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Squires E, Walshe IH, Cheung W, Bowerbank SL, Dean JR, Wood J, McHugh MP, Plattner S, Howatson G. Plasma-Induced Changes in the Metabolome Following Vistula Tart Cherry Consumption. Nutrients 2024; 16:1023. [PMID: 38613057 PMCID: PMC11013268 DOI: 10.3390/nu16071023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Evidence suggests that tart cherry (TC) supplementation has beneficial effects on health indices and recovery following strenuous exercise. However, little is known about the mechanisms and how TC might modulate the human metabolome. The aim of this study was to evaluate the influence of an acute high- and low-dose of Vistula TC supplementation on the metabolomic profile in humans. In a randomised, double-blind, placebo controlled, cross-over design, 12 healthy participants (nine male and three female; mean ± SD age, stature, and mass were 29 ± 7 years old, 1.75 ± 0.1 m, and 77.3 ± 10.5 kg, respectively) visited the laboratory on three separate occasions (high dose; HI, low dose; LO, or placebo), separated by at least seven days. After an overnight fast, a baseline venous blood sample was taken, followed by consumption of a standardised breakfast and dose conditions (HI, LO, or placebo). Subsequent blood draws were taken 1, 2, 3, 5, and 8 h post consumption. Following sample preparation, an untargeted metabolomics approach was adopted, and the extracts analysed by LCMS/MS. When all time points were collated, a principal component analysis showed a significant difference between the conditions (p < 0.05), such that the placebo trial had homogeneity, and HI showed greater heterogeneity. In a sub-group analysis, cyanidine-3-O-glucoside (C3G), cyanidine-3-O-rutinoside (C3R), and vanillic acid (VA) were detected in plasma and showed significant differences (p < 0.05) following acute consumption of Vistula TC, compared to the placebo group. These results provide evidence that phenolics are bioavailable in plasma and induce shifts in the metabolome following acute Vistula TC consumption. These data could be used to inform future intervention studies where changes in physiological outcomes could be influenced by metabolomic shifts following acute supplementation.
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Affiliation(s)
- Emma Squires
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
| | - Ian H. Walshe
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
| | - William Cheung
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
| | - Samantha L. Bowerbank
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
| | - John R. Dean
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
| | - Jacob Wood
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
| | - Malachy P. McHugh
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
- Nicholas Institute of Sports Medicine and Athletic Trauma, Northwell Health, New York, NY 10065, USA
| | | | - Glyn Howatson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (E.S.); (I.H.W.); (W.C.); (S.L.B.); (J.R.D.); (J.W.); (M.P.M.)
- Water Research Group, North West University, Potchefstroom 2531, South Africa
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Abstract
ABSTRACT McHugh, MP, O'Mahoney, CA, Orishimo, KF, Kremenic, IJ, and Nicholas, SJ. Kinematic, kinetic, and temporal metrics associated with golf proficiency. J Strength Cond Res 38(3): 599-606, 2024-The biomechanics of the golf swing have been studied extensively, but the literature is unclear on which metrics are indicative of proficiency. The purpose of this study was to determine which metrics identified golf proficiency. It was hypothesized that discrete kinematic, kinetic, and temporal metrics would vary depending on proficiency and that combinations of metrics from each category would explain specific proficiency metrics. Kinematic, kinetic, and temporal metrics and their sequencing were collected for shots performed with a driver in 33 male golfers categorized as proficient, average, or unskilled (based on a combination of handicap, ball velocity, and driving distance). Kinematic data were collected with high-speed motion analysis, and ground reaction forces (GRF) were collected from dual force plates. Proficient golfers had greater x-factor at ball impact and greater trunk deceleration before ball impact compared with average ( p < 0.05) and unskilled ( p < 0.01) golfers. Unskilled golfers had lower x-factor at the top of the back swing and lower peak x-factor, and they took longer to reach peak trunk velocity and peak lead foot GRF compared with average ( p < 0.05) and proficient ( p < 0.05) golfers. A combination of 2 kinematic metrics (x-factor at ball impact and peak pelvis velocity), 1 kinetic metric (peak lead foot GRF), and 2 timing metrics (the timing of peak trunk and arm velocity) explained 85% of the variability in ball velocity. The finding that x-factor at ball impact and trunk deceleration identified golf proficiency points to the potential for axial trunk rotation training to improve performance.
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Affiliation(s)
- Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY
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Yaari LS, Nicholas SJ, Bedford BB, Mendez-Zfass MS, Hogan DE, Haviv B, McHugh MP. Influence of Pain Sensitivity on Surgical Outcomes of Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study. Am J Sports Med 2023; 51:3802-3809. [PMID: 37975517 DOI: 10.1177/03635465231208113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND The Pain Sensitivity Questionnaire (PSQ) has been found to be a valid tool, and PSQ scores have been shown to be predictive of outcomes after surgery for lumbar stenosis. The effect of pain sensitivity on outcomes of rotator cuff repair (RCR) surgery has not been examined. HYPOTHESIS PSQ scores would be associated with surgical outcomes after arthroscopic RCR surgery. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients 18 to 80 years old scheduled for RCR were consecutively enrolled. Patients with glenohumeral arthritis grade ≥2 or RCR revision surgery were excluded. PSQ was completed preoperatively. The Disabilities of the Arm, Shoulder and Hand score and American Shoulder and Elbow Surgeons score were used as patient-reported outcome measurements (PROMs), and visual analog scale pain score was documented as well. Active shoulder external rotation (ER), internal rotation, and anterior forward elevation range of motion (ROM) were recorded. PROMs and ROM measurements were recorded preoperatively and at 3 months, 6 months, and 1 year after surgery. Rotator cuff tear size, type of repair, and concomitant procedures were documented. Patients were classified as having high or normal pain sensitivity based on PSQ scores. RESULTS Of 100 enrolled patients, 38 patients were classified as having high pain sensitivity. Patients with high pain sensitivity had worse American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand scores preoperatively, 6 months postoperatively, and 1 year postoperatively (P < .01). From the preoperative assessment to 3 months postoperatively, PROMs improved more in patients with high versus normal pain sensitivity. However, for patients with high pain sensitivity, PROMs plateaued after 3 months but continued to improve for patients with normal pain sensitivity (P < .01). Visual analog scale pain scores were higher at all time points for patients with high pain sensitivity (P < .05). Preoperatively, patients with high pain sensitivity had restricted active ROM compared with patients who had normal pain sensitivity for anterior forward elevation, ER, and internal rotation (P = .009, P = .012, and P = .006, respectively). By 1 year after surgery, ER ROM was still restricted in patients with high pain sensitivity. CONCLUSION Pain sensitivity is an important factor influencing RCR outcomes. Patients with high pain sensitivity undergoing RCR showed less improvement in active ROM and worse PROMs after surgery compared with patients who had normal pain sensitivity. Preoperative PSQ may predict postoperative improvements.
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Affiliation(s)
- Lee Shaul Yaari
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
- Department of Orthopedics, Faculty of Medicine, Tel-Aviv University, Israel
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
- New York Orthopedics, New York, New York, USA
| | - Benjamin B Bedford
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
- New York Orthopedics, New York, New York, USA
| | - Matthew S Mendez-Zfass
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
- New York Orthopedics, New York, New York, USA
| | - Daniel E Hogan
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
- Department of Orthopedics, Faculty of Medicine, Tel-Aviv University, Israel
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
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Orishimo KF, Kremenic IJ, Modica E, Fukunaga T, McHugh MP, Bharam S. Lower extremity kinematic and kinetic factors associated with bat speed at ball contact during the baseball swing. Sports Biomech 2023:1-12. [PMID: 37853750 DOI: 10.1080/14763141.2023.2269418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
The purpose of this study was to determine which biomechanical variables measured during the baseball swing are associated with linear bat speed at ball contact (bat speed). Twenty collegiate baseball players hit a baseball from a tee into a net. Kinematics were recorded with a motion capture system sampling at 500 Hz and kinetics were measured by force plates under each foot sampling at 1000 Hz. Associations between bat speed, individual joint and segment kinematics, joint moments and ground reaction forces (GRF) were assessed using Pearson correlations and stepwise linear regression. Average bat speed was 30 ± 2 m/s. Lead foot peak vertical (159 ± 29% BW, r = 0.622, P = 0.001), posterior (-57 ± 12% BW, r = -0.574, P = 0.008) and resultant (170 ± 30% BW, r = 0.662, P = 0.001) GRF were all correlated with bat speed. No combination of factors strengthened the relationship to bat speed beyond these individual variables. These results illustrate the role of the lead leg in generating and transferring ground reaction forces through the kinetic chain in order to accelerate the bat. Training to improve bat speed should include both general lower extremity strengthening exercises and sport-specific hitting drills to improve lower extremity force production following lead foot contact.
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Affiliation(s)
- Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan, Eye, Ear and Throat Hospital, Northwell Health, New York, NY, USA
| | - Ian J Kremenic
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan, Eye, Ear and Throat Hospital, Northwell Health, New York, NY, USA
| | - Edward Modica
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
| | - Takumi Fukunaga
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan, Eye, Ear and Throat Hospital, Northwell Health, New York, NY, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan, Eye, Ear and Throat Hospital, Northwell Health, New York, NY, USA
| | - Srino Bharam
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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McHugh MP, Mullaney MJ. Does High Medial Elbow Stress During Pitching Compromise the Dynamic Stabilizers of The Elbow? Int J Sports Phys Ther 2023; 18:949-957. [PMID: 37547846 PMCID: PMC10399083 DOI: 10.26603/001c.81596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background The flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) are thought to provide dynamic stability to the medial elbow, with a lesser contribution from the pronator teres (PT). Hypothesis/Purpose The purpose of this study was to determine if baseball pitchers with higher valgus elbow torque experience greater FCU and FDS strength loss. Study Design Controlled Laboratory Study. Methods A pilot study was performed to determine if middle and ring finger flexion strength tests preferentially activated the FCU and FDS versus the PT (10 men age 36±12 yr). EMG amplitudes, expressed as percent of maximal voluntary contraction (MVC) were compared between tests and muscles. In a field study of college baseball pitchers, middle finger, ring finger and grip strength were tested prior to, immediately after, and one day after 14 pitching performances in 10 pitchers (21±2 yr). Elbow valgus torque was measured from an inertial measurement unit, housed in a compression sleeve and pitchers were categorized as having high or low valgus torque. Results For the pilot study EMG activations were 74% FDS, 66% FCU and 35% PT for the middle finger test (muscle effect p=0.032) and 93% FCU, 61% FDS and 23% PT for the ring finger test (muscle effect p=0.005). In the field study, pitchers with high valgus torque showed marked post-game middle finger fatigue (88% of baseline) and incomplete recovery the following day (95%), while pitchers with low valgus torque showed no strength loss (107% post game, 106% a day later; group x time p=0.022). Results were similar for ring finger strength (high torque: 94% post game 96% a day later; low torque: 114% post game 107% a day later; group x time p=0.048). By contrast, grip strength was not different between pitchers with high versus low valgus torque (p=0.143). Conclusion High medial elbow stress during pitching fatigues the dynamic stabilizers of the medial elbow. Level of Evidence Level 3©The Author(s).
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McHugh MP, Nicholas SJ, Tyler TF. Adductor Strains in Athletes. Int J Sports Phys Ther 2023; 18:288-292. [PMID: 37020448 PMCID: PMC10069335 DOI: 10.26603/001c.72626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Acute adductor injuries are a common occurrence in sport. The overall incidence of adductor strains across 25 college sports was 1.29 injuries per 1000 exposures, with men's soccer (3.15) and men's hockey (2.47) having the highest incidences. As with most muscle strains there is a high rate of recurrence for adductor strains; 18% in professional soccer and 24% in professional hockey. Effective treatment, with successful return to play, and avoidance of reinjury, can be achieved with a proper understanding of the anatomy, a thorough clinical exam yielding an accurate diagnosis, and an evidence-based treatment approach, including return to play progression.
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Affiliation(s)
- Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, Northwell Health
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, Northwell Health
| | - Timothy F Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, Northwell Health
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Cotton S, McHugh MP, Dewar R, Haas JG, Templeton K. Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes. J Hosp Infect 2023; 135:28-36. [PMID: 36906180 PMCID: PMC9997060 DOI: 10.1016/j.jhin.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND The first epidemic wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over a third of care homes reported an outbreak while there was limited testing of hospital patients discharged to care homes. AIM Investigate hospital discharges as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. METHODS A clinical review was performed for all discharges from hospitals to care homes starting 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease (COVID-19) test history, clinical assessment at discharge, whole genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis by cluster investigation and virus epidemiological tool (CIVET). Patient timelines were obtained using electronic hospital records. FINDINGS In total 787 hospital discharges to care homes were identified. Out of these 776 (99%) were ruled out for hospital discharge introduction. However, for 10 episodes the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission leading to 10 further positive cases in the care home. CONCLUSION Majority of hospital discharges were ruled out for introduction into Lothian care homes highlighting the importance of screening all new admissions when faced with a novel emerging virus and no vaccine available.
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Affiliation(s)
- S Cotton
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; Infection Medicine, Edinburgh Medical School, University of Edinburgh, UK.
| | - M P McHugh
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; School of Medicine, University of St Andrews, UK
| | - R Dewar
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK
| | - J G Haas
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; Infection Medicine, Edinburgh Medical School, University of Edinburgh, UK
| | - K Templeton
- Specialist Virology Centre, Royal Infirmary Edinburgh, NHS Lothian, UK; Infection Medicine, Edinburgh Medical School, University of Edinburgh, UK
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Orishimo KF, Kremenic IJ, Mullaney MJ, Fukunaga T, Serio N, McHugh MP. Role of Pelvis and Trunk Biomechanics in Generating Ball Velocity in Baseball Pitching. J Strength Cond Res 2023; 37:623-628. [PMID: 35836313 DOI: 10.1519/jsc.0000000000004314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Orishimo, KF, Kremenic, IJ, Mullaney, MJ, Fukunaga, T, Serio, N, and McHugh, MP. Role of pelvis and trunk biomechanics in generating ball velocity in baseball pitching. J Strength Cond Res 37(3): 623-628, 2023-The purpose of this study was to determine the impact of pelvis rotation velocity, trunk rotation velocity, and hip-shoulder separation on ball velocity during baseball pitching. Fastball pitching kinematics were recorded in 29 male pitchers (age 17 ± 2 years, 23 high school, 6 college). Pelvis and trunk angular velocities and hip-shoulder separation were calculated and averaged for the 3 fastest pitches. Associations between peak pelvis velocity, peak trunk velocity, hip-shoulder separation at foot contact, and ball velocity were assessed using Pearson correlation coefficients and multiple regression. The average ball velocity was 33.5 ± 2.8 m·s -1 . The average hip-shoulder separation at foot contact was 50 ± 12°. The peak pelvis velocity (596 ± 88°·s -1 ) occurred at 12 ± 11% of the time from stride foot contact to ball release, with the peak trunk velocity (959 ± 120°·s -1 ) occurring at 36 ± 11%. Peak trunk velocity was predictive of ball velocity ( p = 0.002), with 25% of the variability in ball velocity explained. No combination of factors further explained ball velocity. Hip-shoulder separation at foot contact (17%, p = 0.027), peak pelvis velocity (23%, p = 0.008), and the timing of peak pelvis velocity (16%, p = 0.031) individually predicted peak trunk velocity. The combination of peak pelvis velocity, hip-shoulder separation at foot contact, and the timing of peak trunk velocity explained 55% of the variability in trunk rotation velocity ( p < 0.001). These data highlight the importance of interactions between pelvis and trunk for maximizing velocity in pitching. Training to improve pelvis-trunk axial dissociation may increase maximal trunk rotation velocity and thereby increase ball velocity without increasing training load on the shoulder and elbow.
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Affiliation(s)
- Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Northwell Health, Manhattan Eye, Ear and Throat Hospital, New York, New York ; and
| | - Ian J Kremenic
- Nicholas Institute of Sports Medicine and Athletic Trauma, Northwell Health, Manhattan Eye, Ear and Throat Hospital, New York, New York ; and
| | - Michael J Mullaney
- Nicholas Institute of Sports Medicine and Athletic Trauma, Northwell Health, Manhattan Eye, Ear and Throat Hospital, New York, New York ; and
| | - Takumi Fukunaga
- Nicholas Institute of Sports Medicine and Athletic Trauma, Northwell Health, Manhattan Eye, Ear and Throat Hospital, New York, New York ; and
| | | | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Northwell Health, Manhattan Eye, Ear and Throat Hospital, New York, New York ; and
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O'Hara DJ, Tyler TF, McHugh MP, Kwiecien SY, Bergeron T. Use of a Non-Pharmacological Pain Relief Kit to Reduce Opioid Use Following Orthopedic Surgery: A Prospective Randomized Study. Int J Sports Phys Ther 2022; 17:915-923. [PMID: 35949389 PMCID: PMC9340831 DOI: 10.26603/001c.36625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Opioid prescription to treat pain among orthopedic surgery patients remains common practice in the United States but overprescribing opioids can lead to abuse. The purpose of this study was to determine the effect of a multimodal non-pharmacological 'pain relief kit' on pain, function, and opioid consumption in individuals recovering from orthopedic surgery. Hypothesis Patients provided with the pain relief kit would consume less opioid medication, report lower pain levels, and have better functional outcome scores than the control group. Level of Evidence 2b. Methods Fifty-three subjects (18 women, 35 men) having orthopedic surgery were randomly assigned to either receive the Pain Relief Kit (treatment) or control group. At the first postoperative physical therapy visit (within 1 week of surgery) the treatment group was provided elastic resistance bands, kinesiology tape, Biofreeze, and a hot/cold pack as part of the Pain Relief Kit. Patients completed the SF-36 and either the DASH or LEFS questionnaires consistent with their surgery at baseline and four weeks post-op. Both groups reported daily pain (Visual Analogue Scale), opioid use, and over the counter medication use. The treatment group also recorded daily kit modality use. Results There was no significant difference in total opioid use between the treatment (108±252 milligram morphine equivalents) and control groups (132±158 MME; p=0.696). Opioid use and pain declined from week one to four with no difference between groups (p<0.001). Outcome scores and SF-36 scores improved from week one to four with no difference between groups (p<0.001). Conclusion A non-pharmacological pain relief kit did not have an effect on opioid use in this patient population nor did it improve pain relief or function compared to controls.
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McHugh MP. "Precovery" Versus Recovery: Understanding the role of cherry juice in exercise recovery. Scand J Med Sci Sports 2022; 32:940-950. [PMID: 35119142 PMCID: PMC9306613 DOI: 10.1111/sms.14141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 11/27/2022]
Abstract
Cherry juice has become a standard component of athlete recovery strategies. This review covers the history of cherry juice as a recovery drink to give context to its current use. Fifteen studies were identified that included a measure of muscle function, soreness, or inflammation on the days following exercise and had an exercise insult sufficient to assess the effectiveness of the tart cherry intervention. Eight studies used a concentrated juice, three used a juice from fresh‐frozen cherries, two used a tart cherry concentrate gel, and two used a tart cherry powder. The effective juice dose was specific to the type of drink (fresh‐frozen versus concentrate) but dose‐response studies are lacking, and thus, the optimal dose for any specific type of cherry juice is not known. Timing of the dosing regimen is a critical factor. Studies have uniformly shown that muscle function will recover faster on the days after exercise if juice is provided for several days prior to exercise. Effects on soreness or systemic inflammation are more equivocal. The available evidence does not support a regimen that begins on the day of exercise or post‐exercise. Tart cherry powder did not enhance any metric of recovery on the days after exercise. In conclusion, the term recovery implies an intervention that is introduced after an exercise insult. The term “precovery” may be preferable to describe interventions that should be introduced on the days prior to exercise to facilitate recovery on the days after exercise. The evidence supports cherry juice as a precovery intervention across a range of athletic activities.
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Affiliation(s)
- Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital at MEETH, 210 East 64 Street New York, New York, 10065
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Kessler RE, Day MS, Tyler TF, McHugh MP, Bedford BB, Lee SJ, Nicholas SJ. Predictive Value of MRI in Outcomes of Non-Surgical Treatment of Lateral Epicondylitis. JSES Int 2022; 6:305-308. [PMID: 35252931 PMCID: PMC8888164 DOI: 10.1016/j.jseint.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The diagnosis of lateral epicondylitis is typically made on the basis of clinical history and examination. However, magnetic resonance imaging (MRI) is often used to supplement evaluation of the patient with a painful elbow and can identify extensor carpi radialis brevis (ECRB) tendon tears. The objective of this study was to determine if ECRB tear size on MRI could be used as a prognostic indicator for patients with recalcitrant lateral epicondylitis and partial ECRB tears. Methods Forty-one patients with recalcitrant lateral epicondylitis and a partial ECRB tear on MRI were identified (22 men and 19 women; age: 49 ± 8 years; height: 165 ± 36 mm; weight: 73 ± 18 kg). Patients were divided into two groups based on whether they underwent surgery or not. Nonsurgical treatment was evaluated by the Disabilities of the Arm, Shoulder, and Hand questionnaire, and surgery was considered a failure of nonsurgical treatment. Nonsurgical treatment was variable and included a mixture of physical therapy, rest, injection therapy, and splinting. Results Of the 41 patients, 5 patients opted for immediate surgery and 36 patients were treated nonsurgically. Of those 36 patients, 11 patients had symptom relief, 19 patients had subsequent surgery, and 6 patients chose not to have surgery despite continued symptoms. Tear size on MRI did not differ significantly between the patients who had symptom relief with nonsurgical treatment and the other patients (7.7 ± 4.3 mm vs. 9.7 ± 2.5 mm, P = .07). Discussion Only 11 of 41 patients (27%) with recalcitrant lateral epicondylitis and ECRB tear had symptom relief with nonsurgical treatment. However, ECRB tendon defect size on MRI did not predict success or failure of nonsurgical treatment.
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Affiliation(s)
- Rachel E. Kessler
- Nicholas Institute for Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
- Corresponding author: Rachel E. Kessler, BS, 8 Rivington Street, Apt. 6, New York, NY 10002, USA.
| | - Michael S. Day
- Nicholas Institute for Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
| | - Timothy F. Tyler
- Nicholas Institute for Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
- Professional Physical Therapy, Scarsdale, NY, USA
| | - Malachy P. McHugh
- Nicholas Institute for Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
| | - Benjamin B. Bedford
- Nicholas Institute for Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
- New York Orthopedics, New York, NY, USA
| | - Steven J. Lee
- Nicholas Institute for Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
- New York Orthopedics, New York, NY, USA
| | - Stephen J. Nicholas
- Nicholas Institute for Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
- New York Orthopedics, New York, NY, USA
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12
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McHugh MP, O'Mahoney CA, Orishimo KF, Kremenic IJ, Nicholas SJ. Importance of Transverse Plane Flexibility for Proficiency in Golf. J Strength Cond Res 2021; 36:e49-e54. [DOI: 10.1519/jsc.0000000000004167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Galano GJ, Tyler TF, Stubbs T, Ashraf A, Roberts M, McHugh MP, Zoland MP, Nicholas SJ. Resisted adduction sit-up test (RASUT) as a screening tool for pelvic versus hip pathology. J Hip Preserv Surg 2021; 8:331-336. [PMID: 35505809 PMCID: PMC9052402 DOI: 10.1093/jhps/hnab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/29/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Groin pain is a common symptom in hip and pelvic pathology and differentiating between the two remains a challenge. The purpose of this study was to examine whether a test combining resisted adduction with a sit-up (RASUT) differentiates between pelvic and hip pathology. The RASUT was performed on 160 patients with complaints of hip or groin pain who subsequently had their diagnosis confirmed by magnetic resonance imaging (MRI) or surgery. Patients were categorized as having pelvic pathology (athletic pubalgia or other) or hip pathology (intra-articular or other). Athletic pubalgia was defined as any condition involving the disruption of the pubic aponeurotic plate. Sensitivity, specificity, positive predictive accuracy, negative predictive accuracy and diagnostic odds ratios were computed. Seventy-one patients had pelvic pathology (40 athletic pubalgia), 81 had hip pathology and 8 had both. The RASUT was effective in differentiating pelvic from hip pathology; 50 of 77 patients with a positive RASUT had pelvic pathology versus 29 of 83 patients with a negative test (P < 0.001). RASUT was diagnostic for athletic pubalgia (diagnostic odds ratio 6.08, P < 0.001); 35 of 45 patients with athletic pubalgia had a positive RASUT (78% sensitivity) and 73 of 83 patients with a negative RASUT did not have athletic pubalgia (88% negative predictive accuracy). The RASUT can be used to differentiate pelvic from hip pathology and to identify patients without athletic pubalgia. This is a valuable screening tool in the armamentarium of the sports medicine clinician.
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Affiliation(s)
- Gregory J Galano
- New York Orthopedics, 159 East 74 Street, New York, NY 10021, USA
| | - Timothy F Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
- Professional Physical Therapy, 2 Overhill Road, Scarsdale, NY 10583, USA
| | - Trevor Stubbs
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Ali Ashraf
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Michael Roberts
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
| | - Mark P Zoland
- Department of Surgery, Lenox Hill Hospital, 130 East 77 Street, New York, NY 10075, USA
| | - Stephen J Nicholas
- New York Orthopedics, 159 East 74 Street, New York, NY 10021, USA
- Nicholas Institute of Sports Medicine and Athletic Trauma, MEETH, Lenox Hill Hospital, 210 East 64 Street, New York, NY 10075, USA
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14
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Orishimo KF, Fukunaga T, Kremenic IJ, McHugh MP. Asymmetry In Lower-extremity Joint Contributions In Patients During Acl Return To Sports Testing. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760888.75435.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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McHugh MP, Orishimo KF, Kremenic IJ, Fukunaga T, Serio N, Mullaney MJ. The Role Of Pelvis And Trunk Biomechanics In Generating Ball Velocity In Baseball Pitching. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760896.94672.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Mullaney MJ, McHugh MP. Does High Medial Elbow Stress During Pitching Compromise The Dynamic Stabilizers Of The Elbow? Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000759596.84832.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Abstract
Background: Eccentric-focused rotator cuff exercises are clinically useful in rehabilitation; however, to what extent these exercises activate shoulder musculature is unknown.Purpose: Investigate peak electromyographic (EMG) activity of shoulder musculature during eccentric-focused rotator cuff exercises to inform clinical decision-making.Methods: Surface EMG activity was measured in 15 healthy subjects from 5 muscles of the dominant shoulder: supraspinatus, infraspinatus, upper trapezius, lower trapezius, and middle deltoid. Subjects performed 5 exercises: short-to-long scaption, sit-to-stand scaption, standing external rotation (ER), sidelying ER, and sidelying horizontal adduction. The effects of exercise and muscle on peak EMG activity were analyzed using two-way repeated-measures ANOVA and followed with post-hoc pairwise comparisons.Results: Significant exercise-by-muscle interaction effect was found (p < .001). Short-to-long and sit-to-stand scaption elicited higher activity in supraspinatus and middle deltoid compared to other exercises (p < .05); however, no effect of muscle was found for these exercises (p > .05). Infraspinatus and lower trapezius demonstrated higher activity compared to other muscles during standing ER, sidelying ER, and sidelying horizontal adduction (p < .05).Conclusion: Eccentric-focused exercises sufficiently activate the rotator cuff and is effective for use in rehabilitation. Caution must be taken as some exercises do not target specific musculature.
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Affiliation(s)
- Takumi Fukunaga
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye Ear and Throat Hospital, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye Ear and Throat Hospital, NY, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye Ear and Throat Hospital, NY, USA
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18
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Affiliation(s)
- Zachary M. Gillen
- Department of Kinesiology Mississippi State University Mississippi State MS USA
| | - Malachy P. McHugh
- Nicholas Institute of Sports Medicine and Athletic TraumaLenox Hill Hospital New York NY USA
| | - Marni E. Shoemaker
- College of Health SciencesThe University of Texas at El Paso El Paso TX USA
| | - Joel T. Cramer
- College of Health SciencesThe University of Texas at El Paso El Paso TX USA
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19
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Kwiecien SY, McHugh MP. The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. Eur J Appl Physiol 2021; 121:2125-2142. [PMID: 33877402 DOI: 10.1007/s00421-021-04683-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/05/2021] [Indexed: 01/08/2023]
Abstract
Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA.
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
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20
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Mullaney MJ, McHugh MP, Kwiecien SY, Ioviero N, Fink A, Howatson G. Accelerated Muscle Recovery in Baseball Pitchers Using Phase Change Material Cooling. Med Sci Sports Exerc 2021; 53:228-235. [PMID: 32694373 DOI: 10.1249/mss.0000000000002447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to document recovery after a pitching performance and determine whether prolonged postgame phase change material (PCM) cooling of the shoulder and forearm accelerates recovery. METHODS Strength, soreness, and serum creatine kinase (CK) activity were assessed before and on the 2 d after pitching performances in 16 college pitchers. Pitchers were randomized to receive either postgame PCM cooling packs on the shoulder and forearm or no cooling (control). PCM packs were applied inside compression shirts and delivered cooling at a constant temperature of 15°C for 3 h. Strength was assessed for shoulder internal rotation (IR), external rotation (ER), empty can (EC) test, and grip. RESULTS Total pitch count was 60 ± 16 for 23 PCM cooling games and 62 ± 17 for 24 control games (P = 0.679). On the days after pitching, IR strength (P = 0.006) and grip strength (P = 0.036) were higher in the PCM cooling group versus control. One day after pitching, IR strength was 95% ± 14% of baseline with PCM cooling versus 83% ± 13% for control (P = 0.008, effect size d = 0.91) and 107% ± 9% versus 95% ± 10% for grip strength (P = 0.022, effect size d = 1.29). There was a trend for greater ER strength with PCM cooling (P = 0.091, effect size d = 0.51). The EC strength was not impaired after pitching (P = 0.147) and was therefore unaffected by PCM cooling (P = 0.168). Elevations in soreness and CK were not different between treatments (treatment-time CK P = 0.139, shoulder soreness P = 0.885, forearm soreness P = 0.206). CONCLUSION This is one of the first studies to document impairments in muscle function on the days after baseball pitching, and the first study showing a novel cryotherapy intervention that accelerates recovery of muscle function in baseball pitchers after a game.
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Affiliation(s)
| | | | | | - Neil Ioviero
- Athletics Department, Kean University, Union, NJ
| | - Andrew Fink
- Mullaney and Associates Physical Therapy, Matawan, NJ
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21
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McHugh MP, Hickok M, Cohen JA, Virgile A, Connolly DAJ. Is there a biomechanically efficient vertical ground reaction force profile for countermovement jumps? Transl Sports Med 2020. [DOI: 10.1002/tsm2.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Malachy P. McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma Lenox Hill Hospital New York NY USA
- Faculty of Health and Life Sciences Northumbria University Newcastle UK
| | - Marc Hickok
- College of Nursing and Health Sciences University of Vermont Burlington VT USA
| | - Josef A. Cohen
- Nicholas Institute of Sports Medicine and Athletic Trauma Lenox Hill Hospital New York NY USA
| | - Adam Virgile
- College of Nursing and Health Sciences University of Vermont Burlington VT USA
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22
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Kwiecien SY, McHugh MP, Howatson G. Don't Lose Your Cool With Cryotherapy: The Application of Phase Change Material for Prolonged Cooling in Athletic Recovery and Beyond. Front Sports Act Living 2020; 2:118. [PMID: 33345107 PMCID: PMC7739598 DOI: 10.3389/fspor.2020.00118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022] Open
Abstract
Strenuous exercise can result in muscle damage in both recreational and elite athletes, and is accompanied by strength loss, and increases in soreness, oxidative stress, and inflammation. If the aforementioned signs and symptoms associated with exercise-induced muscle damage are excessive or unabated, the recovery process becomes prolonged and can result in performance decrements; consequently, there has been a great deal of research focussing on accelerating recovery following exercise. A popular recovery modality is cryotherapy which results in a reduction of tissue temperature by the withdrawal of heat from the body. Cryotherapy is advantageous because of its ability to reduce tissue temperature at the site of muscle damage. However, there are logistical limitations to traditional cryotherapy modalities, such as cold-water immersion or whole-body cryotherapy, because they are limited by the duration for which they can be administered in a single dose. Phase change material (PCM) at a temperature of 15°C can deliver a single dose of cooling for a prolonged duration in a practical, efficacious, and safe way; hence overcoming the limitations of traditional cryotherapy modalities. Recently, 15°C PCM has been locally administered following isolated eccentric exercise, a soccer match, and baseball pitching, for durations of 3-6 h with no adverse effects. These data showed that using 15°C PCM to prolong the duration of cooling successfully reduced strength loss and soreness following exercise. Extending the positive effects associated with cryotherapy by prolonging the duration of cooling can enhance recovery following exercise and give athletes a competitive advantage.
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Affiliation(s)
- Susan Y. Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, United States
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Malachy P. McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, United States
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Water Research Group, North West University, Potchefstroom, South Africa
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23
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Kwiecien SY, McHugh MP, Hicks KM, Keane KM, Howatson G. Prolonging the duration of cooling does not enhance recovery following a marathon. Scand J Med Sci Sports 2020; 31:21-29. [PMID: 32901996 DOI: 10.1111/sms.13822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Runners commonly utilize cryotherapy as part of their recovery strategy. Cryotherapy has been ineffective in mitigating signs and symptoms of muscle damage following marathon running and is limited by its duration of application. Phase change material (PCM) packs can prolong the duration of cooling. This study aimed to test the efficacy of prolonging the duration of cooling using PCM on perceptual recovery, neuromuscular function, and blood markers following a marathon run. Thirty participants completed a marathon run and were randomized to receive three hours of 15°C PCM treatment covering the quadriceps or recover without an intervention (control). Quadriceps soreness, strength, countermovement jump (CMJ) height, creatine kinase (CK), and high sensitivity C-reactive protein (hsCRP) were recorded at baseline, 24, 48, and 72 hours after the marathon. Following the marathon, strength decreased in both groups (P < .0001), with no difference between groups. Compared to baseline, strength was reduced 24 (P = .004) and 48 hours after the marathon (P = .008) in the control group, but only 24 hours (P = .028) in the PCM group. Soreness increased (P < .0001) and CMJ height decreased (P < .0001) in both groups, with no difference between groups. Compared to baseline, CMJ height was not reduced on any days in the PCM group but was reduced in the control group 24 (P < .0001) and 48 hours (P = .003) after the marathon. CK and hsCRP increased in both groups (P < .0001). Although the marathon run induced significant muscle damage, prolonging the duration of cooling using PCM did not accelerate the resolution of any dependent variables.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Kirsty M Hicks
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Karen M Keane
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Glyn Howatson
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Water Research Group, North West University, Potchefstroom, South Africa
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24
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Cohen JA, McHugh MP, Hickok M, Connolly DAJ. Is There An Optimal Vertical Ground Reaction Force Profile For Maximizing Jump Height In A Countermovement Jump? Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676400.58371.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Glace BW, Kremenic IJ, McHugh MP. Long Term Habituation To Carbohydrate-Restricted Diet Preserved Performance And Central Drive After 2 Hours Of Running: A Case Study. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000680700.47719.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Kwiecien SY, McHugh MP, Hicks KM, Keane K, Howatson G. The Efficacy Of Prolonged Cooling Using Phase Change Material For Enhancing Recovery Following A Marathon. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000670352.72651.5e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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McHugh MP, Cohen JA, Orishimo KF, Kremenic IJ. Effect Of Countermovement Depth On The Neuromechanics Of A Vertical Jump. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676404.56728.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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28
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Orishimo KF, O'Mahoney C, Kremenic IJ, Nicholas SJ, McHugh MP. Biomechanics Metrics Associated With Golfing Prowess. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000676436.03892.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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29
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Schmitt BM, Tyler TF, Kwiecien SY, Fox MB, McHugh MP. MAPPING TENDERNESS TO PALPATION PREDICTS RETURN TO PLAY FOLLOWING ACUTE HAMSTRING STRAIN. Int J Sports Phys Ther 2020; 15:421-428. [PMID: 32566378 PMCID: PMC7297001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION/PURPOSE Currently there is little evidence supporting the use of objective tests, measures, or imaging to help predict time to return to sport (RTS) following a hamstring strain. The purpose of this study is to investigate the predictive value of tenderness to palpation (TTP) as measured by area and location following hamstring strain. STUDY DESIGN Case Series. METHODS Nineteen male athletes (age 28 ± 9 yr) who sustained an acute hamstring strain underwent hamstring tenderness mapping on initial evaluation. The length and width of tenderness of the hamstring was identified with manual palpation, outlined in pen, and was then calculated as a percentage of the length and width of the posterior thigh. All patients underwent the same hamstring rehabilitation protocol with remapping performed at specific stages in rehabilitation. The association between mapping tenderness indices and RTS was assessed by linear regression. RESULTS The average length of the area of tenderness was 22 ± 12% with an average RTS of 43 ± 36 days. The length of the area of tenderness measured on initial evaluation was a strong predictor of RTS (R2 = 0.58, p<0.001; y = 2.3x - 6.2). Area of injury (R2 = 0.36, p = 0.006) and age (R2 = 0.27, p = 0.024) were also related to RTS, while width of injury (R2 = 0.006, p = 0.75) and location of injury were not (proximal-distal p = 0.62, medial-lateral p = 0.64). Adding age with length of injury into a multiple regression analysis improved the prediction of RTS (R2 = 0.73). The relationship between RTS and length of tenderness was relatively unchanged when the additional mapping indices taken during the course of rehabilitation were added to the analysis (R2 = 0.61, p<0.001; y = 2.3x - 4.4). This indicates that the regression equation can be used to estimate RTS regardless of when in the post injury/rehabilitation process the mapping is performed. CONCLUSIONS The length of the area of tenderness to palpation of the injured hamstring muscle was highly predictive of RTS time. Based on the regression equation a patient with a length of tenderness of 10% would have an estimated RTS time of 17 days, while a tenderness length of 30% would be estimated to return in 63 days. This hamstring mapping technique described was predictive of the RTS and may be a useful clinical tool. LEVEL OF EVIDENCE IIb.
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Affiliation(s)
| | - Timothy F Tyler
- The Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, USA
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30
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Kwiecien SY, O'Hara DJ, McHugh MP, Howatson G. Prolonged cooling with phase change material enhances recovery and does not affect the subsequent repeated bout effect following exercise. Eur J Appl Physiol 2019; 120:413-423. [PMID: 31828479 DOI: 10.1007/s00421-019-04285-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this investigation was twofold: (1) to examine the effect of prolonged phase change material (PCM) cooling following eccentric exercise of the quadriceps on indices of muscle damage, and (2) to elucidate whether application of PCM cooling blunted the acute adaptive response to eccentric exercise, known as the repeated bout effect (RBE). METHODS Twenty-six males (25 ± 6 years) performed an initial bout (B1) of 120 eccentric quadriceps contractions on each leg at 90% of their isometric strength and were then randomized to receive PCM packs frozen at 15 °C (treatment) or melted packs (control) worn directly on the skin under shorts for 6 h. The protocol was repeated 14 days later (B2) with all participants receiving the control condition. RESULTS PCM cooling provided protection against strength loss in B1 (P = 0.005) with no difference in strength between treatment groups in B2 (P = 0.172; bout by treatment by time P = 0.008). PCM cooling reduced soreness in B1 (P = 0.009) with no difference between treatment groups in B2 (P = 0.061). Soreness was overall lower following B2 than B1 (P < 0.001). CK was elevated in B1 (P < 0.0001) and reduced in B2 (P < 0.001) with no difference between treatments. The damage protocol did not elevate hsCRP in B1, with no difference between treatments or between bouts. CONCLUSIONS This work provides further evidence that PCM cooling enhances recovery of strength and reduces soreness following eccentric exercise. Importantly, these data show for the first time that prolonged PCM cooling does not compromise the adaptive response associated with the RBE.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 210 East 64 Street, 5th Floor, NISMAT, New York, NY, 10065, USA. .,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.
| | - Denis J O'Hara
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 210 East 64 Street, 5th Floor, NISMAT, New York, NY, 10065, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 210 East 64 Street, 5th Floor, NISMAT, New York, NY, 10065, USA.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Water Research Group, North West University, Potchefstroom, South Africa
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McHugh MP, Orishimo KF, Kremenic IJ, Adelman J, Nicholas SJ. Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair. Orthop J Sports Med 2019; 7:2325967119883357. [PMID: 31763342 PMCID: PMC6854752 DOI: 10.1177/2325967119883357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Weakness in end-range plantarflexion has been demonstrated after Achilles tendon repair and may be because of excessive tendon elongation. The mean frequency (MNF) of surface electromyogram (EMG) data during isometric maximum voluntary contraction (MVC) increases with muscle fiber shortening. Hypothesis During isometric plantarflexion, MNF during MVCs will be higher on the involved side compared with the uninvolved side after Achilles tendon repair because of excessive tendon elongation and greater muscle fiber shortening. Study Design Case series; Level of evidence, 4. Methods Isometric plantarflexion MVC torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantarflexion in 17 patients (15 men, 2 women; mean age, 39 ± 9 years) at a mean 43 ± 26 months after surgery. Surface EMG signals were recorded during strength tests. MNF was calculated from fast Fourier transforms of medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) EMG signals. Results Patients had marked weakness on the involved side versus the uninvolved side in 20° plantarflexion (deficit, 28% ± 18%; P < .001) but no significant weakness in 20° dorsiflexion (deficit, 8% ± 15%; P = .195). MNF increased when moving from dorsiflexion to plantarflexion (P < .001), but overall, it was not different between the involved and uninvolved sides (P = .195). However, differences in MNF between the involved and uninvolved sides were apparent in patients with marked weakness. At 10° plantarflexion, 8 of 17 patients had marked weakness (>20% deficit). MNF at 10° plantarflexion was significantly higher on the involved side versus the uninvolved side in patients with weakness, but this was not apparent in patients with no weakness (side by group, P = .012). Mean MNF at 10° plantarflexion across the 3 muscles was 13% higher on the involved side versus the uninvolved side in patients with weakness (P = .012) versus 3% lower in patients with no weakness (P = .522). Conclusion Higher MNF on the involved side versus the uninvolved side in patients with significant plantarflexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily because of excessive lengthening of the repaired Achilles tendon. If weakness was simply because of atrophy, a lower MNF would have been expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantarflexion after Achilles repair.
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Affiliation(s)
- Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Ian J Kremenic
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Julia Adelman
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
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Kwiecien SY, McHugh MP, Goodall S, Hicks KM, Hunter AM, Howatson G. Exploring the Efficacy of a Safe Cryotherapy Alternative: Physiological Temperature Changes From Cold-Water Immersion Versus Prolonged Cooling of Phase-Change Material. Int J Sports Physiol Perform 2019; 14:1288-1296. [PMID: 30958051 DOI: 10.1123/ijspp.2018-0763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the effectiveness between cold-water immersion (CWI) and phase-change-material (PCM) cooling on intramuscular, core, and skin-temperature and cardiovascular responses. METHODS In a randomized, crossover design, 11 men completed 15 min of 15°C CWI to the umbilicus and 2-h recovery or 3 h of 15°C PCM covering the quadriceps and 1 h of recovery, separated by 24 h. Vastus lateralis intramuscular temperature at 1 and 3 cm, core and skin temperature, heart-rate variability, and thermal comfort were recorded at baseline and 15-min intervals throughout treatment and recovery. RESULTS Intramuscular temperature decreased (P < .001) during and after both treatments. A faster initial effect was observed from 15 min of CWI (Δ: 4.3°C [1.7°C] 1 cm; 5.5°C [2.1°C] 3 cm; P = .01). However, over time (2 h 15 min), greater effects were observed from prolonged PCM treatment (Δ: 4.2°C [1.9°C] 1 cm; 2.2°C [2.2°C] 3 cm; treatment × time, P = .0001). During the first hour of recovery from both treatments, intramuscular temperature was higher from CWI at 1 cm (P = .013) but not 3 cm. Core temperature deceased 0.25° (0.32°) from CWI (P = .001) and 0.28°C (0.27°C) from PCM (P = .0001), whereas heart-rate variability increased during both treatments (P = .001), with no differences between treatments. CONCLUSIONS The magnitude of temperature reduction from CWI was comparable with PCM, but intramuscular temperature was decreased for longer during PCM. PCM cooling packs offer an alternative for delivering prolonged cooling whenever application of CWI is impractical while also exerting a central effect on core temperature and heart rate.
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Brownstein CG, Ansdell P, Škarabot J, McHugh MP, Howatson G, Goodall S, Thomas K. The Effect of Phase Change Material on Recovery of Neuromuscular Function Following Competitive Soccer Match-Play. Front Physiol 2019; 10:647. [PMID: 31244667 PMCID: PMC6562676 DOI: 10.3389/fphys.2019.00647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/07/2019] [Indexed: 01/11/2023] Open
Abstract
Aim: Cryotherapy is commonly implemented following soccer match-play in an attempt to accelerate the natural time-course of recovery, but the effect of this intervention on neuromuscular function is unknown. The aim of the present study was to examine the effect of donning lower-body garments fitted with cooled phase change material (PCM) on recovery of neuromuscular function following competitive soccer match-play. Methods: Using a randomized, crossover design, 11 male semi-professional soccer players wore PCM cooled to 15°C (PCMcold) or left at ambient temperature (PCMamb; sham control) for 3 h following soccer match-play. Pre-, and 24, 48, and 72 h post-match, participants completed a battery of neuromuscular, physical, and perceptual tests. Maximal voluntary contraction force (MVC) and twitch responses to electrical (femoral nerve) and magnetic (motor cortex) stimulation (TMS) during isometric knee-extension and at rest were measured to assess central nervous system (CNS) (voluntary activation, VA) and muscle contractile (quadriceps potentiated twitch force, Qtw,pot) function. Fatigue and perceptions of muscle soreness were assessed via visual analog scales, and physical function was assessed through measures of jump [countermovement jump (CMJ) height and reactive strength index (RSI)] performance. A belief questionnaire was completed pre- and post-intervention to determine the perceived effectiveness of each garment. Results: Competitive soccer match-play elicited persistent decrements in MVC, VA measured with femoral nerve stimulation, Qtw,pot, as well as reactive strength, fatigue and muscle soreness (P < 0.05). Both MVC and VA were higher at 48 h post-match after wearing PCMcold compared with PCMamb (P < 0.05). However, there was no effect of PCM on the magnitude or time-course of recovery for any other neuromuscular, physical function, or perceptual indices studied (P > 0.05). The belief questionnaire revealed that players perceived that both PCMcold and PCMamb were moderately effective in improving recovery, with no difference between the two interventions (P = 0.56). Conclusion: Although wearing cooled PCM garments improved MVC and VA 48 h following match-play, the lack of effect on measures of physical function or perceptual responses to match-play suggest that PCM offers a limited benefit to the recovery process. The lack of effect could have been due to the relatively small magnitude of change in most of the outcome measures studied.
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Affiliation(s)
- Callum G Brownstein
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.,Univ Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France
| | - Paul Ansdell
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Jakob Škarabot
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY, United States
| | - Glyn Howatson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.,Water Research Group, School of Environmental Sciences and Development, Northwest University, Potchefstroom, South Africa
| | - Stuart Goodall
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Kevin Thomas
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Kwiecien SY, McHugh MP, O'Hara DJ, Howatson G. Phase Change Material Cooling Reduces Indices of Muscle Damage and Does Not Inhibit Acute Adaptation. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562429.38904.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Orishimo KF, Shapira A, Kremenic IJ, McHugh MP, Nicholas SJ. Does Wearable Crutch Walking Excessively Load the Hip Joint? Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562587.58642.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mullaney MJ, Kwiecien SY, Fink A, McHugh MP. Accelerated Recovery of Muscle Function in Baseball Pitchers Using Post-Game Phase Change Material Cooling. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562433.92269.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mathew S, Kwiecien SY, Howatson G, McHugh MP. The Effect of Icing with Varying Degrees of Compression on Quadriceps Intramuscular Temperature. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563111.16314.b8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glace BW, Kremenic IJ, McHugh MP. Similar Central and Peripheral Fatigue in Men and Women after Running. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561791.35707.1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McHugh MP, Orishimo KF, Kremenic IJ, Adelman J, Nicholas SJ. Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562020.00405.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kwiecien SY, Mathew S, Howatson G, McHugh MP. The effect of varying degrees of compression from elastic vs plastic wrap on quadriceps intramuscular temperature during wetted ice application. Scand J Med Sci Sports 2019; 29:1109-1114. [PMID: 30963633 DOI: 10.1111/sms.13430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate and compare the effectiveness of wetted ice bag, applied with high compression elastic wrap or held in place with low compression plastic wrap, on reducing vastus lateralis intramuscular temperature and skin surface temperature. Ten healthy male participants had wetted ice packs applied to a standardized area on the anterior aspect of the quadriceps simultaneously to both legs for 30 minutes. The ice pack was secured with high compression (elastic wrap) to the left anterior thigh (60.6 ± 8.1 mm Hg) and low compression (plastic wrap) to the right anterior thigh (15.5 ± 4.0 mm Hg). Intramuscular temperature (1 and 3 cm) and skin temperature of the vastus lateralis were measured continuously during a 10-minute baseline period, 30-minute treatment period, and a 60-minute recovery period. No difference was observed between treatments in terms of the magnitude of reduction in intramuscular temperature at both 1 and 3 cm and skin temperature regardless of compression pressure (P > 0.05). Temperature upon conclusion of elastic wrap treatment was as follows: 17.8 ± 5.2°C at 1 cm and 23.1 ± 4.9°C at 3 cm; plastic wrap treatment: 17.9 ± 4.4°C at 1 cm and 24.5 ± 6.7°C at 3 cm. Plastic wraps may offer a practical alternative to elastic wraps for clinicians as they may be disposed of by the patient or athlete without having to stay at the treatment facility.
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Affiliation(s)
- Susan Y Kwiecien
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York City, New York.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Stephen Mathew
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York City, New York
| | - Glyn Howatson
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Water Research Group, North West University, Potchefstroom, South Africa
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York City, New York.,Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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Affiliation(s)
- Malachy P. McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma Lenox Hill Hospital New York City New York
| | - Timothy F. Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma Lenox Hill Hospital New York City New York
- PRO Sports Physical Therapy of Westchester Scarsdale New York
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Fukunaga T, Johnson CD, Nicholas SJ, McHugh MP. Muscle hypotrophy, not inhibition, is responsible for quadriceps weakness during rehabilitation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:573-579. [PMID: 30269167 DOI: 10.1007/s00167-018-5166-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/25/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE Quadriceps weakness is common after anterior cruciate ligament reconstruction (ACLR). Limited neuromuscular activation may have a role in the weakness. The purpose of this study was to use peripheral magnetic stimulation to measure changes in quadriceps inhibition in patients during rehabilitation from ACLR. METHODS Ten patients (7M/3F; age 35 ± 8 years; BMI 26.0 ± 4.8 kg/m2) who had ACLR with patellar tendon autograft were recruited. At 3 and 6 months postoperatively, patients' knee extension peak torque was measured during maximum voluntary isometric contraction (MVIC), magnetic stimulation-evoked contraction, and MVIC augmented with superimposed burst magnetic stimulation to the femoral nerve. All tests were done bilaterally at 30° and 65° of knee flexion on a dynamometer. Central activation ratio was calculated by dividing the peak torque before stimulation by peak torque after stimulation. RESULTS Patients had marked deficits in MVIC, with improvement from 3 to 6 months that was more apparent at 65° versus 30° (P < 0.05). There was significant deficit in stimulation-evoked torque on the involved side that diminished over time, and this change occurred differently between the two angles (P < 0.05). Central activation ratio was lower on the involved side versus the noninvolved side and this effect was more prominent at 3 versus 6 months: combining the angles, mean central activation ratio on the involved and noninvolved sides, respectively, was 91.4 ± 7.6% and 97.5 ± 5.3% at 3 months, and 93.0 ± 7.8% and 95.8 ± 6.8% at 6 months. CONCLUSIONS At 3 and 6 months after ACLR, there were significant deficits in quadriceps strength and activation. Quadriceps activation levels were high (> 90%) for both sides at both time points. The substantial strength deficits at this postoperative period may be largely due to muscle atrophy with limited contribution from central inhibition. Rehabilitation interventions to normalize quadriceps strength should emphasize hypertrophic stimuli as opposed to neuromuscular activation strategies. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Takumi Fukunaga
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA.
| | - Christopher D Johnson
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Manhattan Eye, Ear, and Throat Hospital, 210 East 64th Sreet, New York, NY, 10065, USA
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McHugh MP, Clifford T, Abbott W, Kwiecien SY, Kremenic IJ, DeVita JJ, Howatson G. Countermovement Jump Recovery in Professional Soccer Players Using an Inertial Sensor. Int J Sports Physiol Perform 2019; 14:9-15. [PMID: 29809065 DOI: 10.1123/ijspp.2018-0131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the utility of an inertial sensor for assessing recovery in professional soccer players. METHODS In a randomized, crossover design, 11 professional soccer players wore shorts fitted with phase change material (PCM) cooling packs or uncooled packs (control) for 3 h after a 90-min match. Countermovement jump (CMJ) performance was assessed simultaneously with an inertial sensor and an optoelectric system: prematch and 12, 36, and 60 h postmatch. Inertial sensor metrics were flight height, jump height, low force, countermovement distance, force at low point, rate of eccentric force development, peak propulsive force, maximum power, and peak landing force. The only optoelectric metric was flight height. CMJ decrements and the effect of PCM cooling were assessed with repeated-measures analysis of variance. Jump heights were also compared between devices. RESULTS For the inertial sensor data, there were decrements in CMJ height on the days after matches (88% [10%] of baseline at 36 h, P = .012, effect size = 1.2, for control condition) and accelerated recovery with PCM cooling (105% [15%] of baseline at 36 h, P = .018 vs control, effect size = 1.1). Flight heights were strongly correlated between devices (r = .905, P < .001), but inertial sensor values were 1.8 [1.8] cm lower (P = .008). Low force during countermovement was increased (P = .031) and landing force was decreased (P = .043) after matches, but neither was affected by the PCM cooling intervention. Other CMJ metrics were unchanged after matches. CONCLUSIONS This small portable inertial sensor provides a practical means of assessing recovery in soccer players.
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Glace BW, Kremenic IJ, McHugh MP. Effect of carbohydrate beverage ingestion on central versus peripheral fatigue: a placebo-controlled, randomized trial in cyclists. Appl Physiol Nutr Metab 2018; 44:139-147. [PMID: 30058344 DOI: 10.1139/apnm-2017-0777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We investigated whether carbohydrate ingestion delays fatigue in endurance-trained cyclists via peripheral or central mechanisms. Ten men (35 ± 9 years of age) and 10 women (42 ± 7 years of age) were assigned, in a double-blind, crossover design, to a sports drink (CHO) or to a placebo (PL). The following strength measures were made 3 times (before exercise, after a time trial (TT), and after a ride to exhaustion): (i) maximal voluntary contraction (MVC); (ii) MVC with superimposed femoral nerve magnetic stimulation to measure central activation ratio (CAR); and (iii) femoral nerve stimulation in a 3-s pulse train on relaxed muscle. The subjects cycled for 2 h at approximately 65% of peak oxygen consumption, with five 1-min sprints interspersed, followed by a 3-km TT. After strength testing, the cyclists remounted their bikes, performed a brief warm-up, and pedaled at approximately 85% peak oxygen consumption until unable to maintain workload. Changes in metabolic and strength measurements were analyzed with repeated-measures ANOVA. From before exercise to after the TT, MVC declined in men (17%) and women (18%) (p = 0.004), with no effect of beverage (p > 0.193); CAR decreased in both sexes with PL (p = 0.009), and the decline was attenuated by CHO in men only (time × treatment, p = 0.022); and there was no evidence of peripheral fatigue in either sex with either beverage (p > 0.122). Men rode faster in the TT with CHO (p = 0.005) but did not improve performance in the ride to exhaustion (p = 0.080). In women, CHO did not improve performance in the TT (p = 0.173) or in the ride to exhaustion (p = 0.930). We concluded that carbohydrate ingestion preserved central activation and performance in men, but not in women, during long-duration cycling.
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Affiliation(s)
- Beth W Glace
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10065, USA.,Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10065, USA
| | - Ian J Kremenic
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10065, USA.,Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10065, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10065, USA.,Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10065, USA
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Orishimo KF, Schwartz-Balle S, Tyler TF, McHugh MP, Bedford BB, Lee SJ, Nicholas SJ. Can Weakness in End-Range Plantar Flexion After Achilles Tendon Repair Be Prevented? Orthop J Sports Med 2018; 6:2325967118774031. [PMID: 29845085 PMCID: PMC5967157 DOI: 10.1177/2325967118774031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Disproportionate end-range plantar flexion weakness, decreased passive stiffness, and inability to perform a heel rise on a decline after Achilles tendon repair are thought to reflect increased tendon compliance or tendon lengthening. Since this was first noted, we have performed stronger repairs and avoided stretching into dorsiflexion for the first 12 weeks after surgery. Hypothesis Using stronger repairs and avoiding stretching into dorsiflexion would eliminate end-range plantar flexion weakness and normalize passive stiffness. Study Design Case series; Level of evidence, 4. Methods Achilles repairs with epitendinous augmentation were performed on 18 patients. Plantar flexion torque, dorsiflexion range of motion (ROM), passive joint stiffness, and standing single-legged heel rise on a decline were assessed at 43 ± 24 months after surgery (range, 9 months to 8 years). Maximum isometric plantar flexion torque was measured at 20° and 10° of dorsiflexion, neutral position, and 10° and 20° of plantar flexion. Passive dorsiflexion ROM was measured with a goniometer. Passive joint stiffness was computed from the increase in passive torque from 10° to 20° of dorsiflexion. Tendon thickness was measured by use of digital calipers. Plantar flexion electromyographic (EMG) data were recorded during strength and functional tests. Analysis of variance and chi-square tests were used to assess weakness and function. Results Marked weakness was evident on the involved side at 20° of plantar flexion (deficit, 26% ± 18%; P < .001), with no weakness at 20° of dorsiflexion (deficit, 6% ± 17%; P = .390). Dorsiflexion ROM was decreased 5.5° ± 8° (P = .015), and tendon width was 8 ± 3 mm greater on the involved side (P < .001). Passive joint stiffness was similar between the involved and noninvolved sides. Only 2 of 18 patients could perform a decline heel rise on the involved side compared with 18 of 18 on the noninvolved side (P = .01). No difference in EMG amplitude was found between the involved and noninvolved sides during the strength or heel rise tests. Conclusion The use of stronger repair techniques and attempts to limit tendon elongation by avoiding dorsiflexion stretching did not eliminate weakness in end-range plantar flexion. EMG data confirmed that end-range weakness was not due to neural inhibition. Physiological changes that alter the force transmission capability of the healing tendon may be responsible for this continued impairment. This weakness has implications for high-demand jumping and sprinting after Achilles tendon repair.
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Affiliation(s)
- Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Sidse Schwartz-Balle
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Timothy F Tyler
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Benjamin B Bedford
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Steven J Lee
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
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Kwiecien SY, McHugh MP, Goodall S, Hicks KM, Hunter AM, Howatson G. Effect of Cold Water Immersion versus Phase Change Material Cooling On Core and Intramuscular Temperature. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538194.56035.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glace BW, Kremenic IJ, McHugh MP. Similar Substrate Use During Prolonged Cycling in Men and Women. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535899.18423.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McHugh MP, Clifford T, Abbott W, Kwiecien SY, Kremenic IJ, Devita JJ, Howatson G. Assessment of Countermovement Jump Performance Recovery in Professional Soccer Players Using an Inertial Sensor. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538642.92699.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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DeVita JJ, Kremenic IJ, Orishimo KF, McHugh MP. Reliability and Validity of a Wireless Inertial Sensor for Assessing Vertical Jump Biomechanics. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536515.79300.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tsang STJ, McHugh MP, Guerendiain D, Gwynne P, Boyd J, Laurenson IF, Templeton KE, Lewis S, Simpson AHRW, Walsh TS. Evaluation of Staphylococcus aureus eradication therapy in orthopaedic surgery. J Med Microbiol 2018; 67:893-901. [PMID: 29671723 DOI: 10.1099/jmm.0.000731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Despite WHO recommendations, there is currently no national screening and eradication policy for the detection of methicillin-sensitive Staphylococcus aureus (MSSA) in the UK prior to elective orthopaedic surgery. This study aimed to evaluate the effectiveness of current standard methicillin-resistant S. aureus (MRSA) eradication therapies in the context of S. aureus (both MRSA and MSSA) decolonization in an elective orthopaedic population. METHODOLOGY A total of 100 patients awaiting joint replacement surgery who were positive for S. aureus on PCR nasal screening underwent the current standard MRSA pre-operative decolonization regimen for 5 days. Prior to commencement of the eradication therapy, swabs of the anterior nares, throat and perineum were taken for culture. Further culture swabs were taken at 48-96 h following treatment, at hospital admission for surgery and at hospital discharge. Following the completion of treatment, patients were asked to provide feedback on their experience using Likert rating scales. The primary outcome of this study was S. aureus clearance 48-96 h following eradication treatment.Results/Key Findings. Clearance of S. aureus 48-96 h following treatment was 94 % anterior nares, 66 % throat and 88 % groin. Mean completion with nasal mupirocin was 98 %. There was no statistically significant recolonization effect between the end of the eradication treatment period and the day of surgery (P>0.05) at a median time of 10 days. CONCLUSION Current MRSA decolonisation regimens are well tolerated and effective for MSSA decolonization for the anterior nares and groin. The decolonization effect is preserved for at least 10 days following treatment.
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Affiliation(s)
- S T J Tsang
- School of Biological Sciences, University of Edinburgh, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK.,Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France, Crescent Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - M P McHugh
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - D Guerendiain
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - P Gwynne
- School of Biological Sciences, University of Edinburgh, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK
| | - J Boyd
- Department of Anaesthesia, Critical care and Pain Medicine, University of Edinburgh, Chancellor's Building, 49 Little France Crescent , Old Dalkeith Road, Edinburgh EH16 4SB, Scotland
| | - I F Laurenson
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - K E Templeton
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - S Lewis
- Edinburgh Clinical Trials Unit, University of Edinburgh, Usher Institute, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - A H R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France, Crescent Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - T S Walsh
- Department of Anaesthesia, Critical care and Pain Medicine, University of Edinburgh, Chancellor's Building, 49 Little France Crescent , Old Dalkeith Road, Edinburgh EH16 4SB, Scotland
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