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Kim M, Yang HM, Yeo IS. Anatomical study of the sacrotuberous ligament and the hamstring muscles: A histomorphological analysis. Clin Anat 2024; 37:383-389. [PMID: 37329174 DOI: 10.1002/ca.24082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
The sacrotuberous ligament (STL) and the hamstrings are important structures that are mutually connected and influenced by the pelvis. However, the anatomical connectivity and histological characteristics of these structures remain unclear. The present study aimed to comprehensively investigate the relationship between the STL and the proximal hamstrings through histological analysis. Sixteen specimens were obtained from eight fresh cadavers (mean age at death, 73.4 years). Verhoeff Van Gieson, Masson's trichrome, and immunohistochemical staining were used to analyze the connectivity between the STL and the hamstrings and to verify the ratios of collagen and elastic fibers. Dense connective tissue that overlapped tightly between the STL and hamstrings was observed. The relative ratios of collagen and elastic fibers between the STL and hamstrings characteristically identified regional differences. The ratio of elastic fibers to collagen in the biceps femoris (BF) was ~38.6 ± 4.7%, and the lowest ratio was 5.9 ± 2.6% observed in the semimembranosus (SM). In the case of the BF, contractibility is well-regulated due to a high content of elastic fibers; however, the muscular structure of the BF is relatively fragile due to the low content of collagen. In the SM, collagen content is higher than that in the STL. This ratio of elastic fibers in the collagen analysis could provide crucial information for understanding the differences in hamstring contractility and maintaining the morphology of these structures.
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Affiliation(s)
- Miri Kim
- Translational Laboratory for Clinical Anatomy, Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hun-Mu Yang
- Translational Laboratory for Clinical Anatomy, Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
- Surgical Anatomy Education Centre, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In-Seung Yeo
- Translational Laboratory for Clinical Anatomy, Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
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Pang SC, Iqbal ZA, Chow DHK. Comparison of muscle activity in school students while carrying backpacks and trolley bags. Work 2024; 79:683-694. [PMID: 38552131 DOI: 10.3233/wor-230628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Trolley bags have gained popularity among students, but there is limited research comparing them to backpack-style school bags. OBJECTIVE This study aimed to compare how carrying a backpack versus a trolley bag affects the activity of trunk and lower limb muscles in secondary school students. METHODS Electromyographic activity was measured in 25 students (13.4±1.1 years) as they walked on level ground and up/down stairs while carrying both types of bags. The activity of the gastrocnemius, tibialis anterior, semitendinosus, rectus femoris, lumbar erector spinae, and rectus abdominis muscles was assessed on both the dominant and non-dominant sides. RESULTS The study found significantly reduced muscle activation in most of the targeted muscles when walking on level ground with the trolley bag and when going up/down stairs with the backpack. CONCLUSIONS Lifting a trolley bag depends on the slope of the walking surface and is more efficient on level ground, while carrying a backpack is more efficient when going up and down stairs. Since it is not practical to switch bags when encountering stairs in schools, a bag with a mixed model design incorporating features of both trolley and backpack may be more beneficial and practical for students to use. Students, parents, and teachers should be aware of the injury risks associated with carrying different types of bags.
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Affiliation(s)
- Siu-Chuen Pang
- Lee Shau Kee School of Business and Administration, Hong Kong Metropolitan University, Hong Kong SAR
| | - Zaheen Ahmed Iqbal
- Department of Health & Physical Education, The Education University of Hong Kong, Hong Kong SAR
| | - Daniel Hung-Kay Chow
- Department of Health & Physical Education, The Education University of Hong Kong, Hong Kong SAR
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Fukunaga T, Fedge C, Tyler T, Mullaney M, Schmitt B, Orishimo K, McHugh M, Nicholas S. Flexor-Pronator Mass Training Exercises Selectively Activate Forearm Musculature. Int J Sports Phys Ther 2023; 18:208-214. [PMID: 36793573 PMCID: PMC9897040 DOI: 10.26603/001c.68073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose/Hypothesis The flexor-pronator mass of the forearm contributes dynamic stability to the medial elbow. Training this muscle group is essential for overhead athletes, however, there is lack of evidence supporting use of training exercises. The purpose of this study was to measure the extent of EMG activity of the flexor pronator musculature during two distinct forearm strengthening exercises using resistance bands. It was hypothesized that two exercises would elicit at least moderate level of muscle activity, but the activation would be different in the pronator versus the flexor muscles. Materials/Methods 10 healthy subjects (all males, age 36±12 years) were included. Surface EMG activity was measured on three muscles of the dominant-side forearm: flexor carpi ulnaris (FCP), flexor digitorum superficialis (FDS), and pronator teres (PT). After measurement of maximal voluntary contraction (MVC) for each muscle, subjects performed wrist ulnar deviation and forearm pronation exercises using elastic band resistance. Resistance was set to elicit moderate exertion (5/10 on the Borg CR10 scale). Order of exercise was randomized and three repetitions of each exercise were performed. Mean peak EMG activity in each muscle across repetitions during the eccentric phase of each exercise was calculated and expressed as a percentage of MVC. Moderate level of activity was defined as 21% of MVC or higher. Peak normalized EMG activity in each muscle was compared using two-way (exercise x muscle) repeated-measures ANOVA with post-hoc pairwise comparisons if a significant interaction was found. Results There was an exercise by muscle interaction effect (p<0.001). The ulnar deviation exercise selectively activated FCU (40.3%) versus FDS (19.5%, p=0.009) and PT (21.5%, p=0.022). Conversely, the pronation exercise selectively activated FDS (63.8%, p=0.002) and PT (73.0%, p=0.001) versus FDS (27.4%). Conclusion The ulnar deviation and pronation exercises using elastic band resistance studied targeted and activated the flexor-pronator mass musculature. The ulnar deviation and pronation exercises using elastic band resistance are practical and effective means of training the flexor-pronator mass. These exercises can be readily prescribed to athletes and patients as part of their arm care program.
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Schneider C, Van Hooren B, Cronin J, Jukic I. The Effects of Training Interventions on Modifiable Hamstring Strain Injury Risk Factors in Healthy Soccer Players: A Systematic Review. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fukunaga T, Fedge C, Tyler T, Mullaney M, Schmitt B, Orishimo K, McHugh M, Nicholas S. Band Pull-Apart Exercise: Effects of Movement Direction and Hand Position on Shoulder Muscle Activity. Int J Sports Phys Ther 2022; 17:400-408. [PMID: 35391860 PMCID: PMC8975561 DOI: 10.26603/001c.33026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background/Purpose The Elastic band pull-apart exercise is commonly used in rehabilitation. It involves pulling an elastic resistance band with both hands in horizontal abduction or diagonal arm movements. The extent of muscle activation during this exercise is unknown. The purpose of this study was to measure the electromyographic (EMG) activity of shoulder-girdle muscles during the pull-apart exercise using resistance bands and to determine the effects of arm position and movement direction on shoulder-girdle muscle activity. Materials/Methods Surface EMG activity was measured on the infraspinatus, upper trapezius, middle trapezius, lower trapezius and posterior deltoid of the dominant shoulder. After measurement of maximal voluntary contraction (MVC) for each muscle, subjects performed the band pull-apart exercise in three hand positions (palm up, neutral, palm down) and three movement directions (diagonal up, horizontal, diagonal down). Elastic band resistance was chosen to elicit moderate exertion (5/10 on the Borg CR10 scale). The order of the exercises was randomized and three repetitions of each exercise were performed. Mean peak EMG activity in each muscle across the repetitions was calculated and expressed as a percentage of MVC. Peak normalized EMG activity in each muscle was compared in two-way (hand position x direction) repeated-measures ANOVA. Results Data were collected from 10 healthy subjects (all males, age 36±12 years). Peak muscle activity ranged from 15.3% to 72.6% of MVC across muscles and exercise conditions. There was a significant main effect of hand position for the infraspinatus and lower trapezius, where muscle activity was highest with the palm up hand position (p < 0.001), and for the upper trapezius and posterior deltoid, where muscle activity was highest with the palm down position (p-value range < 0.001-0.004). There was a significant main effect of movement direction, where the diagonal up direction demonstrated the highest muscle activity for the infraspinatus, upper trapezius, lower trapezius, and posterior deltoid (p-value range < 0.001-0.02). Conclusion Altering hand position and movement direction during performance of an elastic band pull-apart exercise can affect magnitudes of shoulder-girdle muscle activity. Clinicians may alter a patient's hand position and movement direction while performing the band pull-apart exercise in order to increase muscle activity in target muscles or diminish muscle activity in other muscles. Level of Evidence 2b.
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Affiliation(s)
| | - Connor Fedge
- Nicholas Institute of Sports Medicine and Athletic Trauma
| | - Timothy Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma
| | | | | | - Karl Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma
| | - Malachy McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma
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The Inclusion of a Complementary Running Progression Program in the Rehabilitation of Acute Hamstring Injuries: A Critically Appraised Topic. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2022. [DOI: 10.1123/ijatt.2021-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction/Clinical Scenario: As many hamstring injuries occur when the hamstrings are in a lengthened state during the deceleration phase of running when the muscle is eccentrically contracting to slow the body down this functional aspect needs to be addressed. Thus, a rehabilitation program with a focus on progressive targeted eccentric hamstring exercises by gradually placing and exposing the muscle to eccentric force in a lengthened state supplemented with progressive running drills should be evaluated. Focused Clinical Question: Does the inclusion of a complementary running progression program for the rehabilitation of an acute hamstring injury reduce the time to safe return to sport with less hamstring reinjury occurrence for an athletic population? Summary of Key Findings: Three studies assessed the inclusion of a progressive running program with several types of running progression parameters addressed. Progressive running drills will load the hamstring in a functional manner, with a gradual increase in velocity of movement and lengthening of the muscle. Clinical Bottom Line: It appears that a complementary progressive running program within an acute hamstring rehabilitation program should be included as it caused no further harm and does not tend to increase hamstring reinjury occurrence. Strength of Recommendation: There is grade B evidence to include a complementary running progression program within an acute hamstring rehabilitation program.
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Fukunaga T, Orishimo KF, McHugh MP. Electromyographic analysis of select eccentric-focused rotator cuff exercises. Physiother Theory Pract 2021; 38:2554-2562. [PMID: 34313183 DOI: 10.1080/09593985.2021.1949767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Eccentric-focused rotator cuff exercises are clinically useful in rehabilitation; however, to what extent these exercises activate shoulder musculature is unknown.Purpose: Investigate peak electromyographic (EMG) activity of shoulder musculature during eccentric-focused rotator cuff exercises to inform clinical decision-making.Methods: Surface EMG activity was measured in 15 healthy subjects from 5 muscles of the dominant shoulder: supraspinatus, infraspinatus, upper trapezius, lower trapezius, and middle deltoid. Subjects performed 5 exercises: short-to-long scaption, sit-to-stand scaption, standing external rotation (ER), sidelying ER, and sidelying horizontal adduction. The effects of exercise and muscle on peak EMG activity were analyzed using two-way repeated-measures ANOVA and followed with post-hoc pairwise comparisons.Results: Significant exercise-by-muscle interaction effect was found (p < .001). Short-to-long and sit-to-stand scaption elicited higher activity in supraspinatus and middle deltoid compared to other exercises (p < .05); however, no effect of muscle was found for these exercises (p > .05). Infraspinatus and lower trapezius demonstrated higher activity compared to other muscles during standing ER, sidelying ER, and sidelying horizontal adduction (p < .05).Conclusion: Eccentric-focused exercises sufficiently activate the rotator cuff and is effective for use in rehabilitation. Caution must be taken as some exercises do not target specific musculature.
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Affiliation(s)
- Takumi Fukunaga
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye Ear and Throat Hospital, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye Ear and Throat Hospital, NY, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye Ear and Throat Hospital, NY, USA
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Shield AJ, Bourne MN. Hamstring Injury Prevention Practices in Elite Sport: Evidence for Eccentric Strength vs. Lumbo-Pelvic Training. Sports Med 2017; 48:513-524. [DOI: 10.1007/s40279-017-0819-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Monajati A, Larumbe-Zabala E, Goss-Sampson M, Naclerio F. The Effectiveness of Injury Prevention Programs to Modify Risk Factors for Non-Contact Anterior Cruciate Ligament and Hamstring Injuries in Uninjured Team Sports Athletes: A Systematic Review. PLoS One 2016; 11:e0155272. [PMID: 27171282 PMCID: PMC4865209 DOI: 10.1371/journal.pone.0155272] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/26/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hamstring strain and anterior cruciate ligament injuries are, respectively, the most prevalent and serious non-contact occurring injuries in team sports. Specific biomechanical and neuromuscular variables have been used to estimate the risk of incurring a non-contact injury in athletes. OBJECTIVE The aim of this study was to systematically review the evidences for the effectiveness of injury prevention protocols to modify biomechanical and neuromuscular anterior cruciate and/or hamstring injuries associated risk factors in uninjured team sport athletes. DATA SOURCES PubMed, Science Direct, Web of Science, Cochrane Libraries, U.S. National Institutes of Health clinicaltrials.gov, Sport Discuss and Google Scholar databases were searched for relevant journal articles published until March 2015. A manual review of relevant articles, authors, and journals, including bibliographies was performed from identified articles. MAIN RESULTS Nineteen studies were included in this review. Four assessment categories: i) landing, ii) side cutting, iii) stop-jump, and iv) muscle strength outcomes, were used to analyze the effectiveness of the preventive protocols. Eight studies using multifaceted interventions supported by video and/or technical feedback showed improvement in landing and/or stop-jump biomechanics, while no effects were observed on side-cutting maneuver. Additionally, multifaceted programs including hamstring eccentric exercises increased hamstring strength, hamstring to quadriceps functional ratio and/or promoted a shift of optimal knee flexion peak torque toward a more open angle position. CONCLUSIONS Multifaceted programs, supported by proper video and/or technical feedback, including eccentric hamstring exercises would positively modify the biomechanical and or neuromuscular anterior cruciate and/or hamstring injury risk factors.
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Affiliation(s)
- Alireza Monajati
- Department of Life and Sport Science, University of Greenwich. Medway Campus, Central Avenue, Chatham Maritime, Kent ME4 4TB, United Kingdom
| | - Eneko Larumbe-Zabala
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, United States of America
| | - Mark Goss-Sampson
- Department of Life and Sport Science, University of Greenwich. Medway Campus, Central Avenue, Chatham Maritime, Kent ME4 4TB, United Kingdom
| | - Fernando Naclerio
- Department of Life and Sport Science, University of Greenwich. Medway Campus, Central Avenue, Chatham Maritime, Kent ME4 4TB, United Kingdom
- * E-mail:
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Guex KJ, Lugrin V, Borloz S, Millet GP. Influence on Strength and Flexibility of a Swing Phase–Specific Hamstring Eccentric Program in Sprinters' General Preparation. J Strength Cond Res 2016. [DOI: 10.1519/jsc.0000000000001103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Naclerio F, Larumbe-Zabala E, Monajati A, Goss-Sampson M. Effects of two different injury prevention resistance exercise protocols on the hamstring torque-angle relationship: a randomized controlled trial. Res Sports Med 2015; 23:379-93. [PMID: 26264751 DOI: 10.1080/15438627.2015.1076418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The effects of two different 6-week lower body injury prevention programmes on knee muscle torque-angle relationship were examined in soccer players. Thirty-two men were randomly assigned to three groups: hamstring-eccentric (ECC) (n = 11), unstable-squatting (UNS) (n = 11), and control (n = 10). Intervention groups performed three training sessions per week using only three ECC or UNS exercises, respectively. Maximal peak knee flexion torque was measured at 35°, 45°, 60°, 80°, 90°, and 100°, pre- and post-intervention. Peak torque increased at 35° (P = 0.034, Cohen's d = 0.67) and 45° (P = 0.004, Cohen's d = 0.96) in the ECC group, and at 60° (P = 0.024, Cohen's d = 1.16), 80° (P = 0.018, Cohen's d = 1.21), and 90° (P = 0.001, Cohen's d = 1.38) in the UNS group. As these specific modifications might respectively and differentially protect athletes against hamstring and knee-joint injuries, the integration of both types of exercises should be considered when designing injury prevention programmes for soccer players.
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Affiliation(s)
- Fernando Naclerio
- a Centre for Sports Science and Human Performance , University of Greenwich , Chatham , Kent , UK
| | | | - Alireza Monajati
- a Centre for Sports Science and Human Performance , University of Greenwich , Chatham , Kent , UK
| | - Mark Goss-Sampson
- a Centre for Sports Science and Human Performance , University of Greenwich , Chatham , Kent , UK
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Schuermans J, Van Tiggelen D, Danneels L, Witvrouw E. Biceps femoris and semitendinosus--teammates or competitors? New insights into hamstring injury mechanisms in male football players: a muscle functional MRI study. Br J Sports Med 2015; 48:1599-606. [PMID: 25388959 PMCID: PMC4267196 DOI: 10.1136/bjsports-2014-094017] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The hamstring injury mechanism was assessed by investigating the exercise-related metabolic activity characteristics of the hamstring muscles using a muscle functional MRI (mfMRI) protocol. METHODS 27 healthy male football players and 27 football players with a history of hamstring injuries (recovered and playing fully) underwent standardised mfMR Imaging. The mfMRI protocol consisted of a resting scan, a strenuous bilateral eccentric hamstring exercise and a postexercise scan. The exercise-related T2 increase or the signal intensity shift between both scans was used to detect differences in metabolic activation characteristics (1) between the different hamstring muscle bellies and (2) between the injury group and the control group. RESULTS A more symmetrical muscle recruitment pattern corresponding to a less economic hamstring muscle activation was demonstrated in the formerly injured group (p<0.05). The injured group also demonstrated a significantly lower strength endurance capacity during the eccentric hamstring exercise. CONCLUSIONS These findings suggest that the vulnerability of the hamstring muscles to football-related injury is related to the complexity and close coherence in the synergistic muscle recruitment of the biceps femoris and the semitendinosus. Discrete differences in neuromuscular coordination and activity distribution, with the biceps femoris partly having to compensate for the lack of endurance capacity of the semitendinosus, probably increase the hamstring injury risk.
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Affiliation(s)
- Joke Schuermans
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Damien Van Tiggelen
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy Ghent, Ghent University, Ghent, Belgium Department of Physiotherapy, Aspetar, Doha, Qatar
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