Altering the Length-Tension Relationship with Eccentric Exercise

Hamstring Injuries, From the Clinic to the Field: A Narrative Review Discussing Exercise Transfer

PURPOSE

The optimal approach to hamstring training is heavily debated. Eccentric exercises reduce injury risk; however, it is argued that these exercises transfer poorly to improved hamstring function during sprinting. Some argue that other exercises, such as isometric exercises, result in better transfer to running gait and should be used when training to improve performance and reduce injury risk. Given the performance requirements of the hamstrings during the terminal swing phase, where they are exposed to high strain, exercises should aim to improve the torque production during this phase. This should improve the hamstrings' ability to resist overlengthening consequently, improving performance and limiting strain injury. Most hamstring training studies fail to assess running kinematics postintervention. Of the limited evidence available, only eccentric exercises demonstrate changes in swing-phase kinematics following training. Studies of other exercise modalities investigate effects on markers of performance and injury risk but do not investigate changes in running kinematics.

CONCLUSIONS

Despite being inconsistent with principles of transfer, current evidence suggests that eccentric exercises result in transfer to swing-phase kinematics. Other exercise modalities may be effective, but the effect of these exercises on running kinematics is unknown.

Eccentric exercise ≠ eccentric contraction

Whether eccentric exercise involves active fascicle stretch is unclear due to muscle-tendon unit (MTU) series compliance. Therefore, this study investigated the impact of changing the activation timing and level (i.e., preactivation) of the contraction on muscle fascicle kinematics and kinetics of the human tibialis anterior during dynamometer-controlled maximal voluntary MTU-stretch-hold contractions. B-mode ultrasound and surface electromyography were used to assess muscle fascicle kinematics and muscle activity levels, respectively. Although joint kinematics were similar among MTU-stretch-hold contractions (∼40° rotation amplitude), increasing preactivation increased fascicle shortening and stretch amplitudes (9.9-23.2 mm, P ≤ 0.015). This led to increasing positive and negative fascicle work with increasing preactivation. Despite significantly different fascicle kinematics, similar peak fascicle forces during stretch occurred at similar fascicle lengths and joint angles regardless of preactivation. Similarly, residual force enhancement (rFE) following MTU stretch was not significantly affected (6.5-7.6%, P = 0.559) by preactivation, but rFE was strongly correlated with peak fascicle force during stretch (rrm = 0.62, P = 0.003). These findings highlight that apparent eccentric exercise causes shortening-stretch contractions at the fascicle level rather than isolated eccentric contractions. The constant rFE despite different fascicle kinematics and kinetics suggests that a passive element was engaged at a common muscle length among conditions (e.g., optimal fascicle length). Although it remains unclear whether different fascicle mechanics trigger different adaptations to eccentric exercise, this study emphasizes the need to consider MTU series compliance to better understand the mechanical drivers of adaptation to exercise.NEW & NOTEWORTHY Apparent eccentric exercises do not result in isolated eccentric contractions, but shortening-stretch contractions at the fascicle level. The amount of fascicle shortening and stretch depends on the preactivation during the exercise and cannot be estimated from the muscle-tendon unit (MTU) or joint kinematics. As different fascicle mechanics might trigger different adaptations to eccentric exercise, muscle-tendon unit series compliance and muscle preactivation need to be considered when eccentric exercise protocols are designed.

The Effect of Variations in Knee and Hip Angles on Electromyographic Activity of the Hamstrings and Related Muscles During the Nordic Hamstring Exercise

Background

The benefit of performing the Nordic Hamstring Exercise (NHE) on an inclined board has been described, however, isometric hamstring activation in different knee and hip angles has not yet been thoroughly explored.

Purpose

This study investigated the effect of variations in knee and hip angles during the isometric performance of the NHE on electromyographic activity of the hamstring muscles.

Study design

Crossover study.

Methods

Thirteen male volunteers performed isometric contractions during the NHE with the knee (30°, 50°, 60°) and the hip (0°, 30°, and 45°) in various angles of flexion on a leg support platform which was inclined at 30°. An electrical goniometer was used to monitor the knee and hip joint angles during 5-s isometric contractions. A multivariate analysis of variance with repeated measures was used to compare normalized electromyographic values of each muscle across different knee and hip angles, followed by pairwise comparisons.

Results

The electromyographic activity of the biceps femoris, semitendinosus, and semimembranosus at a knee angle of 30° and hip angle of 0° were significantly higher than those observed with a knee angle of 50° and hip angle of 0°, or a knee angle of 60° and hip angle of 0° (p<0.05). The electromyographic activity of the semimembranosus at a knee angle of 60° and hip angle of 45° was significantly higher than values obtained with knee and hip angles of 60° and 0°, respectively (p<0.05).

Conclusions

The results indicate that using a knee flexion of 30° and a hip flexion of 0°, while isometrically performing the NHE on a platform inclined at 30°, may optimize electromyographic activity of the hamstrings.

Level of Evidence

3.

Traumatic muscle injury

Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.

Greater Gastrocnemius Muscle Hypertrophy After Partial Range of Motion Training Performed at Long Muscle Lengths

ABSTRACT

Kassiano, W, Costa, B, Kunevaliki, G, Soares, D, Zacarias, G, Manske, I, Takaki, Y, Ruggiero, MF, Stavinski, N, Francsuel, J, Tricoli, I, Carneiro, MAS, and Cyrino, ES. Greater gastrocnemius muscle hypertrophy after partial range of motion training performed at long muscle lengths. J Strength Cond Res 37(9): 1746-1753, 2023-Whether there is an optimal range of motion (ROM) to induce muscle hypertrophy remains elusive, especially for gastrocnemius. This study aimed to compare the changes in gastrocnemius muscle thickness between calf raise exercise performed with full ROM (FULL ROM ), partial ROM performed in the initial (INITIAL ROM ), and final (FINAL ROM ) portions of the ROM. Forty-two young women performed a calf training program for 8 weeks, 3 days·week -1 , with differences in the calf raise ROM configuration. The calf raise exercise was performed in a pin-loaded, horizontal, leg-press machine, in 3 sets of 15-20 repetition maximum. The subjects were randomly assigned to 1 of the 3 groups: FULL ROM (ankle: -25° to +25°), INITIAL ROM (ankle: -25° to 0°), and FINAL ROM (ankle: 0° to +25°), where 0° was defined as an angle of 90° of the foot with the tibia. The muscle thickness measurements of medial and lateral gastrocnemius were taken by means of B-mode ultrasound. INITIAL ROM elicited greater medial gastrocnemius increases than FULL ROM and FINAL ROM (INITIAL ROM = +15.2% vs. FULL ROM = +6.7% and FINAL ROM = +3.4%; p ≤ 0.009). Furthermore, INITIAL ROM elicited greater lateral gastrocnemius increases than FINAL ROM (INITIAL ROM = +14.9% vs. FINAL ROM = +6.2%; p < 0.024) but did not significantly differ from FULL ROM (FULL ROM = +7.3%; p = 0.060). The current results suggest that calf training performed at longer muscle lengths may optimize gastrocnemius muscle hypertrophy in young women. Therefore, when prescribing hypertrophy-oriented training, the inclusion of the calf raise exercise performed with partial ROM in the initial portion of the excursion should be considered.

The relationship between elastography-based muscle properties and vertical jump performance, countermovement utilization ratio, and rate of force development

This study explored the relationships between passive muscle stiffness (shear modulus) and vertical jumping performance, countermovement utilization ratio (CUR) and rate of force development (RFD) in an attempt to unravel the mechanism that may explain the association between shear modulus and performance. 32 recreationally active participants (16 males, 16 females; age: 22.4 ± 5.1 years) participated. Shear modulus was assessed for the lateral and medial gastrocnemius (GL and GM), and vastus medialis (VM) and lateralis (VL) muscles using shear wave elastography. Squat jump (SJ) and countermovement (CMJ) jump were determined, with CUR being expressed as the ratio between the two. RFD in ankle and knee extension tasks was measured using isometric dynamometers. Our results suggest that within a heterogeneous group of recreational athletes, passive muscle stiffness is not related to RFD and jump performance, but positively related to CUR. In males, shear modulus of the GL was positively related to SJ height (r = 0.55). We also found inverse moderate correlations between VL and VM shear modulus and RFD in females only (r = -0.50 to -0.51), but this relationship was possibly affected by age and body fat content. Different mechanisms may underpin the association between shear modulus and performance depending on the muscle, task and population investigated.

Effect of the Law Enforcement Duty Belt on Muscle Activation during Hip Hinging Movements in Young, Healthy Adults

Sixty percent of all law enforcement officers (LEOs) experience low back pain (LBP), with the LEO duty belt (LEO_DB) commonly reported to be a contributing factor. The primary purpose of the study was to investigate the LEODB's effect on muscular activity and compare it to a tactical vest, which is a commonly used alternative to an LEO_DB. In total, 24 participants (13 male, 11 female; mass, 73.0 ± 11.1 kg; height, 169.0 ± 10.0 cm; age, 24.0 ± 5.8 years) completed a progressive series of hip hinge tasks in a single testing session. All participants completed four conditions (no belt, leather belt, nylon belt, and weight VEST) in a randomized order. Surface electromyography (sEMG) sensors were placed bilaterally on the rectus abdominus, multifidus, biceps femoris, and rectus femoris. Across all tasks, no significant effects of load on muscle activity were found for any of the muscles. Participants rated the VEST condition as more comfortable (p < 0.05) and less restrictive (p < 0.05) than either LEODB. The findings suggest an LEO_DB does not alter muscle activity during bodyweight hip hinging or lifting objects from the ground. Future research should examine whether changes in muscle activity occur with durations of LEO_DB wear more similar to an actual work shift duration for LEOs (≥8 h).

Building for the Future: A Systematic Review of the Effects of Eccentric Resistance Training on Measures of Physical Performance in Youth Athletes

BACKGROUND

Eccentric resistance training is recognised as an effective stimulus for enhancing measures of muscular strength and power in adult populations; however, its value in youth athletes is currently not well understood.

OBJECTIVE

The aim of this systematic review was to critically appraise the effects of eccentric resistance training on measures of physical performance (i.e. muscular strength, jump, sprint and change of direction) in youth athletes 18 years of age and under.

METHODS

Original journal articles published between 1950 and June 2022 were retrieved from electronic search engines of PubMed, SPORTDiscus and Google Scholar's advanced search option. Full journal articles investigating the acute and chronic effects of eccentric resistance training on measures of physical performance in youth athletes (i.e. a person 18 years of age or under who competes in sport) were included. The methodological quality and bias of each study were assessed prior to data extraction using a modified Downs and Black checklist.

RESULTS

The search yielded 749 studies, of which 436 were duplicates. Three-hundred studies were excluded based upon title and abstract review and a further 5 studies were removed following the modified Downs and Black checklist. An additional 14 studies were identified during backward screening. Accordingly, 22 studies were included in our systematic review. The Nordic hamstring exercise and flywheel inertial training were the most frequently used eccentric resistance training methods in youth athletes. Improvements in physical performance following the Nordic hamstring exercise are dependent upon an increase in the breakpoint angle, rather than training volume (sets and repetitions), and are further elevated with the addition of hip extension exercises or high-speed running. A minimum of 3 familiarisation trials is necessary to elicit meaningful adaptations following flywheel inertial training. Furthermore, an emphasis should be placed upon decelerating the rotating flywheel during the final one to two thirds of the eccentric phase, rather than gradually throughout the entire eccentric phase.

CONCLUSIONS

The findings of this systematic review support the inclusion of eccentric resistance training in youth athletes to improve measures of muscular strength, jump, sprint and change of direction performance. The current eccentric resistance training methods are predominantly limited to the Nordic hamstring exercise and flywheel inertial training; however, the efficacy of accentuated eccentric loading to improve jump performance warrants attention in future investigations.

The Effect of Complex Training on Muscle Architecture in Rugby League Players

PURPOSE

To compare the effects of variable-resistance complex training (VRCT) versus traditional complex training (TCT) on muscle architecture in rugby league players during a 6-week mesocycle.

METHODS

Twenty-four rugby league players competing in the British University & Colleges Sport (BUCS) Premier North Division were randomized to VRCT (n = 8), TCT (n = 8), or control (n = 8). Experimental groups completed a 6-week lower-body complex training intervention (2×/wk), which involved alternating high-load resistance exercise with plyometric exercise in the same session. The VRCT group performed resistance exercises at 70% of 1-repetition maximum (1RM) + 0% to 23% of 1RM from band resistance with a 90-second intracontrast rest interval, whereas the TCT group performed resistance exercise at 93% of 1RM with a 4-minute intracontrast rest interval. Muscle thickness (MT), pennation angle, and fascicle length (Lf) were assessed for the vastus lateralis (VL) and gastrocnemius medialis using ultrasound imaging.

RESULTS

Both TCT and VRCT groups significantly improved VL MT and VL Lf compared with control (all P < .05). Standardized within-group changes in MT and Lf (Cohen dav ± 95% CI) were moderate for TCT (dav = 0.91 ± 1.0; dav = 1.1 ± 1.1) and unclear for VRCT (dav = 0.44 ± 0.99; dav = 0.47 ± 0.99), respectively. Differences in change scores between TCT and VRCT were unclear.

CONCLUSIONS

VRCT and TCT can be utilized during the competitive season to induce favorable MT and Lf muscle architecture adaptations for the VL. TCT may induce greater muscle architecture adaptations of the VL, whereas VRCT may be of more practical value given the shorter intracontrast rest interval between resistance and plyometric exercises.

No effect of coactivation on fatigue-induced decreases in isokinetic and isometric torque in healthy young male adults

BACKGROUND

Antagonist activation may contribute to fatigue-induced decreases in torque while assisting in the maintenance of joint stability. This study utilized a reciprocal, slow velocity (60°·s^-1) forearm flexion and extension fatiguing task to examine the contributions of coactivation to torque production at slow and moderate (180°·s^-1) velocities, as well as during a maximal voluntary isometric contraction (MVIC).

METHODS

Twelve recreationally active men (mean ± SD: age = 21.7 ± 1.6 years; body mass = 83.5 ± 8.8 kg; height = 179.4 ± 5.2 cm) completed isokinetic (60 and 180°·s^-1) and isometric pre-testing of forearm flexion and extension, followed by 50 maximal, reciprocal, isokinetic muscle actions at 60°·s^-1, followed by post-testing. The amplitude (AMP) of the electromyographic (EMG) signals from the biceps and triceps brachii were simultaneously recorded. Torque and EMG AMP were normalized to the corresponding values from the pre-testing peak torque movements. Repeated measures ANOVAs and pairwise comparisons were used to identify mean changes in torque, EMG AMP, and coactivation ratios.

RESULTS

The torque analyses indicated greater (p < 0.03) decreases for 180°·s^-1 (24%) and MVIC (23%) than 60°·s^-1 (14%) for forearm flexion. For forearm extension, there were no differences (p > 0.05) in fatigability between velocities. For EMG AMP there were no changes (p > 0.05) from pre- to post-testing for any velocity or movement. There were no changes (p > 0.05) in the coactivation ratio for forearm flexion, but significant increases (13.6 ± 6.6 to 16.9 ± 6.0; p = 0.003) for forearm extension, collapsed across Velocity.

CONCLUSIONS

There was velocity- and movement-specific fatigability for forearm flexion and extension. The parallel, fatigue-induced EMG AMP responses indicated that coactivation did not contribute to the decreases in torque and would not affect elbow joint stability.

Kinetic time-curves can classify individuals in distinct levels of drop jump performance

This study examined whether analysing kinetic features of drop jumps (DJ) as one-dimensional biomechanical curves can reveal specific patterns that are consistent and can cluster DJ performance. Hierarchical clustering analysis on DJ from 40 cm data performed by 128 physically active male participants (23.0 ± 4.5 yrs, 1.84 ± 0.07 m, 79.1 ± 10.8 kg) was performed on the derived time-normalised force, power and vertical stiffness curves to unmask the underlying patterns and to explore the dissimilarities identified from the subgroup (cluster) analysis. Results revealed poor, average and top DJ performers. Top performers exhibited larger peak force, power and vertical stiffness compared to the other two groups, and the poor performers had lower values compared to the average performers (p < .05). The time curves of force, power and vertical stiffness exhibited between cluster dissimilarities from ~25% to ~70%, and ~20% to 40% plus ~55% to 70% from the beginning of the ground contact, respectively. The force and power time-curves distinguished DJ ability similarly since they shared 69% of the cases in the top performers' cluster. The content of cases (membership) for vertical stiffness was different from the membership for the force and power time-curve clusters. In conclusion, stiffness should be considered during plyometric training, but does not distinctly define DJ performance.

Hamstrings force-length relationships and their implications for angle-specific joint torques: a narrative review

Temporal biomechanical and physiological responses to physical activity vary between individual hamstrings components as well as between exercises, suggesting that hamstring muscles operate differently, and over different lengths, between tasks. Nevertheless, the force-length properties of these muscles have not been thoroughly investigated. The present review examines the factors influencing the hamstrings’ force-length properties and relates them to in vivo function. A search in four databases was performed for studies that examined relations between muscle length and force, torque, activation, or moment arm of hamstring muscles. Evidence was collated in relation to force-length relationships at a sarcomere/fiber level and then moment arm-length, activation-length, and torque-joint angle relations. Five forward simulation models were also used to predict force-length and torque-length relations of hamstring muscles. The results show that, due to architectural differences alone, semitendinosus (ST) produces less peak force and has a flatter active (contractile) fiber force-length relation than both biceps femoris long head (BFlh) and semimembranosus (SM), however BFlh and SM contribute greater forces through much of the hip and knee joint ranges of motion. The hamstrings’ maximum moment arms are greater at the hip than knee, so the muscles tend to act more as force producers at the hip but generate greater joint rotation and angular velocity at the knee for a given muscle shortening length and speed. However, SM moment arm is longer than SM and BFlh, partially alleviating its reduced force capacity but also reducing its otherwise substantial excursion potential. The current evidence, bound by the limitations of electromyography techniques, suggests that joint angle-dependent activation variations have minimal impact on force-length or torque-angle relations. During daily activities such as walking or sitting down, the hamstrings appear to operate on the ascending limbs of their force-length relations while knee flexion exercises performed with hip angles 45–90° promote more optimal force generation. Exercises requiring hip flexion at 45–120° and knee extension 45–0° (e.g. sprint running) may therefore evoke greater muscle forces and, speculatively, provide a more optimum adaptive stimulus. Finally, increases in resistance to stretch during hip flexion beyond 45° result mainly from SM and BFlh muscles.

TTN Variants Are Associated with Physical Performance and Provide Potential Markers for Sport-Related Phenotypes

TTN encodes the third myofilament, titin, which plays structural, mechanical, regulatory, and developmental roles in sarcomeres. The aim of this research was to determine the interaction between novel and previously described TTN variants and athletic performance, as well as competition level, in Caucasians. Firstly, 100 athletes and 47 controls were recruited, and whole-genome sequencing was performed. Secondly, 348 athletes (108 endurance, 100 sprint/power, 140 mixed-sport athletes) and 403 volunteers were included, and real-time PCR was performed. We found a significant overrepresentation of the rs10497520 CT and TT genotypes in the sprint/power athlete group (95% CI, 1.41-3.66, p = 0.0013). The rs10497520 T carriers were 2.17 times more likely to become sprint/power athletes (95% CI 1.35-3.49, p = 0.0021). We also found that the likelihood of having the TT genotype was higher for the highly elite and sub-elite sprint/power athletes. Possessing at least one TAA (rs10497520, rs55837610, rs72648256) haplotype resulted in an increase in the log-odds ratio by 0.80 (p = 0.0015), 1.42 (p = 0.003), and 0.77 (p = 0.044) for all, highly elite, and sub-elite sprint/power athletes, respectively. We demonstrated that harbouring the rs10497520 T allele, individually and in a haplotype combination, increased the chance of being an elite sprint/power athlete, indicating that this allele may be favourable for sprint/power performance.

Does category of strength predict return-to-work after occupational injury?

Background

Occupational accidents may lead laborers to lose their working capacities, affecting their physical and mental health. Occupational rehabilitation helps improve the ability of patients with occupational accidents and suggests appropriate jobs to avoid second injuries. This study aimed to identify whether any of the functional capacity evaluation (FCE) strength subtests predicted successful return to work.

Methods

Data were collected of 84 patients receiving government-subsidized occupational rehabilitation between September 2016 and December 2018. A structured questionnaire was employed for pre- and post-training assessment, including basic information, information of the occupational accident, status of the laborer at the opening of the injury case, physical requirement for the job, and physical capacity. Eight subtests of strength were included in the physical capacity evaluation, i.e., carrying, lifting to several levels, power grip, and lateral pinch, to explore the association between the strength tests and return to work.

Results

The unadjusted model showed that for every additional kilogram in bilateral carrying strength before work hardening training, the odds of successful return to work increased (crude odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.01–1.24, p = 0.027). After adjustment for basic demographic information and pre-accident physical functional elements of work, the odds of successful return to work increased (adjusted OR = 1.27, 95% CI = 1.04–1.54, p = 0.02) for every additional kilogram in the pre-training bilateral carrying strength. There were no statistically significant differences observed in the other seven subtests.

Conclusion

Through thorough evaluation and work hardening training provided in the occupational rehabilitation, patients’ physical capacity can be understood and improved. However, a full evaluation of functional capacities is prolonged and time-consuming. This study provides evidence that pre-work-hardening bilateral carrying strength may be a promising predictor of return to work and we recommend to consider it as a prioritized test to assist in determining appropriate advice regarding return to work.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13817-2.

The influence of longitudinal muscle fascicle growth on mechanical function

Skeletal muscle has the remarkable ability to remodel and adapt, such as the increase in serial sarcomere number (SSN) or fascicle length (FL) observed after overstretching a muscle. This type of remodelling is termed longitudinal muscle fascicle growth, and its impact on biomechanical function has been of interest since the 1960s due to its clinical applications in muscle strain injury, muscle spasticity, and sarcopenia. Despite simplified hypotheses on how longitudinal muscle fascicle growth might influence mechanical function, existing literature presents conflicting results partly due to a breadth of methodologies. The purpose of this review is to outline what is currently known about the influence of longitudinal muscle fascicle growth on mechanical function and suggest future directions to address current knowledge gaps and methodological limitations. Various interventions indicate longitudinal muscle fascicle growth can increase the optimal muscle length for active force, but whether the whole force-length relationship widens has been less investigated. Future research should also explore the ability for longitudinal fascicle growth to broaden the torque-angle relationship's plateau region, and the relation to increased force during shortening. Without a concurrent increase in intramuscular collagen, longitudinal muscle fascicle growth also reduces passive tension at long muscle lengths; further research is required to understand whether this translates to increased joint range of motion. Lastly, some evidence suggests longitudinal fascicle growth can increase maximum shortening velocity and peak isotonic power, however, there has yet to be direct assessment of these measures in a neurologically intact model of longitudinal muscle fascicle growth.

The Need for Eccentric Speed: A Narrative Review of the Effects of Accelerated Eccentric Actions During Resistance-Based Training

Eccentric training as a method to enhance athletic performance is a topic of increasing interest to both practitioners and researchers. However, data regarding the effects of performing the eccentric actions of an exercise at increased velocities are limited. This narrative review aimed to provide greater clarity for eccentric methods and classification with regard to temporal phases of exercises. Between March and April 2021, we used key terms to search the PubMed, SPORTDiscus, and Google Scholar databases within the years 1950-2021. Search terms included 'fast eccentric', 'fast velocity eccentric', 'dynamic eccentric', 'accentuated eccentric loading', and 'isokinetic eccentric', analysing both the acute and the chronic effects of accelerated eccentric training in human participants. Review of the 26 studies that met the inclusion criteria identified that completing eccentric tempos of < 2 s increased subsequent concentric one repetition maximum performance, velocity, and power compared with > 4 s tempos. Tempos of > 4 s duration increased time under tension (TUT), whereas reduced tempos allowed for greater volume to be completed. Greater TUT led to larger accumulation of blood lactate, growth hormone, and testosterone when volume was matched to that of the reduced tempos. Overall, evidence supports eccentric actions of < 2 s duration to improve subsequent concentric performance. There is no clear difference between using eccentric tempos of 2-6 s if the aim is to increase hypertrophic response and strength. Future research should analyse the performance of eccentric actions at greater velocities or reduced time durations to determine more factors such as strength response. Tempo studies should aim to complete the same TUT for protocols to determine measures for hypertrophic response.

The Effect of Repetitive Drop Jumps among Different Heights on Bilateral Asymmetry of Countermovement Jumps

Background: The study explored the influence of repeated drop jumps (DJs) from different drop heights on the lower extremity bilateral asymmetry and muscle activation of countermovement jumps (CMJs). Methods: Eighteen male athletes performed 200 drop jumps (DJs200) from three drop jump height (DJH30, 40 and 50 cm). The CMJs were performed before the first DJ and after the 50th, 100th, 150th and 200th DJs, recording them as pre-CMJ, CMJs50, CMJs100, CMJs150 and CMJs200. One-way repeated measures ANOVA was used to compare differences among the three drop heights at pre-CMJ, CMJs50, CMJs100, CMJs150 and CMJs200, respectively. Results: The peak ground reaction forces (PGRF) of CMJs100, CMJs150 and CMJs200 at DJH50 were greater than at DJH30 and DJH40 (all p < 0.05). The muscle activation during CMJs50 at DJH50 was greater than at DJH30 and DJH40 (all p < 0.05). The muscle activation during CMJs100, CMJs150 and CMJs200 at DJH50 was smaller than at DJH40 and DJH30 (all p < 0.05). The PGRF had no significant difference among the three different drop heights during CMJs50 (p > 0.05). Conclusions: The DJs50 at DJH50 had no effect on the bilateral asymmetry and increased muscle activation of CMJs. The excessive DJs100 at DJH50 increased bilateral asymmetry and decreased CMJ muscle activation during CMJs.

Torque-angle curve of the knee flexors in athletes with a prior history of hamstring strain

OBJECTIVES

To investigate the knee flexor torque-angle curve after hamstring strain injury using different muscle action types and angular velocities.

DESIGN

Cross-sectional.

SETTING

Controlled laboratory.

PARTICIPANTS

Thirteen collegiate athletes injured hamstring strain (21.0 ± 0.8 years; 173.9 ± 6.5 cm; 70.1 ± 10.5 kg).

MAIN OUTCOME MEASURES

Concentric and eccentric knee flexor torque was measured at 60 & 300°/sec. Peak torque and average torque every 10° were determined from torque-angle curve and injured side was compared with non-injured side.

RESULTS

No significant differences were found in the concentric muscle actions. However, the eccentric peak torque was significantly lower on the injured side at 60°/sec (p = 0.048) and at 300°/sec (p = 0.002). The average eccentric torque was significantly lower on the injured side at 60°/sec from 10° to 20° of knee flexion (p = 0.012-0.018) and at 300°/sec from 10° to 60° of knee flexion (p = 0.005-0.049).

CONCLUSION

The knee flexor torque-angle curve changes with eccentric muscle action after hamstring injury. Eccentric torque declines were close to full knee extension at 60°/sec and a wide range of knee flexion at 300°/sec. The assessment and rehabilitation of eccentric hamstring strength may be important to consider the effect of the angular velocity after hamstring strain injury.

Deceleration Training in Team Sports: Another Potential 'Vaccine' for Sports-Related Injury?

High-intensity horizontal decelerations occur frequently in team sports and are typically performed to facilitate a reduction in momentum preceding a change of direction manoeuvre or following a sprinting action. The mechanical underpinnings of horizontal deceleration are unique compared to other high-intensity locomotive patterns (e.g., acceleration, maximal sprinting speed), and are characterised by a ground reaction force profile of high impact peaks and loading rates. The high mechanical loading conditions observed when performing rapid horizontal decelerations can lead to tissue damage and neuromuscular fatigue, which may diminish co-ordinative proficiency and an individual’s ability to skilfully dissipate braking loads. Furthermore, repetitive long-term deceleration loading cycles if not managed appropriately may propagate damage accumulation and offer an explanation for chronic aetiological consequences of the ‘mechanical fatigue failure’ phenomenon. Training strategies should look to enhance an athlete’s ability to skilfully dissipate braking loads, develop mechanically robust musculoskeletal structures, and ensure frequent high-intensity horizontal deceleration exposure in order to accustom individuals to the potentially damaging effects of intense decelerations that athletes will frequently perform in competition. Given the apparent importance of horizontal decelerations, in this Current Opinion article we provide considerations for sport science and medicine practitioners around the assessment, training and monitoring of horizontal deceleration. We feel these considerations could lead to new developments in injury-mitigation and physical development strategies in team sports.

Is the Integration of Additional Eccentric, Balance and Core Muscles Exercises into a Typical Soccer Program Effective in Improving Strength and Postural Stability?

Soccer teams integrate specific exercises into their typical workout programs for injury prevention. The purpose of this study was to investigate whether the incorporation of a brief and supplementary training program that involves eccentric, balance, and core exercises into the weekly soccer schedule can cause positive neuromuscular adaptations. Twenty-one soccer players were randomly allocated to either a training (n = 11) or a control group (n = 10). All players followed their teams’ typical program, consisting of 4–5 soccer-specific sessions plus 1 match, weekly. Training group players additionally performed biweekly, hamstring eccentric, balance, and core stability exercises for 8 weeks. Isokinetic concentric and eccentric peak torque (PT) of the hamstrings and quadriceps, changes in the center of pressure (COP) during a 30 s single-leg stance, and a supine bridge (trunk stability) test were assessed before and after the intervention. After the intervention, a 27% increase in hamstring concentric PT and a 33% reduction in COP sway in the stance test, were observed for the training group only (p < 0.05). These improvements were significant only for the non-dominant leg. Furthermore, the control group displayed an increase in COP sway during the bridge test compared to baseline values (p < 0.05), which reflects a deterioration in postural balance over time. Consequently, incorporating small doses of hamstring eccentric, proprioception, and core stability exercises into a typical training program of youth soccer players improves strength and postural balance in the non-dominant leg, as well as core muscle performance.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Ice Hockey: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored women's ice hockey championships since 2001, and sponsorship has grown over time.

BACKGROUND

Routine examinations of injuries sustained by athletes are important for identifying and understanding patterns that can be used to inform sport safety practices.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 5.89 per 1000 athlete-exposures; preseason injury incidence rose sharply during 2016-2017 through 2018-2019. Head/face injuries (15.2%), knee injuries (13.2%), and shoulder injuries (12.9%) were the most commonly injured body parts, and injuries were most often classified as contusions (18.9%), strains (18.7%), and sprains (15.5%). Concussion (11.9%) was the most commonly reported specific injury, and concussion rates notably increased during 2017-2018 through 2018-2019.

SUMMARY

Study findings were generally consistent with the existing epidemiological evidence. Injury incidence in preseason and the etiology of strains warrant further attention in this population.

Asymmetries in Ground Reaction Forces During Turns by Elite Slalom Alpine Skiers Are Not Related to Asymmetries in Muscular Strength

The ground reaction forces (GRF) associated with competitive alpine skiing, which are relatively large, might be asymmetric during left and right turns due to asymmetries in the strength of the legs and torso and the present investigation was designed to evaluate this possibility. While skiing a symmetrical, 20-gate slalom course, the asymmetries of 9 elite alpine skiers were calculated on the basis of measurements provided by inertial motion units (IMU), a Global Navigation Satellite System and pressure insoles. In addition, specialized dynamometers were utilized to assess potential asymmetry in the strength of their legs and torso in the laboratory. In total, seven variables related to GRF were assessed on-snow and eight related to strength of the legs and torso in the laboratory. The asymmetries in these parameters between left and right turns on snow were expressed in terms of the symmetry (SI) and Jaccard indices (JI), while the asymmetries between the left and right sides of the body in the case of the laboratory measurements were expressed as the SIs. The three hypotheses to be tested were examined using multivariable regression models. Our findings resulted in rejection of all three hypotheses: The asymmetries in total GRF (H1), as well as in the GRF acting on the inside and outside legs (H2) and on the rear- and forefeet GRF (H3) during left and right turns were not associated with asymmetries in parameters related to muscular strength. Nevertheless, this group of elite slalom skiers exhibited significant asymmetry between their right and left legs with respect to MVC during ankle flexion (0.53 ± 0.06 versus 0.60 ± 0.07 Nm/kg, respectively) and hip extension (2.68 ± 0.39 versus 2.17 ± 0.26 Nm/kg), as well as with respect to the GRFs on the inside leg while skiing (66.8 ± 7.39 versus 76.0 ± 10.0 %BW). As indicated by the JI values, there were also large asymmetries related to GRF as measured by pressure insoles (range: 42.7–56.0%). In conclusion, inter-limb asymmetries in GRFs during elite alpine skiing are not related to corresponding asymmetries in muscular strength. Although our elite athletes exhibited relatively small inter-limb asymmetries in strength, their asymmetries in GRF on-snow were relatively large.

Development of a Novel Nordic Hamstring Exercise Device to Measure and Modify the Knee Flexors' Torque-Length Relationship

The Nordic hamstring exercise (NHE) has been shown to reduce hamstring injury risk when employed in training programs. This study investigates a novel device to modify the NHE torque-length relationship of the knee flexors, as targeting the hamstrings at a more extended length may have benefits for hamstring strain injury prevention and rehabilitation. Eighteen recreational male participants completed three bilateral NHE repetitions at a conventional 0° flat position, a 10° incline, and a 10° decline slope on a novel device (HALHAM°). Measures of peak torque and break-torque angle explored the effect of inclination on the knee flexors' length-tension relationship. Relative thigh-to-trunk angle and angular velocity of the knee joint were used to assess influence of inclination on technique and exercise quality. Break-torque angle increased when performed at an incline (134.1 ± 8.6°) compared to both the decline (112.1 ± 8.3°, p <0.0001, g = 2.599) and standard flat NHE positions (126.0 ± 9.8°, p = 0.0002, g = 0.885). Despite this, altering inclination did not affect eccentric knee flexor peak torque (decline = 132.0 ± 63.1 Nm, flat = 149.7 ± 70.1 Nm, incline = 148.9 ± 64.9 Nm, F = 0.952, p = 0.389), angular velocity of the knee joint at break-torque angle (decline = 23.8 ± 14.4°, flat = 29.2 ± 22.6°, incline = 24.5 ± 22.6°, F = 0.880, p = 0.418) or relative thigh-to-trunk angle at break-torque angle (decline = 20.4 ± 10.4°, flat = 16.7 ± 10.8°, incline = 20.2 ± 11.2°, F = 1.597, p = 0.207). The report recommends the use of arbitrary metrics such as break-torque angle that can be replicated practically in the field by practitioners to assess proxy muscle length changes i.e., the angular range over which the torque can be produced. Inclination of the Nordic hamstring exercise leads to hamstring muscle failure at longer muscle lengths without reductions in the maximal force exuded by the muscle. Therefore, the NHE performed on an incline may be a more effective training intervention, specific to the proposed mechanism of hamstring strain injury during sprinting that occurs whilst the muscle is rapidly lengthening. Using a graded training intervention through the inclinations could aid gradual return-to-play rehabilitation.

Altered Drop Jump Landing Biomechanics Following Eccentric Exercise-Induced Muscle Damage

Limited research exists in the literature regarding the biomechanics of the jump-landing sequence in individuals that experience symptoms of muscle damage. The present study investigated the effects of knee localized muscle damage on sagittal plane landing biomechanics during drop vertical jump (DVJ). Thirteen regional level athletes performed five sets of 15 maximal eccentric voluntary contractions of the knee extensors of both legs at 60°/s. Pelvic and lower body kinematics and kinetics were measured pre- and 48 h post-eccentric exercise. The examination of muscle damage indicators included isometric torque, muscle soreness, and serum creatine kinase (CK) activity. The results revealed that all indicators changed significantly following eccentric exercise (p < 0.05). Peak knee and hip joint flexion as well as peak anterior pelvic tilt significantly increased, whereas vertical ground reaction force (GRF), internal knee extension moment, and knee joint stiffness significantly decreased during landing (p < 0.05). Therefore, the participants displayed a softer landing pattern following knee-localized eccentric exercise while being in a muscle-damaged state. This observation provides new insights on how the DVJ landing kinematics and kinetics alter to compensate the impaired function of the knee extensors following exercise-induced muscle damage (EIMD) and residual muscle soreness 48 h post-exercise.

Residual Force Enhancement Is Present in Consecutive Post-Stretch Isometric Contractions of the Hamstrings during a Training Simulation

Residual force enhancement (rFE) is observed when isometric force following an active stretch is elevated compared to an isometric contraction at corresponding muscle lengths. Acute rFE has been confirmed in vivo in upper and lower limb muscles. However, it is uncertain whether rFE persists using multiple, consecutive contractions as per a training simulation. Using the knee flexors, 10 recreationally active participants (seven males, three females; age 31.00 years ± 8.43 years) performed baseline isometric contractions at 150° knee flexion (180° representing terminal knee extension) of 50% maximal voluntary activation of semitendinosus. Participants performed post-stretch isometric (PS-ISO) contractions (three sets of 10 repetitions) starting at 90° knee extension with a joint rotation of 60° at 60°·s-1 at 50% maximal voluntary activation of semitendinosus. Baseline isometric torque and muscle activation were compared to PS-ISO torque and muscle activation across all 30 repetitions. Significant rFE was noted in all repetitions (37.8-77.74%), with no difference in torque between repetitions or sets. There was no difference in activation of semitendinosus or biceps femoris long-head between baseline and PS-ISO contractions in all repetitions (ST; baseline ISO = 0.095-1.000 ± 0.036-0.039 Mv, PS-ISO = 0.094-0.098 ± 0.033-0.038 and BFlh; baseline ISO = 0.068-0.075 ± 0.031-0.038 Mv). This is the first investigation to observe rFE during multiple, consecutive submaximal PS-ISO contractions. PS-ISO contractions have the potential to be used as a training stimulus.

The effects of training with high-speed interval running on muscle performance are modulated by slope

We examined changes in selected muscle performance parameters after 8 weeks of interval training using two opposite running inclinations. We hypothesized that the uphill training will affect endurance muscle performance outcomes, whereas the downhill training will affect power muscle performance outcomes. Fourteen physically active volunteers were randomly assigned into either the Uphill group (UG; n = 7; uphill interval running at +10% incline) or the Downhill group (DG; n = 7; downhill interval running at -10% incline) and completed 16 training sessions. Each session consisted of ten 30 s treadmill runs at 90% of maximum aerobic speed (MAS) with a work to rest ratio of 1:2. Vertical jump performance, isometric (MVC) and isokinetic torque of knee extensors and flexors, and fatigue of knee extensors were evaluated pre and post-training. Moreover, body composition (via bioimpedance) and vastus lateralis muscle architecture (via ultrasonography) were assessed pre and post-training. Relative lean tissue mass, relative fat mass, and squat jump (cm) significantly (p < .05) changed from baseline values by +4.5 ± 4.0%, -11.5 ± 9.6%, and +9.5 ± 11.7%, respectively, only in the DG. Similarly, DG improved absolute values of knee extension rate of torque development and impulse (p < .05), whereas knee flexion peak torque angle significantly decreased in both groups (p < .05). On the other hand, the UG increased the number of repetitions achieved during the fatigue protocol and total work by 21.2 ± 32.6% and 13.8 ± 21.2%, respectively (p < .05). No differences were found between groups in muscle architecture. Introducing variations in slope during HIIT could be used to induce specific improvements toward muscle endurance or power performance characteristics.

Hamstring Injuries Prevention in Soccer: A Narrative Review of Current Literature

Hamstring injuries and reinjuries are one of the most important sport lesions in several sport activities including soccer, Australian football, track and field, rugby, and in general in all sport activities requiring sprinting and acceleration. However, it is important to distinguish between the lesions of the biceps femoris and semitendinosus and semimembranosus. Indeed, three muscles representing the hamstring complex have a very different injury etiology and consequently require different prevention strategies. This fact may explain, at least in part, the high incidence of reinjuries. In soccer, hamstring injuries cause an important rate of time loss (i.e., in average 15–21 matches missed per club per season). The hamstring injury risk factors may be subdivided in three categories: “primary injury risk factors” (i.e., the risk factors mainly causing a first lesion), “recurrent injury risk factors” (i.e., the risk that can cause a reinjury), and bivalent injury risk factors” (i.e., the risk factors that can cause both primary injuries and reinjuries). The high incidence of hamstring lesions caused consequently an important increase in hamstring injury research. However, although the prevention has increased paradoxically, epidemiological data do not show a loss in injuries and/or reinjuries but, on the contrary, they show an increase in hamstring injuries. This apparent paradox highlights the importance both of the improvement in the prevention programs quality and the criteria for return to play after hamstring injury.

Triceps Surae Muscle Architecture Adaptations to Eccentric Training

Background

Eccentric exercises have been used in physical training, injury prevention, and rehabilitation programs. The systematic use of eccentric training promotes specific morphological adaptations on skeletal muscles. However, synergistic muscles, such as the triceps surae components, might display different structural adaptations due to differences in architecture, function, and load sharing. Therefore, the purpose of this study was to determine the effects of an eccentric training program on the triceps surae (GM, gastrocnemius medialis; GL, gastrocnemius lateralis; and SO, soleus) muscle architecture.

Methods

Twenty healthy male subjects (26 ± 4 years) underwent a 4-week control period followed by a 12-week eccentric training program. Muscle architecture [fascicle length (FL), pennation angle (PA), and muscle thickness (MT)] of GM, GL, and SO was evaluated every 4 weeks by ultrasonography.

Results

Fascicle lengths (GM: 13.2%; GL: 8.8%; SO: 21%) and MT (GM: 14.9%; GL: 15.3%; SO: 19.1%) increased from pre- to post-training, whereas PAs remained similar. GM and SO FL and MT increased up to the 8th training week, whereas GL FL increased up to the 4th week. SO displayed the highest, and GL the smallest gains in FL post-training.

Conclusion

All three synergistic plantar flexor muscles increased FL and MT with eccentric training. MT increased similarly among the synergistic muscles, while the muscle with the shortest FL at baseline (SO) showed the greatest increase in FL.

Kinematic and electromyographic analysis of variations in Nordic hamstring exercise

The purpose of this study was to present and biomechanically evaluate several variations of the Nordic hamstring exercise (NHE), achieved by altering the slope of the lower leg support and by asumming different hip flexion angles. Electromyographic and 2D kinematic measurements were conducted to analyse muscle activity (biceps femoris, semitendinosus, gluteus maximus, erector spine and lateral head of the gastrocnemius), knee and hip joint torques during 6 variations of NHE. The study involved 18 adults (24.9 ± 3.7 years) with previous experience in resistance training, but with little or no experience with NHE. Increasing the slope of the lower leg support from 0° (standard NHE) to 20° and 40° enabled the participants to perform the exercise through a larger range of motion, while achieving similar peak knee and hip torques. Instructions for increased hip flexion from 0° (standard NHE) to 25°, 50° and 75° resulted in greater peak knee and hip torque, although the participants were not able to maintain the hip angle at 50° nor 75°. Muscle activity decreased or remained similar in all modified variations compared to the standard NHE for all measured muscles. Our results suggest that using the presented variations of NHE might contribute to optimization of hamstring injury prevention and rehabilitation programs, by providing appropriate difficulty for the individual’s strength level and also allow eccentric strengthening at longer hamstring lengths.

Modeling the Angle-Specific Isokinetic Hamstring to Quadriceps Ratio Using Multilevel Generalized Additive Models

Background and Objectives: This study considered the use of a generalized additive multilevel model to describe the joint-angle-specific functional hamstring to quadriceps ratio (H:Q ratio) in the knee, using all of the available truly isokinetic data within the range. Materials and Methods: Thirty healthy male basketball players aged 15.0 (1.4) years (average stature = 180.0 cm, SD = 11.1 cm; average body mass = 71.2, SD = 14.9 kg) years were considered. All players considered had no history of lower extremity musculoskeletal injury at the time of testing or during the 6 months before testing, and had been engaged in formal basketball training and competition for 5.9 (2.4) years. Moments of force of the reciprocal concentric and eccentric muscular actions for the knee extensors and flexors assessed by isokinetic dynamometry at 60°∙s⁻¹ were used. Results: Maximum moments of force were attained at different angle positions for knee extension. For knee flexion, it was apparent that there was an ability to maintain high levels of moment of force between 30° and 60° in the concentric muscular action, corresponding to the concentric action of the hamstrings. However, for the eccentric knee flexion, corresponding to the quadriceps action, there was a marked peak of moment of force at about 55°. The functional H:Q ratio for the knee extension was non-linear, remaining higher than 1.0 (i.e., point of equality) from the beginning of the extension until approximately 40° of the knee extension, leveling off below the point of equality thereafter. On average, the functional H:Q ratio for the knee flexion did not attain 1.0 across the range of motion. The functional H:Q ratio for the knee in the present sample peaked at 20° and 80°, declining between these angle positions to below 0.50 at about 0.54. Conclusions: Estimating the form of the non-linear relationship on-the-fly using a generalized additive multilevel model provides joint-angle-specific curves and joint-angle-specific functional H:Q ratio patterns, allowing the identification and monitoring of strength development, with potential implications for injury and performance.

Eccentric Muscle Contractions: Risks and Benefits

Eccentric contractions, characterized by the lengthening of the muscle-tendon complex, present several unique features compared with other types of contractions, which may lead to unique adaptations. Due to its specific physiological and mechanical properties, there is an increasing interest in employing eccentric muscle work for rehabilitation and clinical purposes. However, unaccustomed eccentric exercise is known to cause muscle damage and delayed pain, commonly defined as “Delayed-Onset Muscular Soreness” (DOMS). To date, the most useful preventive strategy to avoid these adverse effects consists of repeating sessions involving submaximal eccentric contractions whose intensity is progressively increased over the training. Despite an increased number of investigations focusing on the eccentric contraction, a significant gap still remains in our understanding of the cellular and molecular mechanisms underlying the initial damage response and subsequent adaptations to eccentric exercise. Yet, unraveling the molecular basis of exercise-related muscle damage and soreness might help uncover the mechanistic basis of pathological conditions as myalgia or neuromuscular diseases. In addition, a better insight into the mechanisms governing eccentric training adaptations should provide invaluable information for designing therapeutic interventions and identifying potential therapeutic targets.

PRACTICAL CONSIDERATIONS FOR STANDARDIZED RECORDING OF MUSCLE MECHANICAL PROPERTIES USING A MYOMETRIC DEVICE: RECORDING SITE, MUSCLE LENGTH, STATE OF CONTRACTION AND PRIOR ACTIVITY

Purpose: This study aimed to systematically examine the influence of various muscle and experimental conditions on Myoton recordings. Methods: A cross-sectional, observational design was used to examine muscle conditions and experimental factors (different recording sites, muscle length, level of contraction and prior physical activity) that may influence reproducibility of Myoton recordings for biceps brachii (BB) and rectus femoris (RF). Fifty-three healthy adults (26 young, 27 older) aged 18–90 years were studied. Muscle stiffness, tone and elasticity were measured using the MyotonPRO device. Results: Statistically significant differences in Myoton parameters were found for aspects of all four muscle and experimental conditions compared with the control condition ([Formula: see text]). However, clinically relevant differences in tone, stiffness and elasticity were only found for contracted compared to resting muscle, with changes being greater than the minimal detectable change. Elasticity was not affected by prior activity. Conclusions: The conditions studied significantly altered Myoton parameters of BB and RF in healthy adults, but only changes in parameters during muscle contraction were clinically relevant. These findings provide evidence to support the need to consider muscle condition and experimental factors for improving the robustness of test protocols for assessing muscle mechanical properties using the MyotonPRO device.

Sex-Related Responses to Eccentric-Only Resistance Training in Knee-Extensors Muscle Strength and Architecture

PURPOSE

The present study aimed to investigate whether or not eccentric-only training induced different sex-related adaptations in vastus lateralis muscle architecture and knee extensors strength.

METHODS

Thirteen healthy women and 13 healthy men were recruited. Vastus lateralis pennation angle, fascicle length, and muscle thickness, as well as knee extensors eccentric, isometric, and concentric peak torque and one-repetition maximum (1RM) were measured. Both women and men underwent a unilateral iso-load knee-extension eccentric-only training with 120% of the concentric 1RM, consisting of 4 sets × 10 repetitions twice a week for a total of 8 weeks.

RESULTS

Pennation angle increased in women (+ 14%, 95% CI [10, 17], effect size [ES] = 1.54) but not in men (+ 5%, 95% CI [-1, 11], ES = 0.28), while fascicle length increased in both women (+ 7%, 95% CI [4, 10], ES = 1.02) and men (+ 12%, 95% CI [8, 16], ES = 1.82) and muscle thickness increased in women (+ 13%, 95% CI [8, 18], ES = 1.11) and men (+ 11%, 95% CI [7, 15], ES = 0.89). In both women and men, eccentric (18%, 95% CI [11, 25], ES = 0.96, and 16%, 95% CI [9, 22], ES = 0.82, respectively), isometric (17%, 95% CI [11, 23], ES = 0.53, and 17%, 95% CI [10, 24], ES = 0.62), concentric (12%, 95% CI [7, 16], ES = 0.49, and 9%, 95% CI [5, 13], ES = 0.42) peak torque and 1RM (10%, 95% CI [6, 14], ES = 0.53, and 10%, 95% CI [5, 15], ES = 0.50) similarly increased after the intervention.

CONCLUSIONS

This study showed that the adaptations in strength are not sex-dependent, but the increases in pennation angle only in women suggest that the changes in muscle architecture may depend on sex.

Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis

BACKGROUND

Change of direction and kicking have been described as the main actions resulting in adductor longus injury. Video descriptions of inciting events are lacking.

OBJECTIVE

Perform a standardised visual video analysis of a series of acute adductor longus injuries in football.

STUDY DESIGN

Cross-sectional.

METHODS

Video footage was reviewed by players, and assessed independently by five sports medicine professionals. Inciting events were described and categorised using standardised scoring, including playing situation, player/opponent behaviour, movement and body positions.

RESULTS

Videos of acute adductor longus injuries in 17 professional male football players were analysed. Most injuries occurred in non-contact situations (71%), following a quick reaction to a change in play (53%). Injury actions were: change of direction (35%), kicking (29%), reaching (24%) and jumping (12%). Change of direction and reaching injuries were categorised as closed chain movements (59%), characterised by hip extension and abduction with external rotation. Kicking and jumping injuries were categorised as open chain (41%), characterised by a change from hip extension to hip flexion, and hip abduction to adduction, with external rotation.

CONCLUSION

Acute adductor longus injuries in football occur in a variety of situations. Player actions can be categorised into closed (change of direction and reaching) and open (kicking and jumping) chain movements involving triplanar hip motion. A rapid muscle activation during a rapid muscle lengthening appears to be the fundamental injury mechanism for acute adductor longus injuries.

Torque, power and muscle activation of eccentric and concentric isokinetic cycling

This study aimed to establish the effect of cycling mode and cadence on torque, external power output, and lower limb muscle activation during maximal, recumbent, isokinetic cycling. After familiarisation, twelve healthy males completed 6 × 10 s of maximal eccentric (ECC) and concentric (CON) cycling at 20, 40, 60, 80, 100, and 120 rpm with five minutes recovery. Vastus lateralis, medial gastrocnemius, rectus femoris, and biceps femoris surface electromyography was recorded throughout. As cadence increased, peak torque linearly decreased during ECC (350-248 N·m) and CON (239-117 N·m) and peak power increased in a parabolic manner. Crank angle at peak torque increased with cadence in CON (+13°) and decreased in ECC (-9.0°). At all cadences, peak torque (mean +129 N·m, range 111-143 N·m), and power (mean +871 W, range 181-1406 W), were greater during ECC compared to CON. For all recorded muscles the crank angle at peak muscle activation was greater during ECC compared to CON. This difference increased with cadence in all muscles except the vastus lateralis. Additionally, peak vastus laterallis and biceps femoris activation was greater during CON compared to ECC. Eccentric cycling offers a greater mechanical stimulus compared to concentric cycling but the effect of cadence is similar between modalities. Markers of technique (muscle activation, crank angle at peak activation and torque) were different between eccentric and concentric cycling and respond differently to changes in cadence. Such data should be considered when comparing between, and selecting cadences for, recumbent, isokinetic, eccentric and concentric cycling.

Preseason Adductor Squeeze Strength in 303 Spanish Male Soccer Athletes: A Cross-sectional Study

Background:

Hip adductor muscle weakness and a history of groin injury both have been identified as strong risk factors for sustaining a new groin injury. Current groin pain and age have been associated with hip adductor strength. These factors could be related, but this has never been investigated.

Purpose:

To investigate whether soccer athletes with past-season groin pain and with different durations of past-season groin pain had lower preseason hip adductor squeeze strength compared with those without past-season groin pain. We also investigated whether differences in preseason hip adductor squeeze strength in relation to past-season groin pain and duration were influenced by current groin pain and age.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

In total, 303 male soccer athletes (mean age, 23 ± 4 years; mean weight, 74.0 ± 7.9 kg; mean height, 178.1 ± 6.3 cm) were included in this study. Self-reported data regarding current groin pain, past-season groin pain, and duration were collected. Hip adductor squeeze strength was obtained using 2 different reliable testing procedures: (1) the short-lever (resistance placed between the knees, feet at the examination bed, and 45° of hip flexion) and (2) the long-lever (resistance placed between the ankles and 0° of hip flexion) squeeze tests.

Results:

There was no difference between those with (n = 123) and without (n = 180) past-season groin pain for hip adductor squeeze strength when adjusting for current groin pain and age. However, athletes with past-season groin pain lasting longer than 6 weeks (n = 27) showed 11.5% and 15.3% lower values on the short-lever (P = .006) and long-lever (P < .001) hip adductor squeeze strength tests, respectively, compared with those without past-season groin pain.

Conclusion:

Male soccer athletes with past-season groin pain lasting longer than 6 weeks are likely to begin the next season with a high-risk groin injury profile, including a history of groin pain and hip adduction weakness.

Whey protein hydrolysate supplementation accelerates recovery from exercise-induced muscle damage in females

A number of different forms of protein and their analogues have been investigated for their efficacy in ameliorating exercise-induced muscle damage (EIMD) and recovery. Preliminary data regarding whey protein hydrolysate (WPH) supplementation are promising. However, its efficacy beyond acute eccentric/resistance exercise bouts or longer term training programmes are limited and all investigations have been conducted in male or mixed-sex groups. This study sought to elucidate whether the benefits of WPH previously reported can be demonstrated in females following repeated-sprint exercise. Twenty physically active females were assigned to consume 2 doses of 70 mL WPH or isoenergetic carbohydrate (CHO) for 4 days post-EIMD. Measures of muscle soreness, limb girth, flexibility, muscle function, and creatine kinase were collected before, immediately after, and 24, 48, and 72 h postexercise. Time effects were observed for all variables (p < 0.05) except limb girth, which is indicative of EIMD. Flexibility improved beyond baseline measures following WPH by 72 h, but had failed to recover in the CHO group (p = 0.011). Reactive strength index was higher throughout recovery in the WPH group compared with CHO (p = 0.016). Reductions in creatine kinase were greater following WPH compared with CHO at 48 h post-EIMD (p = 0.031). The findings suggest that 4-day supplementation of WPH is beneficial for reducing symptoms of EIMD and improving recovery of muscle function in physically active females.

Skeletal Muscle Remodeling in Response to Eccentric vs. Concentric Loading: Morphological, Molecular, and Metabolic Adaptations

Skeletal muscle contracts either by shortening or lengthening (concentrically or eccentrically, respectively); however, the two contractions substantially differ from one another in terms of mechanisms of force generation, maximum force production and energy cost. It is generally known that eccentric actions generate greater force than isometric and concentric contractions and at a lower metabolic cost. Hence, by virtue of the greater mechanical loading involved in active lengthening, eccentric resistance training (ECC RT) is assumed to produce greater hypertrophy than concentric resistance training (CON RT). Nonetheless, prevalence of either ECC RT or CON RT in inducing gains in muscle mass is still an open issue, with some studies reporting greater hypertrophy with eccentric, some with concentric and some with similar hypertrophy within both training modes. Recent observations suggest that such hypertrophic responses to lengthening vs. shortening contractions are achieved by different adaptations in muscle architecture. Whilst the changes in muscle protein synthesis in response to acute and chronic concentric and eccentric exercise bouts seem very similar, the molecular mechanisms regulating the myogenic adaptations to the two distinct loading stimuli are still incompletely understood. Thus, the present review aims to, (a) critically discuss the literature on the contribution of eccentric vs. concentric loading to muscular hypertrophy and structural remodeling, and, (b) clarify the molecular mechanisms that may regulate such adaptations. We conclude that, when matched for either maximum load or work, similar increase in muscle size is found between ECC and CON RT. However, such hypertrophic changes appear to be achieved through distinct structural adaptations, which may be regulated by different myogenic and molecular responses observed between lengthening and shortening contractions.

The effect of Nordic hamstring strength training on muscle architecture, stiffness, and strength

PURPOSE

Hamstring strain injury is a frequent and serious injury in competitive and recreational sports. While Nordic hamstring (NH) eccentric strength training is an effective hamstring injury-prevention method, the protective mechanism of this exercise is not understood. Strength training increases muscle strength, but also alters muscle architecture and stiffness; all three factors may be associated with reducing muscle injuries. The purpose of this study was to examine the effects of NH eccentric strength training on hamstring muscle architecture, stiffness, and strength.

METHODS

Twenty healthy participants were randomly assigned to an eccentric training group or control group. Control participants performed static stretching, while experimental participants performed static stretching and NH training for 6 weeks. Pre- and post-intervention measurements included: hamstring muscle architecture and stiffness using ultrasound imaging and elastography, and maximal hamstring strength measured on a dynamometer.

RESULTS

The experimental group, but not the control group, increased volume (131.5 vs. 145.2 cm³, p < 0.001) and physiological cross-sectional area (16.1 vs. 18.1 cm², p = 0.032). There were no significant changes to muscle fascicle length, stiffness, or eccentric hamstring strength.

CONCLUSIONS

The NH intervention was an effective training method for muscle hypertrophy, but, contrary to common literature findings for other modes of eccentric training, did not increase fascicle length. The data suggest that the mechanism behind NH eccentric strength training mitigating hamstring injury risk could be increasing volume rather than increasing muscle length. Future research is, therefore, warranted to determine if muscle hypertrophy induced by NH training lowers future hamstring strain injury risk.

Moderate Load Eccentric Exercise; A Distinct Novel Training Modality

Over the last 20 years a number of studies have been published using progressive eccentric exercise protocols on motorized ergometers or similar devices that allow for controlled application of eccentric loads. Exercise protocols ramp eccentric loads over an initial 3 weeks period in order to prevent muscle damage and delayed onset muscle soreness. Final training loads reach 400-500 W in rehabilitative settings and over 1200 W in elite athletes. Training is typically carried out three times per week for durations of 20-30 min. This type of training has been characterizes as moderate load eccentric exercise. It has also been denoted RENEW (Resistance Exercise via Negative Eccentric Work by LaStayo et al., 2014). It is distinct from plyometric exercises (i.e., drop jumps) that impose muscle loads of several thousand Watts on muscles and tendons. It is also distinct from eccentric overload training whereby loads in a conventional strength training setting are increased in the eccentric phase of the movement to match concentric loads. Moderate load eccentric exercise (or RENEW) has been shown to be similarly effective as conventional strength training in increasing muscle strength and muscle volume. However, as carried out at higher angular velocities of joint movement, it reduces joint loads. A hallmark of moderate load eccentric exercise is the fact that the energy requirements are typically 4-fold smaller than in concentric exercise of the same load. This makes moderate load eccentric exercise training the tool of choice in medical conditions with limitations in muscle energy supply. The use and effectiveness of moderate load eccentric exercise has been demonstrated mostly in small scale studies for cardiorespiratory conditions, sarcopenia of old age, cancer, diabetes type 2, and neurological conditions. It has also been used effectively in the prevention and rehabilitation of injuries of the locomotor system in particular the rehabilitation after anterior cruciate ligament surgery.

Clinical Practice Patterns and Beliefs in the Management of Hamstrings Strain Injuries

CONTEXT

Hamstrings strain injuries (HSIs) are among the most commonly occurring injuries in sport and are top causes of missed playing time. Lingering symptoms, prolonged recovery, and a high reinjury rate (12%-34%) make HSI management a frustrating and challenging process for the athletic trainer (AT). The clinical practice patterns and opinions of ATs regarding HSI treatment and rehabilitation are unknown.

OBJECTIVE

To examine the frequency of method use and opinions about current HSI management among ATs.

DESIGN

Cross-sectional study.

SETTING

Survey administered to registrants at the 2013 National Athletic Trainers' Association Clinical Symposia and AT Expo.

PATIENTS OR OTHER PARTICIPANTS

A total of 1356 certified ATs (691 men, 665 women; age = 35.4 ± 10.5 years, time certified = 11.92 ± 9.75 years).

DATA COLLECTION AND ANALYSIS

A survey was distributed electronically to 7272 registrants and on paper to another 700 attendees. Validity and reliability were established before distribution. Participants reported demographic information and rated their frequency of treatment and rehabilitation method use and agreement with questions assessing confidence, satisfaction, and desire for better clinical practice guidelines. Exploratory factor analysis and principal axis factor analysis were used. We also calculated descriptive statistics and χ(2) tests to assess practice patterns.

RESULTS

The response rate was 17% (n = 1356). A 2-factor solution was accepted for factor analysis (r = 0.76, r = 0.70), indicating that ATs follow either a contemporary or traditional management style. Various practice patterns were evident across employment settings and years of clinical experience. Satisfaction with the current HSI management plan was high (73.6%), whereas confidence in returning an athlete to play was lower (62.0%). Rates of use were associated with belief in effectiveness for all methods assessed (P < .001). Higher confidence levels were associated with high use of several methods; we observed increased satisfaction (χ(2)2 = 22.5, P = .002) but not increased confidence levels in more experienced ATs.

CONCLUSIONS

Our study demonstrated the lack of consensus in HSI treatment and rehabilitation and the ATs' desire for better clinical practice guidelines. Future research in which multimodal strategies, including both traditional and contemporary methods, are studied is warranted for effective management of HSI.