maximal range of motion (ROM) at the beginning and maximal discomfort angle, knee maximal tolerated passive torque, joint passive stiffness, viscoelastic stress relaxation, knee passive torque at a given angle, and affective responses to training. RESULTS No significant differences were observed between groups for any variable. ROM at the beginning and maximal discomfort angle increased at 6 and 12 weeks, respectively. ROM significantly increased with the initial angle of discomfort (P < .001, effect size = 1.38) over the pretest measures by 13.4% and 14.6% at the 6- and 12-week assessments, respectively, and significantly improved with the maximal discomfort angle (P < .001, effect size = 1.25) by 15.6% and 18.8% from the pretest to the 6- and 12-week assessments, respectively. No significant effects were seen for muscle architecture and affective responses. Initial viscoelastic relaxation for the low-intensity group was lower than ending viscoelastic relaxation. CONCLUSION These results suggest that stretching with either low or high discomfort intensities are effective in increasing joint maximal ROM, and that does not impact on ROM, stiffness, fascicle angle and length, or affective response differences.
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Martin-Alguacil JL, Arroyo-Morales M, Martin-Gómez JL, Lozano-Lozano M, Galiano-Castillo N, Cantarero-Villanueva I. Comparison of knee sonography and pressure pain threshold after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:260-265. [PMID: 31201076 PMCID: PMC6738273 DOI: 10.1016/j.aott.2019.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 03/05/2019] [Accepted: 04/28/2019] [Indexed: 12/16/2022]
Abstract
Objective The aim of this study was to compare the pressure pain threshold and muscle architecture after an anatomic single bundle reconstruction with quadriceps tendon and hamstring tendon autografts of the anterior cruciate ligament in competitive soccer players. We hypothesized that both procedures will obtain similar outcomes. Methods Fifty-one participants were enrolled in this secondary analysis of a randomized controlled trial and were categorised into two groups: quadriceps tendon (QT) group (23 men and 3 women; mean age 18.7 ± 3.6; BMI 23.0 ± 2.2) or hamstring tendon (HT) group (16 men and 9 women; mean age 19.2 ± 3.6 BMI 23.5 ± 3.5). Both groups followed the same rehabilitation staged protocol. Pressure pain threshold (PPT), as a measure of perceived pain, was obtained in several points of quadriceps and hamstring muscles. Ultrasound imaging measurements were obtained in quadriceps tendon and knee cartilage thickness. Four measurements were taken in this study: baseline, 1, 3, 6, and 12 months after the anterior cruciate ligament (ACL) reconstruction. Results The analysis of PPT did not find significant differences in both groups × interaction time in the points evaluated: epicondyle (QT = 421.1 ± 184.1 vs HT = 384.7 ± 154.1 kPa), vastus lateralis (QT = 576.2 ± 221.3 vs HT = 560.1 ± 167.7 kPa), vastus medialis (QT = 544.7 ± 198.8 vs HT = 541.1.1 ± 181.77 kPa), patellar tendon (QT = 626.3 ± 221.1 vs HT = 665.0 ± 205.5 kPa), QT (QT = 651.1 ± 276.9 vs HT = 660.0 ± 195.2 kPa). (QT = 667.8 ± 284.7 vs HT = 648.2 ± 193.4 kPa) injured knee (all P > 0.05). The results of ultrasound imaging did not show significant differences in both groups × interaction time in the thickness of the QT (QT = 9.9 ± 2.4 vs HT = 9.4 ± 1.7 kPa) and patellar cartilage (QT = 3.2 ± 0.6 vs HT = 3.2 ± 0.4 kPa) (P > 0.05). Conclusion A QT autograft produces similar results to a HT autograft in ACL reconstructions in terms of pressure pain threshold and ultrasound muscle architecture during the 1-year follow-up. Level of Evidence Level I, Therapeutic Study.
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Pimenta R, Blazevich AJ, Freitas SR. Biceps Femoris Long-Head Architecture Assessed Using Different Sonographic Techniques. Med Sci Sports Exerc 2019; 50:2584-2594. [PMID: 30067589 DOI: 10.1249/mss.0000000000001731] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the repeatability of, and measurement agreement between, four sonographic techniques used to quantify biceps femoris long head (BFlh) architecture: (i) static-image with linear extrapolation; extended field-of-view (EFOV) with linear ultrasound probe path (linear-EFOV), using either (ii) straight or (iii) segmented analyses; and (iv) EFOV with nonlinear probe path and segmented analysis (nonlinear-EFOV) to follow the complex fascicle trajectories. METHODS Twenty individuals (24.4 ± 5.7 yr; 175 ± 0.8 cm; 73 ± 9.0 kg) without history of hamstrings strain injury were tested in two sessions separated by 1 h. An ultrasound scanner coupled with 6-cm linear probe was used to assess BFlh architecture in B-mode. RESULTS The ultrasound probe was positioned at 52.0% ± 5.0% of femur length and 57.0% ± 6.0% of BFlh length. We found an acceptable repeatability when assessing BFlh fascicle length (ICC3,k = 0.86-0.95; SEM = 1.9-3.2 mm) and angle (ICC3,k = 0.86-0.97; SEM = 0.8°-1.1) using all sonographic techniques. However, the nonlinear-EFOV technique showed the highest repeatability (fascicle length ICC3,k = 0.95; fascicle angle, ICC3,k = 0.97). The static-image technique, which estimated 35.4% ± 7.0% of the fascicle length, overestimated fascicle length (8%-11%) and underestimated fascicle angle (8%-9%) compared with EFOV techniques. Also, the rank order of individuals varied by approximately 15% between static-image and nonlinear-EFOV (segmented) when assessing the fascicle length. CONCLUSIONS Although all techniques showed good repeatability, absolute errors were observed using static-image (7.9 ± 6.1 mm for fascicle length) and linear-EFOV (between 3.7 ± 3.0 and 4.2 ± 3.7 mm), probably because the complex fascicle trajectories were not followed. The rank order of individuals for fascicle length and angle were also different between static-image and nonlinear-EFOV, so different muscle function and injury risk estimates could likely be made when using this technique.
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Affiliation(s)
- Ricardo Pimenta
- Faculty of Human Kinetic, University of Lisbon, Cruz-Quebrada, Dafundo, PORTUGAL
| | - Anthony J Blazevich
- Edith Cowan University, Centre for Exercise and Sports Science Research (CESSR), School of Medical and Health Sciences, Joondalup, AUSTRALIA
| | - Sandro R Freitas
- Faculty of Human Kinetic, University of Lisbon, Cruz-Quebrada, Dafundo, PORTUGAL
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Eccentric knee flexor weakness in elite female footballers 1-10 years following anterior cruciate ligament reconstruction. Phys Ther Sport 2019; 37:144-149. [PMID: 30959444 DOI: 10.1016/j.ptsp.2019.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine eccentric knee flexor strength in elite female Australian Rules Football (ARF) players with and without a history of unilateral anterior cruciate ligament reconstruction (ACLR) using an ipsilateral semitendinosus graft. DESIGN Case-control. SETTING Elite ARF Women's competition. PARTICIPANTS Eighty-four elite female ARF players (mean age, 25 ± 4.9 years; height, 1.71 ± 0.73 m; weight, 67 kg ± 7.4 kg) with (n = 12) and without (n = 72) a history of unilateral ACLR in the previous 10 years. MAIN OUTCOME MEASURES Peak eccentric knee flexor force during the Nordic hamstring exercise (NHE). RESULTS Players with a history of unilateral ACLR displayed lower levels of eccentric knee flexor strength in their surgically reconstructed limb than their uninjured contralateral limb (mean difference -53.77 N, 95% CI = -85.06 to -24.27, d = -0.51) and compared to the limbs of players with no history of injury (mean difference = -46.32 N, 95% CI = -86.65 to -11.13, d = -0.73). CONCLUSION Elite female ARF players with a history of unilateral ACLR display deficits in eccentric knee flexor strength in their surgically reconstructed limb for up to 10 years following surgery.
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Kellis E. Intra- and Inter-Muscular Variations in Hamstring Architecture and Mechanics and Their Implications for Injury: A Narrative Review. Sports Med 2019; 48:2271-2283. [PMID: 30117053 DOI: 10.1007/s40279-018-0975-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Understanding the architecture, anatomy, and biomechanics of the hamstrings may assist in explaining the mechanisms that affect and improve their function. The aim of this review is to specifically examine intra- and inter-muscular variations in architecture and mechanical properties of the hamstrings. Of the hamstrings, the long head of the biceps femoris shows the shortest and more pennated fibers. The semimembranosus has a similar muscle architecture with a long head of the biceps femoris but it has a different proximal attachment as well as a different moment arm compared with the long head of the biceps femoris. For the same joint motion, the semitendinosus displays less relative strain than the other hamstrings probably owing to a greater length, longer fascicles and, possibly, a longer tendon. Intra-muscular variations in architecture are documented but their implications are currently unclear. Proximally, the long head of the biceps femoris has shorter and more pennated fibers coupled with a narrower aponeurosis than distally, while the semitendinosus is the only muscle that entails a tendinous inscription. In conclusion, some of the identified intra- and inter-muscular variations in architecture may help explain why some muscles sustain injuries more than others. In the same line, exercises designed for the hamstrings may not provide the same stimulus for all components of this muscle group. Future research could examine whether intervention strategies that target specific muscles or specific areas of the hamstrings may offer additional benefits for injury prevention or rehabilitation of their function.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, 62110, Greece.
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Aeles J, Lichtwark GA, Lenchant S, Vanlommel L, Delabastita T, Vanwanseele B. Information from dynamic length changes improves reliability of static ultrasound fascicle length measurements. PeerJ 2017; 5:e4164. [PMID: 29259845 PMCID: PMC5733898 DOI: 10.7717/peerj.4164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose Various strategies for improving reliability of fascicle identification on ultrasound images are used in practice, yet these strategies are untested for effectiveness. Studies suggest that the largest part of differences between fascicle lengths on one image are attributed to the error on the initial image. In this study, we compared reliability results between different strategies. Methods Static single-image recordings and image sequence recordings during passive ankle rotations of the medial gastrocnemius were collected. Images were tracked by three different raters. We compared results from uninformed fascicle identification (UFI) and results with information from dynamic length changes, or data-informed tracking (DIT). A second test compared tracking of image sequences of either fascicle shortening (initial-long condition) or fascicle lengthening (initial-short condition). Results Intra-class correlations (ICC) were higher for the DIT compared to the UFI, yet yielded similar standard error of measurement (SEM) values. Between the initial-long and initial-short conditions, similar ICC values, coefficients of multiple determination, mean squared errors, offset-corrected mean squared errors and fascicle length change values were found for the DIT, yet with higher SEM values and greater absolute fascicle length differences between raters on the first image in the initial-long condition and on the final image in the initial-short condition. Conclusions DIT improves reliability of fascicle length measurements, without lower SEM values. Fascicle length on the initial image has no effect on subsequent tracking results. Fascicles on ultrasound images should be identified by a single rater and care should be taken when comparing absolute fascicle lengths between studies.
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Affiliation(s)
- Jeroen Aeles
- Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Glen A Lichtwark
- School of Human Movement Studies, University of Queensland, Brisbane, Australia
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Kellis E. Biceps femoris fascicle length during passive stretching. J Electromyogr Kinesiol 2017; 38:119-125. [PMID: 29223017 DOI: 10.1016/j.jelekin.2017.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to quantify the relative changes in fascicle (FL) and muscle-tendon unit (LMTU) length of the long head of the biceps femoris (BFlh) at different combinations of hip and knee joint positions. Fourteen participants performed passive knee extension trials from 0°, 45° and 90° of hip flexion. FL, LMTU, pennation angle (PA) and effective FL (FL multiplied by the cosine of the PA) of the BFlh were quantified using ultrasonography (US). Three-way analysis of variance designs indicated that at each hip angle, FL and LMTU increased and PA decreased from 90° to 0° of knee flexion. Increasing hip flexion angle from 0° to 90° led to a higher FL and LMTU and a lower PA (p < .05). The average lengthening of the LMTU and effective FL was 28.00 ± 1.82% and 85.88 ± 21.92%, respectively. The average effective FL change accounted for 51.36 ± 7.39% of LMTU change. The relationship between effective FL and LMTU was almost linear with a slope equal to 0.49 ± 0.06 (r2 = 0.52 to 0.97). To achieve greater lengthening of the fascicles of the BFlh, passive stretch with the hip flexed at least 45° and the knee reaching full extension is necessary.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece.
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TIMMINS RYANG, BOURNE MATTHEWN, HICKEY JACKT, MANIAR NIRAV, TOFARI PAULJ, WILLIAMS MORGAND, OPAR DAVIDA. Effect of Prior Injury on Changes to Biceps Femoris Architecture across an Australian Football League Season. Med Sci Sports Exerc 2017; 49:2102-2109. [DOI: 10.1249/mss.0000000000001333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kellis E, Ellinoudis A, Intziegianni K. Reliability of Sonographic Assessment of Biceps Femoris Distal Tendon Strain during Passive Stretching. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1769-1779. [PMID: 28606648 DOI: 10.1016/j.ultrasmedbio.2017.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/15/2017] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to determine the intra-rater, inter-examiner and inter-observer reliability of biceps femoris long head (BFlh) tendon strain using ultrasound imaging. Nineteen patients (age: 20.4 ± 0.35 y) were tested twice with a 1-wk interval. Each session included passive stretching from three different hip positions. Tests were performed independently by two examiners while BFlh tendon displacement (mm) and strain (%) were manually extracted from ultrasound video footages by two observers. Intra-rater comparisons revealed an intra-class correlation coefficient (ICC2,1) range of 0.87 to 0.98 and a variability less than 4.74%. Inter-examiner comparisons revealed an ICC2,1 range of 0.83 to 0.99 and less than 4.69% variability. Inter-observer ICCs ranged from 0.93 to 0.97 with variability less than 4.89%. Using a well-defined scanning protocol, two experienced examiners attained high levels of intra-rater agreement, with similarly excellent results for inter-rater and inter-observer reliability for BFlh tendon displacement and strain.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Serres, Greece.
| | - Athanasios Ellinoudis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Konstantina Intziegianni
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
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Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. Br J Sports Med 2017; 51:1189-1194. [PMID: 28259848 DOI: 10.1136/bjsports-2016-097177] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review the literature to identify risk factors for calf strain injury, and to direct future research into calf muscle injuries. DESIGN Systematic review DATA SOURCES: Database searches conducted for Medline, CINAHL, EMBASE, AMED, AUSPORT, SportDiscus, PEDro and Cochrane Library. Manual reference checks, ahead of press searches, citation tracking. From inception to June 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies evaluating and presenting data related to intrinsic or extrinsic risk factors for sustaining future calf injury. RESULTS Ten studies were obtained for review. Subjects across football, Australian football, rugby union, basketball and triathlon were reported on, representing 5397 athletes and 518 calf/ lower leg muscle injuries. Best evidence synthesis highlights chronological age and previous history of calf strain are the strongest risk factors for future calf muscle injury. Previous lower limb injuries (hamstring, quadriceps, adductor, knee) show some limited evidence for an association. Numerous factors lack evidence of an association, including height, weight, gender and side dominance. SUMMARY/CONCLUSION Increasing age and previous calf strain injury are the most predictive of future calf injury. The overall paucity of evidence and the trend for studies of a high risk of bias show that further research needs to be undertaken.
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Affiliation(s)
- Brady Green
- Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
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