The Effect of a Previous Strain Injury on Regional Neuromuscular Activation Within the Rectus Femoris

Epidemiology of quadriceps muscle strain injuries in elite male Australian football players

OBJECTIVE

To describe the epidemiology of quadriceps muscle strain injury (QMSI) in elite Australian Football League (AFL) players, explore recovery milestones and determine whether recovery is impacted by factors such as injury type (index vs. re-injury), the primary muscle injured and the mechanism of injury.

MEASURES

All QMSI data reported to the Soft Tissue Injury Registry of the AFL from the 2014 to 2020 seasons were evaluated. Player demographic data, circumstances of injury, MRI reports and recovery outcomes following injury were extracted. Descriptive statistics and frequency distributions are presented. Recovery outcomes for injury type, primary muscle injured and the mechanism of injury were compared using univariate analyses.

RESULTS

There were 164 QMSIs from 122 players reported (134 index; 30 re-injuries). Almost all (91.3%) QMSIs involved the rectus femoris. Half (48.4%) of the QMSIs occurred during kicking and most commonly affected the dominant kicking leg (72%). The majority occurred at training (64.6%). All re-injuries involved the rectus femoris, most occurred from kicking (63.0%) and within 6 months of the preceding injury (70%). The mean return to play (RTP) time was 25.4 days (95%CI = 22.6-28.2) and rectus femoris injuries took around 14 days longer to RTP than vastii injuries (p = 0.001). QMSIs with a kicking mechanism took the longest to RTP of all injury mechanisms.

CONCLUSION

In AFL players, QMSIs occur mostly in the dominant leg from a kicking mechanism. Rectus femoris injuries are more prevalent and result in longer RTP time frames. Re-injuries exclusively involved the rectus femoris, primarily from kicking.

Effects of superficial tissue and intermuscular connections on rectus femoris muscle shear modulus heterogeneity

INTRODUCTION

Intramuscular heterogeneity exists in the shear modulus of the rectus femoris (RF) muscle. However, the underlying heterogeneity mechanisms are not entirely understood. Previous research has reported that detachment of superficial tissues reduces the shear modulus by 50%. The aim of this study was to examine the effects of the skin, deep fascia, and intermuscular connections on the shear modulus of the RF at multiple sites.

MATERIALS AND METHODS

Eleven donors were fixed using the Thiel method. Measurements were performed at 0°, 60°, and 120° knee flexion in a neutral hip position. Tissue processing was performed under four conditions: superficial tissue (CONT), skin off (SKIN), deep fascia detachment (FASC), and intermuscular connections detachment (ALL). The shear modulus at the proximal, central, and distal regions were measured using ultrasound shear wave elastography. The study was approved by the Sapporo Medical University Ethical Committee.

RESULTS

Three-way ANOVA revealed no significant interaction between treatment, site, and angle (P = 0.156), treatment and angle (P = 0.067), or site and angle (P = 0.441). There was a significant effect of treatment (P < 0.001), site (P = 0.010), and angle (P < 0.001) and interaction between treatment and site (P < 0.001). The proximal shear modulus was greater than the central for CONT. There were no significant differences between the measurement sites for SKIN. The distal shear modulus was greater than the proximal for FASC. The distal shear modulus was also greater than the proximal and central for ALL.

CONCLUSIONS

Intramuscular regional differences that influence superficial tissue and intermuscular connections of RF elasticity heterogeneity were observed.

Tendinopatias do quadril: Uma atualização de conceitos e abordagens

The present update was based on new scientific evidence of major hip-related tendinopathies. Themes were addressed that involve the principles of the onset of tendinopathies through, mainly, the principle of capacity versus demand and the biomechanical aspects involved in its onset, its main characteristics, and clinical presentations. Associated with this, treatment-related updates were presented, with exercise therapy being the focus of conservative treatment and surgical approaches necessary for the control or resolution of these cases.

Central Tendon Injury Impairs Regional Neuromuscular Activation of the Rectus Femoris Muscle

We aimed to uncover which rectus femoris strain injury types affect regional activation within the rectus femoris. The rectus femoris has a region-specific functional role; the proximal region of the rectus femoris contributes more than the middle and distal regions during hip flexion. Although a history of strain injury modifies the region-specific functional role within the rectus femoris, it was not obvious which rectus femoris strain injury types affect regional activation within it. We studied 12 soccer players with a history of rectus femoris strain injury. Injury data were obtained from a questionnaire survey and magnetic resonance imaging. To confirm the region-specific functional role of the rectus femoris, surface multichannel electromyographic signals were recorded. Accordingly, eight legs had a history of central tendon injury, four had a history of myofascial junction injury, and four had a healed strain injury. When the injury was limited to the central tendon, the region-specific functional role disappeared. The region-specific functional role was confirmed when the injury was outside the central part. The neuromuscular function was also inhibited when the longitudinal range of the injured region was long. Our findings suggest that a central tendon injury with a long injury length impairs regional neuromuscular activation of the rectus femoris muscle.

Muscle Activity and Activation in Previously Strain-Injured Lower Limbs: A Systematic Review

BACKGROUND

Lower limb muscle strain injury is highly prevalent in running-based sports and is considered a risk factor for recurrent injury. It is possible that differences in muscle activity and activation in previously strain-injured limbs may contribute to the elevated risk of reinjury.

OBJECTIVES

To systematically review available literature investigating whether muscle activity and/or activation is different in previously strain-injured muscles compared to contralateral uninjured muscles or uninjured controls.

METHODS

A systematic review of literature in SPORTDiscus, MEDLINE Complete, CINAHL and Web of Science was conducted. Full-text English articles which compared indicators of neuromuscular function between injured and uninjured contralateral limbs or control groups in those with a history of muscle strain injury were included.

RESULTS

Twelve studies were included in the review after eligibility criteria were applied. A best evidence synthesis revealed moderate to limited evidence suggesting differences in surface electromyography (sEMG) amplitude, integrated sEMG amplitude, inter-muscle sEMG ratios and voluntary activation in injured limbs, most often during eccentric contractions. Studies utilising sprinting assessments demonstrated conflicting evidence when comparing late swing phase biceps femoris sEMG amplitude between limbs with a history of hamstring strain injury and uninjured contralateral limbs.

CONCLUSIONS

Differences in muscle activity and activation were observed between injured and uninjured limbs across a variety of strength assessments. The evidence supporting these differences was most often moderate or limited and was generally observed during eccentric contractions. Mostly conflicting or limited evidence was found to suggest that participants with previous hamstring strain injury demonstrate no differences in muscle activity during running tasks when compared with their uninjured counterparts or contralateral limbs.

TRIAL REGISTRY

PROSPERO (ID, CRD42019135681).

Intramuscular differences in shear modulus of the rectus femoris muscle during passive knee flexion

PURPOSE

This study aimed to determine (1) intramuscular regional differences in the changes in the shear modulus of the rectus femoris (RF) muscle during passive knee flexion and (2) the relationship between shear modulus and passive knee extension torque.

METHOD

The shear modulus maps as an index of muscle stiffness and the passive torque were obtained at seven regions during passive knee flexion at 2°/s within a knee joint range of motion of 0°-130° in 16 healthy males.

RESULTS

The shear modulus of RF increased with the knee angle of flexion. The shear modulus of each longitudinal region was greater in the order of proximal, central, and distal region (p < 0.05). The relationship between the shear modulus and passive torque was highly fitted for all 16 subjects (p < 0.05). The mean coefficient of determination (R²) at second-order polynomial model per subject was 0.96 (± 0.03; range 0.61-0.99), and whole group was 0.58 (± 0.03; range 0.54-0.64) in all regions.

CONCLUSIONS

The passive stiffness of RF was higher in the proximal region than in the other regions during passive knee flexion. Furthermore, the shear modulus-passive torque was related regardless of the measurement region within a muscle, and the results suggest that the passive knee extension torque reflects passive muscle stiffness of the RF.