Addressing Circadian Disruptions in Visually Impaired Paralympic Athletes

PURPOSE

Transmeridian travel is common for elite athletes participating in competitions and training. However, this travel can lead to circadian misalignment wherein the internal biological clock becomes desynchronized with the light-dark cycle of the new environment, resulting in performance decrement and potential negative health consequences. Existing literature extensively discusses recommendations for managing jet lag, predominantly emphasizing light-based interventions to synchronize the internal clock with the anticipated time at the destination. Nevertheless, visually impaired (VI) athletes may lack photoreceptiveness, diminishing or nullifying the effectiveness of this therapy. Consequently, this invited commentary explores alternative strategies for addressing jet lag in VI athletes.

CONCLUSIONS

VI athletes with light perception but reduced visual acuity or visual fields may still benefit from light interventions in managing jet lag. However, VI athletes lacking a conscious perception of light should rely on gradual shifts in behavioral factors, such as meal timing and exercise, to facilitate the entrainment of circadian rhythms to the destination time. Furthermore, interventions like melatonin supplementation may prove useful during and after travel. In addition, it is recommended that athlete guides adopt phase-forward or phase-back approaches to synchronize with the athlete, aiding in jet-lag management and optimizing performance.

Assessing spring-mass similarity in elite and recreational runners

The dynamic complexity and individualization of running biomechanics has challenged the development of objective and comparative gait measures. Here, we present and explore several novel biomechanical metrics for running that are informed by a canonical inter-species gait template-the spring-mass model. The measures assess running mechanics systemically against the template via quantifying characteristics of a runner's kinetics relative to the energy-conserving elastic system-i.e., their "spring-mass similarity". Applying these metrics in a retrospective cohort investigation, we studied the overground kinetics of two heterogenous populations of runners in two footwear conditions: elite and recreational athletes in shod and barefoot conditions. Across all measures and within foot strike types, the elite runners exhibited mechanics that were more similar to those of the ideally elastic spring-mass template. The elite runners had more symmetric bounces, less discrepancy (i.e., greater coordination) between horizontal and vertical kinetic changes, and better fit to a spring-mass vertical ground reaction force time series. Barefoot running elicited greater kinetic coordination in the recreational runners. At a faster speed, the elites further improved their similarity to the template. Overall, the more economical elite group exhibited greater likeness to the linearly elastic, energy-conserving spring-mass system than their recreational counterparts. This study introduces novel biomechanical measures related to performance in distance running. More broadly, it provides new, approachable metrics for systemic quantification of gait biomechanics in runners across all demographics. These metrics may be applied to assess a runner's global biomechanical response to a variety of interventions, including training adaptations, rehabilitation programs, and footwear conditions.

Changes in running biomechanics during the 2017 IAAF world championships men's 1500 m final

The aim of this study was to analyze key kinematic, spatiotemporal, and global mechanical characteristics in world-class middle-distance racing. Eight men were recorded halfway along the home straight on the second, third, and final laps in the 2017 IAAF World Championship 1500 m final. Video data (150 Hz) from three high-definition camcorders were digitized to calculate relevant variables, subsequently analyzed in relation to running speed and finishing position. Better-placed finishers had greater hip extension at initial contact and through late stance, greater knee excursion throughout stance, and longer overstriding distances. Step length did not change with faster speeds as runners relied on increasing step frequency, but the highest-finishing athletes had longer contact phases and greater fluctuations in speed through the step cycle, which were related to higher normalized peak horizontal forces. The best athletes also had lower leg stiffnesses and vertical stiffnesses. The extended contact phase and greater compression could allow for more sustained force production, enabling better acceleration and maintenance of sprinting speed, indicating a trade-off between aerobic energetic efficiency and anaerobic power capacity. Coaches should note that these factors, as well as the best athletes' greater overstriding distances, show that elite 1500 m runners might prioritize a technique that favors running speed over economy.

Position-Specific Physical Workload Intensities in American Collegiate Football Training

ABSTRACT

MamonJr, MA, Olthof, SBH, Burns, GT, Lepley, AS, Kozloff, KM, and Zernicke, RF. Position-specific physical workload intensities in American collegiate football training. J Strength Cond Res 36(2): 420-426, 2022-Quantifying player training loads allows football coaching staff to make informed adjustments to the volume and intensity of training. Physical workload intensity in American football practices have not been extensively quantified. The current study examined physical workload intensities across positions in American collegiate football during training. Data from player tracking technology (Catapult Vector) were collected from 72 American football players (National Collegiate Athletic Association Division I) during in-season practices. Players were involved in individualized skill (indy), team playbook (team), and special team (ST) drills during practice and analyzed for their specialist offensive or defensive role (e.g., linebacker or wide receiver). Player running (i.e., high-speed running and sprint) and accelerations (i.e., high-intensity PlayerLoad and high-intensity inertial movement analysis) per minute were of interest. Drill type and practice day had significant effects on all workload intensity metrics (p < 0.01), but not position. Greater running intensities were seen in ST drills compared with other drill types. Tuesday practice sessions had greater overall intensities compared with other days. Interaction effect of position and drill type was significant (p < 0.001) for all intensity metrics, indicating that position groups exhibited unique workload responses to the drill types. Drill type and practice day interaction effect was significant for all intensity metrics (p < 0.01). The findings may be informative for coaches to tailor physical workloads of practice drills for positional roles in preparation for games and practices. Player tracking technology can add value for strength and conditioning coaches to adjust training programs based on position-specific on-field demands of players.

A simple computational method to estimate stance velocity in running

Running dynamical analyses typically approximate a runner's stance velocity as the average stride cycle velocity (the average running speed). That approximation necessarily overestimates stance velocity and biases subsequent results. Stance velocity is crucial in kinetic spring-mass analyses of running, where approximation of a runner's impact angle and calculation of leg stiffness require that input. Here, a new method is presented to approximate a runner's stance velocity via measurement of contact and flight times with the runner's average speed, leg length or height, and mass. This method accurately estimated the stance velocity of simulated spring-mass systems across typical running speeds of 3.5-5.5 m s-1 (r>0.99) and more accurately estimated the impact angle and leg stiffness. The method also accurately estimated the peak horizontal ground reaction force across speeds (r=0.82), but the bias magnitude increased with speed. Robustness of the new method was further tested for runners at 2.5, 3.5 and 4.5 m s-1, and the new method provided steeper impact angles than those from traditional estimates and correspondingly higher leg stiffnesses, analogous to the observations in the simulation models. Horizontal ground reaction force estimates were weakly correlated in braking and propulsion. They were improved by a corrective algorithm, but the intra- and inter-individual variation persisted. The directionality and magnitude of angle and stiffness estimates in the human runners were similar to simulations, suggesting the new method more accurately modeled runners' spring-mass characteristics by using an accurate approximation of stance velocity. The new method can improve traditional kinetic analyses of running where stance velocity recordings are not captured with kinematic recordings and extend opportunities for accurate field-based analyses with limited measurement sources.

Improving spring-mass parameter estimation in running using nonlinear regression methods

Runners are commonly modeled as spring-mass systems, but the traditional calculations of these models rely on discrete observations during the gait cycle (e.g. maximal vertical force) and simplifying assumptions (e.g. leg length), challenging the predicative capacity and generalizability of observations. We present a method to model runners as spring-mass systems using nonlinear regression (NLR) and the full vertical ground reaction force (vGRF) time series without additional inputs and fewer traditional parameter assumptions. We derived and validated a time-dependent vGRF function characterized by four spring-mass parameters - stiffness, touchdown angle, leg length and contact time - using a sinusoidal approximation. Next, we compared the NLR-estimated spring-mass parameters with traditional calculations in runners. The mixed-effect NLR method (ME NLR) modeled the observed vGRF best (RMSE:155 N) compared with a conventional sinusoid approximation (RMSE: 230 N). Against the conventional methods, its estimations provided similar stiffness approximations (-0.2±0.6 kN m^-1) with moderately steeper angles (1.2±0.7 deg), longer legs (+4.2±2.3 cm) and shorter effective contact times (-12±4 ms). Together, these vGRF-driven system parameters more closely approximated the observed vertical impulses (observed: 214.8 N s; ME NLR: 209.0 N s; traditional: 223.6 N s). Finally, we generated spring-mass simulations from traditional and ME NLR parameter estimates to assess the predicative capacity of each method to model stable running systems. In 6/7 subjects, ME NLR parameters generated models that ran with equal or greater stability than traditional estimates. ME NLR modeling of the vGRF in running is therefore a useful tool to assess runners holistically as spring-mass systems with fewer measurement sources or anthropometric assumptions. Furthermore, its utility as statistical framework lends itself to more complex mixed-effects modeling to explore research questions in running.

Step frequency patterns of elite ultramarathon runners during a 100-km road race

Step frequency (SF) in running has received substantial interest from researchers, coaches, therapists, and runners. It has been widely studied in controlled settings, but no published study has measured it continuously in elite-level competition. The present study used wrist-based accelerometers in consumer-grade watches to monitor SF and SF variability of competitors in the 2016 100-km World Championship road race. Using linear mixed-model regression, SF and SF variability were assessed across the race. The average SF (steps-per-minute) of competitors ( n = 20) was 182.0 spm (range: 155.4-203.1 spm). Race fluctuations in SF were influenced only by the speed the competitors were running, with faster speeds being associated with greater SF (5.6 spm/m·s^-1, P < 0.001). Independently of this speed relation, SF did not significantly change over the course of the race. SF was further linked to the runner's stature (-123.1 spm/m, P = 0.01) but not significantly related to sex, weight, age, or years of experience. The SF coefficient-of-variation was inversely associated with running speed and distance covered, with runners demonstrating decreasing variability both at faster speeds and as the race progressed. Together, these results add ecological evidence to observations of a speed dependency of SF in a highly trained, elite population of runners and suggest that in road race conditions, SF changes only with speed and not fatigue. Furthermore, it presents evidence that the variability of an elite runner's SF is linked to both speed and fatigue but not to any other characteristics of the runner. The current findings are important for runners, clinicians, and coaches as they seek to monitor or manipulate SF. NEW & NOTEWORTHY Stride frequency (SF; or the synonymous "cadence") has become a popular point of monitoring and manipulation in runners. Advances in wearable technology have enabled continuous monitoring of SF. This study is the first to examine SF and SF variability patterns throughout an entire road race in elite ultramarathon runners. This adds ecological, normative data to the field's understanding of SF and demonstrates how it relates to running speed, fatigue, and individual characteristics.

Evaluating Internal Fixation Skills Using Surgical Simulation

BACKGROUND

Open reduction and internal fixation (ORIF) is an essential skill for an orthopaedic surgeon, yet teaching its components to surgical residents poses challenges in both complexity and cost. Surgical simulation has demonstrated efficacy and is now a mandated component of residency programs, but the techniques and resources required for effective simulation vary greatly. We hypothesized that simulation of ORIF skills could be accomplished in a cost-effective, quantifiable, and reproducible manner and that this experience coupled with didactic learning would increase skill proficiency and enhance ORIF performance.

METHODS

Sixteen postgraduate-year-1 orthopaedic surgery interns were assessed on performance of ORIF simulation tasks before and after attending a module designed to introduce and practice internal fixation techniques. Simulation tasks addressed drilling accuracy via oblique drilling through polyvinyl chloride (PVC) cylinders and bisecting wooden dowels and plunge control via drilling through layered boards of varying densities. Fracture fixation simulation involved fixing oblique fractures on synthetic ulnae. Task performance was assessed at 3 time points: immediately before the module, 1 week after the module, and 3 months after the module. Fracture fixation was assessed before and after the module via load-to-failure testing. Success rates for the tasks were analyzed using a repeated-measures analysis of variance, and mechanical properties of the fixed ulnar constructs were compared using paired t tests.

RESULTS

In all ORIF simulation tasks, pre-module to post-module improvement in success rates was significant (p < 0.001) and improvements were maintained between the post-module assessment and the 3-month follow-up. The interns also achieved significantly greater strengths in their ulnar fixation constructs, with a mean improvement of 256 N (p = 0.01) after the module.

CONCLUSIONS

These results indicate that the technical and sensorimotor skills relevant to internal fixation (with emphasis on the specific skill of using a drill) can be significantly augmented and retained in the short term in surgical residents after exposure to faculty-led lecture and hands-on skills practice using low-cost materials.

CLINICAL RELEVANCE

This study provides evidence for an effective, accessible method of enhancing and assessing surgical skills in training.

Biomechanical Analysis of Intervertebral Cement Extravasation in Vertebral Motion Segments

Kyphoplasty is a therapeutic option for pain relief in the setting of compression fractures. Cement extravasation into adjacent disks is a common occurrence. The biomechanical and clinical consequences of cement in the disks currently are unknown. This study investigated the biomechanical effects of cement extravasation into the intervertebral disk in a human cadaveric model. Seven thoracolumbar and lumbar embalmed human cadaveric motion segments were evaluated in axial rotation, right and left lateral bending, and flexion and extension. Stiffness was calculated at baseline and following injection of 1 mL of cement into the intervertebral disk. There was a 13.4% (P=.041) increase in stiffness in axial rotation compared with preinjection motion segments. No significant difference was observed in lateral bending or flexion and extension. In this model, cement extravasation into the disk space increased stiffness in axial rotation. [Orthopedics. 2017; 40(2):e300-e304.].