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Keogh JAJ, Waddington EE, Masood Z, Mahmood S, Palanisamy AC, Ruder MC, Karsan S, Bishop C, Jordan MJ, Heisz JJ, Kobsar D. Monitoring lower limb biomechanical asymmetry and psychological measures in athletic populations-A scoping review. Scand J Med Sci Sports 2023; 33:2125-2148. [PMID: 37551046 DOI: 10.1111/sms.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Lower limb biomechanics, including asymmetry, are frequently monitored to determine sport performance level and injury risk. However, contributing factors extend beyond biomechanical and asymmetry measures to include psychological, sociological, and environmental factors. Unfortunately, inadequate research has been conducted using holistic biopsychosocial models to characterize sport performance and injury risk. Therefore, this scoping review summarized the research landscape of studies concurrently assessing measures of lower limb biomechanics, asymmetry, and introspective psychological state (e.g., pain, fatigue, perceived exertion, stress, etc.) in healthy, competitive athletes. METHODS A systematic search of MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science Core Collections was designed and conducted in accordance with PRISMA guidelines. Fifty-one articles were included in this review. RESULTS Significant relationships between biomechanics (k = 22 studies) or asymmetry (k = 20 studies) and introspective state were found. Increased self-reported pain was associated with decreased range of motion, strength, and increased lower limb asymmetry. Higher ratings of perceived exertion were related to increased lower limb asymmetry, self-reported muscle soreness, and worse jump performance. Few studies (k = 4) monitored athletes longitudinally throughout one or more competitive season(s). CONCLUSION This review highlights the need for concurrent analysis of introspective, psychological state, and biomechanical asymmetry measures along with longitudinal research to understand the contributing factors to sport performance and injury risk from biopsychosocial modeling. In doing so, this framework of biopsychosocial preventive and prognostic patient-centered practices may provide an actionable means of optimizing health, well-being, and sport performance in competitive athletes.
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Affiliation(s)
- Joshua A J Keogh
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Emma E Waddington
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Sobia Mahmood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Anil C Palanisamy
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Matthew C Ruder
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Sameena Karsan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Chris Bishop
- London Sports Institute, Middlesex University, London, UK
| | - Matthew J Jordan
- Faculty of Kinesiology, Sport Medicine Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer J Heisz
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Dylan Kobsar
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
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Quarmby A, Khajooei M, Kurtz P, Henschke J, Kim M, Mayer F, Engel T. Unexpected running perturbations: Reliability and validity of a treadmill running protocol with analysis of provoked reflex activity in the lower extremities. Front Sports Act Living 2023; 5:1129058. [PMID: 37008630 PMCID: PMC10050738 DOI: 10.3389/fspor.2023.1129058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionBalance is vital for human health and experiments have been conducted to measure the mechanisms of postural control, for example studying reflex responses to simulated perturbations. Such studies are frequent in walking but less common in running, and an understanding of reflex responses to trip-like disturbances could enhance our understanding of human gait and improve approaches to training and rehabilitation. Therefore, the primary aim of this study was to investigate the technical validity and reliability of a treadmill running protocol with perturbations. A further exploratory aim was to evaluate the associated neuromuscular reflex responses to the perturbations, in the lower limbs.MethodsTwelve healthy participants completed a running protocol (9 km/h) test-retest (2 weeks apart), whereby 30 unilateral perturbations were executed via the treadmill belts (presets:2.0 m/s amplitude;150 ms delay (post-heel contact);100ms duration). Validity of the perturbations was assessed via mean ± SD comparison, percentage error calculation between the preset and recorded perturbation characteristics (PE%), and coefficient of variation (CV%). Test-retest reliability (TRV%) and Bland-Altman analysis (BLA; bias ± 1.96 * SD) was calculated for reliability. To measure reflex activity, electromyography (EMG) was applied in both legs. EMG amplitudes (root mean square normalized to unperturbed strides) and latencies [ms] were analysed descriptively.ResultsLeft-side perturbation amplitude was 1.9 ± 0.1 m/s, delay 105 ± 2 ms, and duration 78 ± 1 ms. Right-side perturbation amplitude was 1.9 ± 0.1 m/s, delay 118 ± 2 ms, duration 78 ± 1 ms. PE% ranged from 5–30% for the recorded perturbations. CV% of the perturbations ranged from 19.5–76.8%. TRV% for the perturbations was 6.4–16.6%. BLA for the left was amplitude: 0.0 ± 0.3m/s, delay: 0 ± 17 ms, duration: 2 ± 13 ms, and for the right was amplitude: 0.1 ± 0.7, delay: 4 ± 40 ms, duration: 1 ± 35 ms. EMG amplitudes ranged from 175 ± 141%–454 ± 359% in both limbs. Latencies were 109 ± 12–116 ± 23 ms in the tibialis anterior, and 128 ± 49-157 ± 20 ms in the biceps femoris.DiscussionGenerally, this study indicated sufficient validity and reliability of the current setup considering the technical challenges and limitations, although the reliability of the right-sided perturbations could be questioned. The protocol provoked reflex responses in the lower extremities, especially in the leading leg. Acute neuromusculoskeletal adjustments to the perturbations could be studied and compared in clinical and healthy running populations, and the protocol could be utilised to monitor chronic adaptations to interventions over time.
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Quarmby A, Mönnig J, Mugele H, Henschke J, Kim M, Cassel M, Engel T. Biomechanics and lower limb function are altered in athletes and runners with achilles tendinopathy compared with healthy controls: A systematic review. Front Sports Act Living 2023; 4:1012471. [PMID: 36685067 PMCID: PMC9845578 DOI: 10.3389/fspor.2022.1012471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Achilles tendinopathy (AT) is a debilitating injury in athletes, especially for those engaged in repetitive stretch-shortening cycle activities. Clinical risk factors are numerous, but it has been suggested that altered biomechanics might be associated with AT. No systematic review has been conducted investigating these biomechanical alterations in specifically athletic populations. Therefore, the aim of this systematic review was to compare the lower-limb biomechanics of athletes with AT to athletically matched asymptomatic controls. Databases were searched for relevant studies investigating biomechanics during gait activities and other motor tasks such as hopping, isolated strength tasks, and reflex responses. Inclusion criteria for studies were an AT diagnosis in at least one group, cross-sectional or prospective data, at least one outcome comparing biomechanical data between an AT and healthy group, and athletic populations. Studies were excluded if patients had Achilles tendon rupture/surgery, participants reported injuries other than AT, and when only within-subject data was available.. Effect sizes (Cohen's d) with 95% confidence intervals were calculated for relevant outcomes. The initial search yielded 4,442 studies. After screening, twenty studies (775 total participants) were synthesised, reporting on a wide range of biomechanical outcomes. Females were under-represented and patients in the AT group were three years older on average. Biomechanical alterations were identified in some studies during running, hopping, jumping, strength tasks and reflex activity. Equally, several biomechanical variables studied were not associated with AT in included studies, indicating a conflicting picture. Kinematics in AT patients appeared to be altered in the lower limb, potentially indicating a pattern of "medial collapse". Muscular activity of the calf and hips was different between groups, whereby AT patients exhibited greater calf electromyographic amplitudes despite lower plantar flexor strength. Overall, dynamic maximal strength of the plantar flexors, and isometric strength of the hips might be reduced in the AT group. This systematic review reports on several biomechanical alterations in athletes with AT. With further research, these factors could potentially form treatment targets for clinicians, although clinical approaches should take other contributing health factors into account. The studies included were of low quality, and currently no solid conclusions can be drawn.
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Affiliation(s)
- Andrew Quarmby
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany,Correspondence: Andrew Quarmby
| | - Jamal Mönnig
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Hendrik Mugele
- Department of Sport Science, Laboratory for Environmental and Exercise Science, University of Innsbruck, Innsbruck, Austria
| | - Jakob Henschke
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - MyoungHwee Kim
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
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Contreras-Hernandez I, Falla D, Schneebeli A, Martinez-Valdes E. Neuromechanical changes in Achilles tendinopathy and the effects of exercise-induced mechanical tendon loading: a protocol for a systematic review. BMJ Open 2022; 12:e050186. [PMID: 35135764 PMCID: PMC8830232 DOI: 10.1136/bmjopen-2021-050186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Achilles tendinopathy (AT) is a debilitating overuse injury characterised by pain, impaired functional performance, morpho-mechanical changes to the Achilles tendon and triceps surae neuromuscular alterations. Loading-based exercise has become the principal non-surgical choice for the treatment of AT; however, mechanistic evidence by which loading-based treatment may help to resolve tendon pain remains unclear. This systematic review aims to summarise the evidence of the neuromechanical changes produced by AT and by exercise-induced mechanical loading. METHODS AND ANALYSIS This systematic review protocol was informed and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-P) and the Cochrane Handbook for Systematic Reviews of Interventions. Pubmed, MEDLINE, EMBASE, CINAHL Plus, Web of Science and SPORTDiscus electronic databases will be searched from inception to February 2021. Additionally, grey literature and key journals will be reviewed. Risk of bias will be determined independently by two reviewers using the version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2) and the risk of bias in non-randomised studies - of interventions (ROBINS-I) tool according to Cochrane recommendations. Quality of the cumulative evidence will be assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines. If homogeneity exists between groups of studies, a random-effects meta-analysis will be conducted. If not, results will be synthesised narratively. ETHICS AND DISSEMINATION Our findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. No ethical approval was required. PROSPERO REGISTRATION NUMBER CRD42021231933.
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Affiliation(s)
- Ignacio Contreras-Hernandez
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alessandro Schneebeli
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Fernandes GL, Orssatto LBR, Shield AJ, Trajano GS. Runners with mid-portion Achilles tendinopathy have greater triceps surae intracortical inhibition than healthy controls. Scand J Med Sci Sports 2021; 32:728-736. [PMID: 34897835 DOI: 10.1111/sms.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/25/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to investigate short-interval intracortical inhibition (SICI) and muscle function in the triceps surae of runners with mid-portion Achilles tendinopathy (AT). METHODS Runners with (n = 11) and without (n = 13) AT were recruited. Plantar flexor isometric peak torque and rate of torque development (RTD) were measured using an isokinetic dynamometer. Triceps surae endurance was measured as single-leg heel raise (SLHR) to failure test. SICI was assessed using paired-pulse transcranial magnetic stimulation during a sustained contraction at 10% of plantar flexor isometric peak torque. RESULTS Triceps surae SICI was 14.3% (95% CI: -2.1 to 26.4) higher in AT than in the control group (57.9%, 95% CI: 36.2 to 79.6; and 43.6% 95% CI: 16.2 to 71.1, p = 0.032) irrespective of the tested muscle. AT performed 16 (95% CI: 7.9 to 23.3, p < 0.001) fewer SLHR repetitions on the symptomatic side compared with controls, and 14 (95% CI: 5.8 to 22.0, p = 0.004), fewer SLHR repetitions on the non-symptomatic compared with controls. We found no between-groups differences in isometric peak torque (p = 0.971) or RTD (p = 0.815). PERSPECTIVE Our data suggest greater intracortical inhibition for the triceps surae muscles for the AT group accompanied by reduced SLHR endurance, without deficits in isometric peak torque or RTD. The increased SICI observed in the AT group could be negatively influencing triceps surae endurance; thus, rehabilitation aiming to reduce intracortical inhibition should be considered to improve patient outcomes. Furthermore, SLHR is a useful clinical tool to assess plantar flexor function in AT patients.
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Affiliation(s)
- Gabriel L Fernandes
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Lucas B R Orssatto
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
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Sanderson A, Wang SF, Elgueta-Cancino E, Martinez-Valdes E, Sanchis-Sanchez E, Liew B, Falla D. The effect of experimental and clinical musculoskeletal pain on spinal and supraspinal projections to motoneurons and motor unit properties in humans: A systematic review. Eur J Pain 2021; 25:1668-1701. [PMID: 33964047 DOI: 10.1002/ejp.1789] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/30/2020] [Accepted: 04/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Numerous studies have examined the influence of pain on spinal reflex excitability, motor unit behaviour and corticospinal excitability. Nevertheless, there are inconsistencies in the conclusions made. This systematic review sought to understand the effect of pain on spinal and supraspinal projections to motoneurons and motor unit properties by examining the influence of clinical or experimental pain on the following three domains: H-reflex, corticospinal excitability and motor unit properties. DATABASES AND DATA TREATMENT MeSH terms and preselected keywords relating to the H-reflex, motor evoked potentials and motor unit decomposition in chronic and experimental pain were used to perform a systematic literature search using Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Web of Science, Medline, Google Scholar and Scopus databases. Two independent reviewers screened papers for inclusion and assessed the methodological quality using a modified Downs and Black risk of bias tool; a narrative synthesis and three meta-analyses were performed. RESULTS Sixty-one studies were included, and 17 different outcome variables were assessed across the three domains. Both experimental and clinical pain have no major influence on measures of the H-reflex, whereas experimental and clinical pain appeared to have differing effects on corticospinal excitability. Experimental pain consistently reduced motor unit discharge rate, a finding which was not consistent with data obtained from patients. The results indicate that when in tonic pain, induced via experimental pain models, inhibitory effects on motoneuron behaviour were evident. However, in chronic clinical pain populations, more varied responses were evident likely reflecting individual adaptations to chronic symptoms. SIGNIFICANCE This is a comprehensive systematic review and meta-analysis which synthesizes evidence on the influence of pain on spinal and supraspinal projections to motoneurons and motor unit properties considering measures of the H-reflex, corticospinal excitability and motor unit behaviour. The H-reflex is largely not influenced by the presence of either clinical or experimental pain. Whilst inhibitory effects on corticospinal excitability and motor unit behaviour were evident under experimental pain conditions, more variable responses were observed for people with painful musculoskeletal disorders.
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Affiliation(s)
- Andy Sanderson
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Shuwfen F Wang
- Graduate Institute and School of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - Edith Elgueta-Cancino
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Enrique Sanchis-Sanchez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Bernard Liew
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,School of Sport, Rehabilitation and Exercise Sciences, Faculty of Physiotherapy, University of Essex, Colchester, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Are Plantarflexor Muscle Impairments Present Among Individuals with Achilles Tendinopathy and Do They Change with Exercise? A Systematic Review with Meta-analysis. SPORTS MEDICINE-OPEN 2021; 7:18. [PMID: 33689050 PMCID: PMC7947084 DOI: 10.1186/s40798-021-00308-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/14/2021] [Indexed: 01/22/2023]
Abstract
Background Understanding plantarflexor muscle impairments among individuals with Achilles tendinopathy (AT) may help to guide future research and inform clinical management of AT. Therefore, the aim of this review is to evaluate plantarflexor muscle impairments among individuals with AT and whether plantarflexor muscle function changes following resistance training interventions. Methods We searched relevant databases including Cochrane Central Register of Controlled Trials, Ovid (MEDLINE, EMBASE, AMED) and EBSCO (CINAHL Plus and SPORTDiscus) up to September 2020. Studies investigating plantarflexor muscle function were included if they met the following criteria: (1) any study design enabled comparison of plantarflexor muscle function between individuals with and without AT, or the affected and unaffected side of individuals with unilateral AT, and (2) any studies enabled investigation of change in plantarflexion muscle function over time with use of resistance training intervention. We included studies that recruited adults with either insertional or mid-portion AT of any duration. Study selection, quality assessment and data extraction were undertaken independently by two reviewers. Discrepancies were resolved via discussion, or by consulting a third reviewer where necessary. The Joanna Briggs Institute (JBI) critical appraisal tools specific to each study design were used to assess the methodological quality of included studies. Grading the strength of evidence for each outcome was determined according to the quality and number of studies. Results A total of 25 studies (545 participants) met inclusion. Participants’ mean age was 40 ± 7 years old. Six studies were high quality for all domains, while the remaining were susceptible to the risk of bias (e.g. selection criteria, reporting findings). This review identified moderate evidence that individuals with AT have impairment in maximal plantarflexor torque (seven studies including one with a mixed population) on their affected side, compared with the unaffected side. Impairments were modest (9% and 13% [pooled effect divided by mean of the unaffected side scores]) and of uncertain clinical importance. The remaining evidence, primarily among individuals with mid-portion AT, showed conflicting impairments for plantarflexor function (i.e. explosive strength and endurance) between sides. There was limited to very limited evidence for improvement in plantarflexor endurance (7% and 23%) but not power or strength (five studies including one with a mixed population for strength) over time, despite individuals undertaking several weeks of resistance training. Conclusions Plantarflexor impairments appear more common between sides than compared with control groups but given limitations in the literature further exploration of these relationships is needed. Registration PROSPERO Database; number CRD42019100747. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00308-8.
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Mantovani L, Maestroni L, Bettariga F, Gobbo M, Lopomo NF, McLean S. "Does isometric exercise improve leg stiffness and hop pain in subjects with Achilles tendinopathy? A feasibility study". Phys Ther Sport 2020; 46:234-242. [PMID: 32998087 DOI: 10.1016/j.ptsp.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Achilles tendinopathy (AT) the ability to store and recycle elastic energy during ground contact phase is often altered. A measure of this function is represented by leg stiffness (LS). Immediate responses in LS following therapeutic intervention have not been examined. OBJECTIVE The aim of this paper was to examine the feasibility of the protocol in participants with AT. DESIGN Single cohort feasibility study. PARTICIPANTS Adults with persistent AT pain, symptoms on palpation and less than 80 points on the Visa-A questionnaire. INTERVENTION heavy isometric exercise sequence in plantarflexion. OUTCOME MEASURES Feasibility was assessed by evaluating: the willingness of participants to enroll into the study, the number of eligible participants, the recruitment rate, adherence to the intervention, the drop-out rate, the tolerability of the protocol. LS, reactive strength index, pain and rate of perceived effort were secondary outcomes. RESULTS 22 AT were eligible for data collection and 19 entered the statistical analysis. The intervention was well tolerated, no withdrawals. Pain scores were low during both the intervention and the assessment. Immediate improvements in LS and pain were recorded. CONCLUSIONS The isometric exercise protocol was feasible. Future research should investigate its effectiveness.
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Affiliation(s)
- Lisa Mantovani
- Studioerre, Via della Badia 18, 25127, Brescia, BS, Italy.
| | - Luca Maestroni
- Studioerre, Via della Badia 18, 25127, Brescia, BS, Italy; Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy; London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, United Kingdom.
| | | | - Massimiliano Gobbo
- Laboratory of Clinical Integrative Physiology, University of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy.
| | - Nicola Francesco Lopomo
- Department of Information Engineering, University of Brescia, Italy; Laboratory of Clinical Integrative Physiology, University of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy.
| | - Sionnadh McLean
- School of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Broomhall Road, Sheffield, United Kingdom.
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Maestroni L, Read P, Bishop C, Turner A. Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance. Sports Med 2020; 50:239-252. [PMID: 31559567 DOI: 10.1007/s40279-019-01195-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed.
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Affiliation(s)
- Luca Maestroni
- Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy.
- StudioErre, Via della Badia, 18, 25127, Brescia, BS, Italy.
| | - Paul Read
- Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
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Local Anesthetic Injection Resolves Movement Pain, Motor Dysfunction, and Pain Catastrophizing in Individuals With Chronic Achilles Tendinopathy: A Nonrandomized Clinical Trial. J Orthop Sports Phys Ther 2020; 50:334-343. [PMID: 32349638 PMCID: PMC10016231 DOI: 10.2519/jospt.2020.9242] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Peripherally directed treatments (targeted exercise, surgery) can reduce, but not fully eliminate, pain for up to 40% of patients with Achilles tendinopathy. The objectives of the present study were (1) to identify indicators of altered central processing in participants with Achilles tendinopathy compared to controls, and (2) to determine which indicators of altered central processing would persist after a local anesthetic injection in patients with Achilles tendinopathy. DESIGN Mechanistic clinical trial. METHODS Forty-six adults (23 with chronic Achilles tendinopathy, 23 matched controls) repeated (1) a movement-evoked pain rating, (2) motor performance assessment, (3) pain psychology questionnaires, and (4) quantitative sensory testing. Participants with Achilles tendinopathy received a local anesthetic injection before repeat testing and controls did not. Mixed-effects analyses of variance examined the effects of group, time, and group by time. RESULTS The Achilles tendinopathy group had movement-evoked pain, motor dysfunction, and higher pain psychological factors (pain catastrophizing, kinesiophobia) compared to controls (P<.05). The Achilles tendinopathy group did not have indicators of nociplastic pain with quantitative sensory testing (P>.05). In those with Achilles tendinopathy, local anesthetic injection eliminated pain and normalized the observed deficits in heel-raise performance and pain catastrophizing (group-by-time effect, P<.01), but not in kinesiophobia (P = .45). Injection did not affect measures of nociplastic pain (P>.05). CONCLUSION People with Achilles tendinopathy had elevated pain psychological factors and motor dysfunction but no signs of nociplastic pain with quantitative sensory testing. Removal of nociceptive input normalized movement-evoked pain and some indicators of altered central processing (motor dysfunction, pain catastrophizing), but not kinesiophobia. J Orthop Sports Phys Ther 2020;50(6):334-343. Epub 29 Apr 2020. doi:10.2519/jospt.2020.9242.
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McAuliffe S, Tabuena A, McCreesh K, O'Keeffe M, Hurley J, Comyns T, Purtill H, O'Neill S, O'Sullivan K. Altered Strength Profile in Achilles Tendinopathy: A Systematic Review and Meta-Analysis. J Athl Train 2019; 54:889-900. [PMID: 31386582 DOI: 10.4085/1062-6050-43-18] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Persistent strength deficits secondary to Achilles tendinopathy (AT) have been postulated to account for difficulty engaging in tendon-loading movements, such as running and jumping, and may contribute to the increased risk of recurrence. To date, little consensus exists on the presence of strength deficits in AT. Consequently, researchers are uncertain about the appropriate methods of assessment that may inform rehabilitation in clinical practice. OBJECTIVE To evaluate and synthesize the literature investigating plantar-flexion (PF) strength in individuals with AT. STUDY SELECTION Two independent reviewers searched 9 electronic databases using an agreed-upon set of key words. DATA EXTRACTION Data were extracted from studies comparing strength measures (maximal, reactive, and explosive strength) between individuals with AT and healthy control participants or between the injured and uninjured sides of people with AT. The Critical Appraisal Skills Programme Case-Control Study Checklist was used to assess the risk of bias for the included studies. DATA SYNTHESIS A total of 19 studies were eligible. Pooled meta-analyses for isokinetic dynamometry demonstrated reductions in maximal strength (concentric PF peak torque [PT] slow [Hedges g = 0.52, 44% deficit], concentric PF PT fast [Hedges g = 0.61, 38% deficit], and eccentric PF PT slow [Hedges g = 0.26, 18% deficit]). Reactive strength, particularly during hopping, was also reduced (Hedges g range = 0.32-2.61, 16%-35% deficit). For explosive strength, reductions in the rate of force development (Hedges g range = 0.31-1.73, 10%-21% deficit) were observed, whereas the findings for ground reaction force varied but were not consistently altered. CONCLUSIONS Individuals with AT demonstrated strength deficits compared with the uninjured side or with asymptomatic control participants. Deficits were reported across the strength spectrum for maximal, reactive, and explosive strength. Clinicians and researchers may need to adapt their assessment of Achilles tendon function, which may ultimately help to optimize rehabilitation outcomes.
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Affiliation(s)
- Seán McAuliffe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ariane Tabuena
- School of Allied Health, University of Limerick, Ireland
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Ireland
| | - Mary O'Keeffe
- School of Allied Health, University of Limerick, Ireland
| | - John Hurley
- School of Allied Health, University of Limerick, Ireland
| | - Tom Comyns
- Department of Physical Education and Sports Science, University of Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics & Statistics, University of Limerick, Ireland
| | - Seth O'Neill
- Department of Medical & Social Care Education, University of Leicester, United Kingdom
| | - Kieran O'Sullivan
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,School of Allied Health, University of Limerick, Ireland
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Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018; 48:A1-A38. [PMID: 29712543 DOI: 10.2519/jospt.2018.0302] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
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Grosprêtre S, Gimenez P, Martin A. Neuromuscular and electromechanical properties of ultra-power athletes: the traceurs. Eur J Appl Physiol 2018; 118:1361-1371. [DOI: 10.1007/s00421-018-3868-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/13/2018] [Indexed: 12/19/2022]
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Heales LJ, Vicenzino B, MacDonald DA, Hodges PW. Forearm muscle activity is modified bilaterally in unilateral lateral epicondylalgia: A case-control study. Scand J Med Sci Sports 2015; 26:1382-1390. [DOI: 10.1111/sms.12584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/01/2022]
Affiliation(s)
- L. J. Heales
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
| | - B. Vicenzino
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
| | - D. A. MacDonald
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
| | - P. W. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health; School of Health and Rehabilitation Science; The University of Queensland; Brisbane Australia
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15
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Chang YJ, Kulig K. The neuromechanical adaptations to Achilles tendinosis. J Physiol 2015; 593:3373-87. [PMID: 26046962 DOI: 10.1113/jp270220] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/01/2015] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Achilles tendinosis is a localized degenerative musculoskeletal disorder that develops over a long period of time and leads to a compliant human Achilles tendon. We demonstrate that the compliant Achilles tendon elicited a series of adaptations from different levels of the human movement control system, such as the muscle-tendon interaction, CNS control and other muscles in the lower leg. These results illustrate the human body's capacity to adapt to tendon pathology and provide the physiological basis for intervention or prevention strategies. Human movement is initiated, controlled and executed in a hierarchical system including the nervous system, muscle and tendon. If a component in the loop loses its integrity, the entire system has to adapt to that deficiency. Achilles tendon, when degenerated, exhibits lower stiffness. This local mechanical deficit may be compensated for by an alteration of motor commands from the CNS. These modulations in motor commands from the CNS may lead to altered activation of the agonist, synergist and antagonist muscles. The present study aimed to investigate the effect of tendon degeneration on its mechanical properties, the neuromechanical behaviour of the surrounding musculature and the existence of the CNS modulation accompanying tendinosis. We hypothesize that the degenerated tendon will lead to diminished tissue mechanical properties and protective muscle activation patterns, as well as an up-regulated descending drive from the CNS. Strong evidence, as reported in the present study, indicates that tendinotic tendons are more compliant compared to healthy tendons. This unilateral involvement affected the neuromuscular control on the involved side but not the non-involved side. The muscle-tendon unit on the tendinotic side exhibits a lowered temporal efficiency, which leads to altered CNS control. The altered CNS control is then expressed as an adapted muscle activation pattern in the lower leg. Taken together, the findings of the present study illustrate the co-ordinated multi-level adaptations to a mechanical lesion in a tendon caused by pathology.
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Affiliation(s)
- Yu-Jen Chang
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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16
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Wang JH, Hsu WL, Lee SC, Wang TG, Rolf C, Su SC, Shih TTF, Wang HK. Neuromechanical characteristics in the knees of patients who had primary conservative treatment for a torn cruciate ligament and reconstruction afterward. J Formos Med Assoc 2015; 114:1240-9. [PMID: 25624115 DOI: 10.1016/j.jfma.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND/PURPOSE To compare the neuromechanical characteristics and subjective outcomes for knees of patients with a cruciate ligament tear and reconstruction with those for knees of controls at three time intervals, and to determine correlations between the characteristics and subjective outcomes. METHODS Ten participants with a cruciate ligament tear and at least a 12-week conservative treatment prior to ligament reconstruction were prospectively measured prior to and 3 months and 6 months after surgery. Ten healthy individuals were recruited as controls. Questionnaire surveys regarding the injured knee were conducted, as were bilateral measurements of root mean square electromyography (EMG), the rate of EMG rise, the median frequency in the vastus medialis of the quadriceps muscles and antagonist coactivation from the semitendinosus muscle, and force capacities, including peak torque, rate of force development, and total works of the knee extension. Correlations between the EMG variables (of the vastus medialis and semitendinosus) and the force capacities, and between the EMG variables and the knee injury and osteoarthritis outcome scores (KOOS), and between force capacities and the KOOS were assessed in the participants with a ligament reconstruction. RESULTS Pre- and postoperative results of EMG variable and force capacities were lower in both knees of the experimental group participants than in the control group participants (all p < 0.05). Correlations between EMG and force capacities, and between these parameters and the KOOS were found. CONCLUSION There were bilateral neuromechanical defects in the knees of the participants who had undergone conservative treatment as well as reconstruction after a cruciate ligament tear.
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Affiliation(s)
- Jyh-Horng Wang
- Department of Orthopedic Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Song-Ching Lee
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tyng-Guey Wang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Christer Rolf
- Department of Orthopaedics, Clintec, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sheng-Chu Su
- Department of Business Administration, Hwa Hsia Institute of Technology, Taipei, Taiwan, ROC
| | - Tiffany T F Shih
- Department of Medical Image, National Taiwan University Hospital, Taipei, Taiwan, ROC; Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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17
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Increased patellar tendon microcirculation and reduction of tendon stiffness following knee extension eccentric exercises. J Orthop Sports Phys Ther 2014; 44:304-12. [PMID: 24450371 DOI: 10.2519/jospt.2014.4872] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVES To measure and compare patellar tendon stiffness and microcirculation in college tennis players and nonathletic students when performing eccentric knee extension exercises that do and do not reduce tendon stiffness. BACKGROUND Previous studies suggest that tendon microcirculation response during exercises may vary based on the tendon's plastic properties. Methods The study included 3 groups of college-age male students: tennis players who performed 4 sets of either 40 (n = 12) or 80 (n = 13) repetitions of eccentric knee extension exercise and nonathletic students (n = 14) who performed 4 sets of 40 repetitions. Tendon stiffness was measured before and after exercise completion. Changes in total hemoglobin and oxygen saturation (OSat) were analyzed while performing the 4 sets. Comparisons were made within and between the groups. The level of association between tendon microcirculation and stiffness reduction was assessed. RESULTS The 2 groups (player/4 × 80 and student/4 × 40) exhibiting patellar tendon stiffness reductions (P<.008) showed higher total hemoglobin and OSat levels, above the pre-exercise levels, in the fourth set compared to the first set of exercises (P<.004). The tennis players who performed 4 sets of 40 repetitions exhibited higher OSat levels in the fourth set than in the first set (P = .004) but had no reduction in tendon stiffness. Changes in OSat levels in the fourth set were correlated with patellar tendon stiffness reductions (r = -0.381, P = .02). CONCLUSION We conclude that there was increased patellar tendon microcirculation after performing knee extension eccentric exercises that resulted in a reduction in tendon stiffness.
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18
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Wang HK, Un CP, Lin KH, Chang EC, Shiang TY, Su SC. Effect of a combination of whole-body vibration and low resistance jump training on neural adaptation. Res Sports Med 2014; 22:161-71. [PMID: 24650336 DOI: 10.1080/15438627.2014.881822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated and compared the effects of an eight-week program of whole body vibration combined with counter-movement jumping (WBV + CMJ) or counter-movement jumping (CMJ) alone on players. Twenty-four men's volleyball players of league A or B were randomized to the WBV + CMJ or CMJ groups (n = 12 and 12; mean [SD] age of 21.4 [2.2] and 21.7 [2.2] y; height of 175.6 [4.6] and 177.6 [3.9] cm; and weight, 69.9 [12.8] and 70.5 [10.7] kg, respectively). The pre- and post-training values of the following measurements were compared: H-reflex, first volitional (V)-wave, rate of electromyography rise (RER) in the triceps surae and absolute rate of force development (RFD) in plantarflexion and vertical jump height. After training, the WBV + CMJ group exhibited increases in H reflexes (p = 0.029 and <0.001); V-wave (p < 0.001); RER (p = 0.003 and <0.001); jump height (p < 0.001); and RFD (p = 0.006 and <0.001). The post-training values of V wave (p = 0.006) and RFD at 0-50 (p = 0.009) and 0-200 ms (p = 0.008) in the WBV + CMJ group were greater than those in the CMJ group. This study shows that a combination of WBV and power exercise could impact neural adaptation and leads to greater fast force capacity than power exercise alone in male players.
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Affiliation(s)
- Hsing-Kuo Wang
- a School and Graduate Institute of Physical Therapy, College of Medicine , National Taiwan University Taipei , Taiwan , Republic of China
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Wang HK, Chiang H, Chen WS, Shih TT, Huang YC, Jiang CC. Early Neuromechanical Outcomes of the Triceps Surae Muscle-Tendon After an Achilles' Tendon Repair. Arch Phys Med Rehabil 2013; 94:1590-8. [DOI: 10.1016/j.apmr.2013.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/02/2012] [Accepted: 01/16/2013] [Indexed: 11/29/2022]
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20
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Wang HK, Lin KH, Su SC, Shih TTF, Huang YC. Effects of tendon viscoelasticity in Achilles tendinosis on explosive performance and clinical severity in athletes. Scand J Med Sci Sports 2012; 22:e147-55. [DOI: 10.1111/j.1600-0838.2012.01511.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2012] [Indexed: 11/29/2022]
Affiliation(s)
- H.-K. Wang
- School and Graduate Institute of Physical Therapy; College of Medicine; National Taiwan University; Taipei; Taiwan
| | - K.-H. Lin
- School and Graduate Institute of Physical Therapy; College of Medicine; National Taiwan University; Taipei; Taiwan
| | - S.-C. Su
- Department of Business Administration; Hwa Hsia Institute of Technology; Taipei; Taiwan
| | | | - Y.-C. Huang
- Department of Physical Medicine and Rehabilitation; Chen Hsin Rehabilitation Medical Center; Taipei; Taiwan
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21
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Un CP, Lin KH, Shiang TY, Chang EC, Su SC, Wang HK. Comparative and reliability studies of neuromechanical leg muscle performances of volleyball athletes in different divisions. Eur J Appl Physiol 2012; 113:457-66. [DOI: 10.1007/s00421-012-2454-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 06/28/2012] [Indexed: 10/27/2022]
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