High-threshold motor unit firing reflects force recovery following a bout of damaging eccentric exercise

Beyond Efficiency: Surface Electromyography Enables Further Insights into the Surgical Movements of Urologists

INTRODUCTION

Surgical skill evaluation while performing minimally invasive surgeries is a highly complex task. It is important to objectively assess an individual's technical skills throughout surgical training to monitor progress and to intervene when skills are not commensurate with the year of training. The miniaturization of wireless wearable platforms integrated with sensor technology has made it possible to non-invasively assess muscle activations and movement variability during performance of minimally invasive surgical tasks. Our objective was to use electromyography to deconstruct the motions of a surgeon during robotic suturing and distinguish quantifiable movements that characterize the skill of an experienced, expert urologic surgeon from trainees.

METHODS

Three skill groups of participants: novice (n=11), intermediate (n=12) and expert (n=3) were enrolled in the study. A total of 12 wireless wearable sensors consisting of surface electromyograms (EMGs) and accelerometers were placed along upper extremity muscles to assess muscle activations and movement variability, respectively. Participants then performed a robotic suturing task.

RESULTS

EMG-based parameters: total time, dominant frequency, cumulative muscular workload (CMW were significantly different across the three skill groups. We also found nonlinear movement variability parameters such as correlation dimension, Lyapunov exponent trended differently across the three skill groups.

CONCLUSIONS

These findings suggest that economy of motion variables and nonlinear movement variabilities are affected by surgical experience level. Wearable sensor signal analysis could make it possible to objectively evaluate surgical skill level periodically throughout the residency training experience.

SV, John EB. Evaluation of surgical skill using machine learning with optimal wearable sensor locations

Evaluation of surgical skills during minimally invasive surgeries is needed when recruiting new surgeons. Although surgeons’ differentiation by skill level is highly complex, performance in specific clinical tasks such as pegboard transfer and knot tying could be determined using wearable EMG and accelerometer sensors. A wireless wearable platform has made it feasible to collect movement and muscle activation signals for quick skill evaluation during surgical tasks. However, it is challenging since the placement of multiple wireless wearable sensors may interfere with their performance in the assessment. This study utilizes machine learning techniques to identify optimal muscles and features critical for accurate skill evaluation. This study enrolled a total of twenty-six surgeons of different skill levels: novice (n = 11), intermediaries (n = 12), and experts (n = 3). Twelve wireless wearable sensors consisting of surface EMGs and accelerometers were placed bilaterally on bicep brachii, tricep brachii, anterior deltoid, flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), and thenar eminence (TE) muscles to assess muscle activations and movement variability profiles. We found features related to movement complexity such as approximate entropy, sample entropy, and multiscale entropy played a critical role in skill level identification. We found that skill level was classified with highest accuracy by i) ECU for Random Forest Classifier (RFC), ii) deltoid for Support Vector Machines (SVM) and iii) biceps for Naïve Bayes Classifier with classification accuracies 61%, 57% and 47%. We found RFC classifier performed best with highest classification accuracy when muscles are combined i) ECU and deltoid (58%), ii) ECU and biceps (53%), and iii) ECU, biceps and deltoid (52%). Our findings suggest that quick surgical skill evaluation is possible using wearables sensors, and features from ECU, deltoid, and biceps muscles contribute an important role in surgical skill evaluation.

Changes in torque complexity and maximal torque after a fatiguing exercise protocol

Torque outputs exhibit non-random fluctuations in their temporal structure, i.e., complexity. Fatigue has been shown to alter this structure. The torque outputs typically become more regular, resulting in decreased adaptability. Importantly, torque complexity was shown a different recovery pattern after fatigue compared to maximal torque. However, it remains to be understood if these uncoupled patterns of recovery are muscle dependent. In addition, it also remains to be investigated if changes in maximal torque and complexity are correlated. This study investigated (i) the effects of a fatiguing protocol on the complexity and maximal torque from plantar flexors and (ii) the relationship between changes in these two outputs. Ten participants visited the laboratory, and measures were taken at baseline, immediately after, 1 h after and 24 h after the fatiguing protocol. Maximum voluntary contraction, isometric contractions at 30% of maximum and pain pressure threshold were collected. Both legs were assessed, but only one was given the fatiguing protocol. Two-way ANOVAs and correlations were conducted. The fatiguing protocol decreased torque complexity (~35%) and maximal torque (~20%), and they exhibited uncoupled patterns of recovery. Moreover, the correlation analysis showed no correlation between changes in these parameters. These findings support that these parameters are independent of each other.

The role of the neural stimulus in regulating skeletal muscle hypertrophy

Resistance training is frequently performed with the goal of stimulating muscle hypertrophy. Due to the key roles motor unit recruitment and mechanical tension play to induce muscle growth, when programming, the manipulation of the training variables is oriented to provoke the correct stimulus. Although it is known that the nervous system is responsible for the control of motor units and active muscle force, muscle hypertrophy researchers and trainers tend to only focus on the adaptations of the musculotendinous unit and not in the nervous system behaviour. To better guide resistance exercise prescription for muscle hypertrophy and aiming to delve into the mechanisms that maximize this goal, this review provides evidence-based considerations for possible effects of neural behaviour on muscle growth when programming resistance training, and future neurophysiological measurement that should be tested when training to increase muscle mass. Combined information from the neural and muscular structures will allow to understand the exact adaptations of the muscle in response to a given input (neural drive to the muscle). Changes at different levels of the nervous system will affect the control of motor units and mechanical forces during resistance training, thus impacting the potential hypertrophic adaptations. Additionally, this article addresses how neural adaptations and fatigue accumulation that occur when resistance training may influence the hypertrophic response and propose neurophysiological assessments that may improve our understanding of resistance training variables that impact on muscular adaptations.

Changes in electromyographic activity, mechanical power, and relaxation rates following inspiratory ribcage muscle fatigue

Muscle fatigue is a complex phenomenon enclosing various mechanisms. Despite technological advances, these mechanisms are still not fully understood in vivo. Here, simultaneous measurements of pressure, volume, and ribcage inspiratory muscle activity were performed non-invasively during fatigue (inspiratory threshold valve set at 70% of maximal inspiratory pressure) and recovery to verify if inspiratory ribcage muscle fatigue (1) leads to slowing of contraction and relaxation properties of ribcage muscles and (2) alters median frequency and high-to-low frequency ratio (H/L). During the fatigue protocol, sternocleidomastoid showed the fastest decrease in median frequency and slowest decrease in H/L. Fatigue was also characterized by a reduction in the relative power of the high-frequency and increase of the low-frequency. During recovery, changes in mechanical power were due to changes in shortening velocity with long-lasting reduction in pressure generation, and slowing of relaxation [i.e., tau (τ), half-relaxation time (½RT), and maximum relaxation rate (MRR)] was observed with no significant changes in contractile properties. Recovery of median frequency was faster than H/L, and relaxation rates correlated with shortening velocity and mechanical power of inspiratory ribcage muscles; however, with different time courses. Time constant of the inspiratory ribcage muscles during fatigue and recovery is not uniform (i.e., different inspiratory muscles may have different underlying mechanisms of fatigue), and MRR, ½RT, and τ are not only useful predictors of inspiratory ribcage muscle recovery but may also share common underlying mechanisms with shortening velocity.

Resistance Training to Failure vs. Not to Failure: Acute and Delayed Markers of Mechanical, Neuromuscular, and Biochemical Fatigue

ABSTRACT

González-Hernández, JM, García-Ramos, A, Colomer-Poveda, D, Tvarijonaviciute, A, Cerón, J, Jiménez-Reyes, P, and Márquez, G. Resistance training to failure vs. not to failure: acute and delayed markers of mechanical, neuromuscular, and biochemical fatigue. J Strength Cond Res 35(4): 886-893, 2021-This study aimed to compare acute and delayed markers of mechanical, neuromuscular, and biochemical fatigue between resistance training sessions leading to or not to failure. Twelve resistance-trained men completed 2 sessions that consisted of 6 sets of the full-squat exercise performed against the 10 repetitions maximum load. In a randomized order, in one session the sets were performed to failure and in the other session the sets were not performed to failure (5 repetitions per set). Mechanical fatigue was quantified through the recording of the mean velocity during all repetitions. The neuromuscular function of the knee extensors was assessed through a maximal voluntary contraction and the twitch interpolation technique before training, immediately after each set, and 1, 24, and 48 hours post-training. Serum creatine kinase (CK) and aspartate aminotransferase (AST) were measured before training and 1, 24, and 48 hours post-training to infer muscle damage. Alpha was set at a level of 0.05. A higher velocity loss between sets was observed during the failure protocol (-21.7%) compared with the nonfailure protocol (-3.5%). The markers of peripheral fatigue were generally higher and long lasting for the failure protocol. However, the central fatigue assessed by the voluntary activation was comparable for both protocols and remained depressed up to 48 hours post-training. The concentrations of CK and AST were higher after the failure protocol revealing higher muscle damage compared with the nonfailure protocol. These results support the nonfailure protocol to reduce peripheral fatigue and muscle damage, whereas the central fatigue does not seem to be affected by the set configuration.

Exercise-induced muscle damage: mechanism, assessment and nutritional factors to accelerate recovery

There have been a multitude of reviews written on exercise-induced muscle damage (EIMD) and recovery. EIMD is a complex area of study as there are a host of factors such as sex, age, nutrition, fitness level, genetics and familiarity with exercise task, which influence the magnitude of performance decrement and the time course of recovery following EIMD. In addition, many reviews on recovery from exercise have ranged from the impact of nutritional strategies and recovery modalities, to complex mechanistic examination of various immune and endocrine signaling molecules. No one review can adequately address this broad array of study. Thus, in this present review, we aim to examine EIMD emanating from both endurance exercise and resistance exercise training in recreational and competitive athletes and shed light on nutritional strategies that can enhance and accelerate recovery following EIMD. In addition, the evaluation of EIMD and recovery from exercise is often complicated and conclusions often depend of the specific mode of assessment. As such, the focus of this review is also directed at the available techniques used to assess EIMD.

Muscle length influence on rectus femoris damage and protective effect in knee extensor eccentric exercise

This study tested the hypothesis that the magnitude of rectus femoris (RF) damage and the repeated bout effect (RBE) would be greater after knee extensor eccentric exercise performed in a supine (long RF lengths) than a sitting (short RF lengths) position, and the muscle length effects would be more prominent at the proximal than distal RF. Young untrained men were placed to one of the two groups (n = 14 per group). S group performed the knee extensor eccentric exercise in the sitting position for the first bout and the supine position for the second bout, and L group performed the exercise in the supine position for two bouts, with 4 weeks between bouts. Dependent variables included evoked and maximal voluntary isometric contraction (MVC) torque, electromyography (EMG) during MVC, muscle soreness, and shear modulus, which were measured before and 1‐3 days after each exercise bout. After the first bout, L group in comparison with S group showed greater (P < .05) changes in hip flexor MVC torque (average of 1‐3 days post‐exercise: −11.1 ± 9.4% vs −5.0 ± 7.5%), proximal RF EMG (−22.4 ± 16% vs −9.0 ± 21.9%), and proximal RF shear modulus (33.2 ± 22.8% vs 16.9 ± 13.5%). No significant differences between groups were evident for any of other variables after the first bout including knee extensor MVC torque, and for the changes in all variables after the second bout. These results supported the hypothesis that RF damage would be greater for the spine than sitting position especially at the proximal region, but did not support the hypothesis about the RBE.

EFFECT OF AQUATIC EXERCISE AFTER ECCENTRIC CONTRACTION-INDUCED MUSCLE INJURY

ABSTRACT Introduction: Muscle microlesions produced by eccentric contractions (EC) cause changes in strength, endurance, power and neuromuscular activity parameters for an extended period of time. Objectives: To investigate the effect of aquatic exercise after EC-induced muscle injury on strength, endurance, power and neuromuscular activity parameters. Methods: A cross-sectional experimental study with six subjects (age 25 ± 4 years, weight 77 ± 4kg and height of 162 ± 2 cm) with EC-induced muscle injury followed up during a recovery period (48h, 72h and 96h) without intervention (Group 1A) and involving aquatic exercises (Group 1B). Dynamic and isometric strength, muscular endurance, and vertical/horizontal power tests as well as vastus lateralis neuromuscular activity measurements were performed before, immediately after, and during the recovery period. Results: Our results indicate that the intervention in Group 1B, when compared to Group 1A, accelerated the recovery of dynamic (p <0.01) and isometric (p <0.03) strength at 48h and 72h, increased vertical power at 48h (p <0.05) and horizontal power at 48h and 72h (p <0.05), and reduced neuromuscular activity (p <0.05) at 48h and 72h after EC. Conclusions: According to our findings, performing aquatic exercises during the recovery period improves muscle efficiency and accelerates strength, power and neuromuscular activity recovery. Level of evidence l; Randomized clinical trial.