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Schlattmann B, Kiyono K, Kelty-Stephen DG, Mangalam M. Angular distribution of fractal temporal correlations supports adaptive responses to wobble board instability. J R Soc Interface 2025; 22:20240664. [PMID: 39904365 PMCID: PMC11793983 DOI: 10.1098/rsif.2024.0664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/17/2024] [Accepted: 12/02/2024] [Indexed: 02/06/2025] Open
Abstract
Contemporary dynamical models of human postural control propose an intermittent controller regulating the postural centre of pressure (CoP) about a stable saddle-shaped manifold along anatomical anteroposterior (AP) and mediolateral (ML) axes, releasing CoP in an outwards spiral when inactive. Experimental manipulations can evoke this saddle-type topology in fractal temporal correlations along the AP axis and reducing correlations along the ML axis. However, true effects of task demands may often manifest within angular space between anatomical AP and ML axes-a space not typically modelled explicitly. We tested how instability and attentional load influence postural control across the full angular range of fractal variability along the two-dimensional (2D) support surface. Forty-eight healthy young adults performed a suprapostural Trail Making Test (TMT) while standing on a wobble board, inducing continuous perturbations along the ML axis. Stable, quiet standing exhibited classic saddle-like topology, with stronger fractal temporal correlations in CoP displacements along AP axes. The attentional demand of the TMT did not affect angular variation or strength of fractal temporal correlations across the 2Dsupport surface. However, maintaining upright balance on the wobble board reshaped and reoriented the angular distribution of fractal temporal correlations, accentuating saddle-like angular variation and rotating the strongest fractal temporal correlations predominantly along the ML axis. Stabilizing posture in the face of wobble board instability prompted the saddle-type angular distribution of fractal temporal correlations. These findings challenge the traditional dependence of postural control theories exclusively on external force-plate axes and underscore the significance of multifractality in defining control parameters that govern postural stability across the full angular range of the 2D support surface.
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Affiliation(s)
- Brian Schlattmann
- Department of Biomechanics, Center for Research in Human Movement Variability, Division of Biomechanics and Research Development, University of Nebraska at Omaha, Omaha, NE68182, USA
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka560-8531, Japan
| | - Damian G. Kelty-Stephen
- Department of Psychology, State University of New York at New Paltz, New Paltz, NY12561, USA
| | - Madhur Mangalam
- Department of Biomechanics, Center for Research in Human Movement Variability, Division of Biomechanics and Research Development, University of Nebraska at Omaha, Omaha, NE68182, USA
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Faghihi R, Khanmohammadi R. Comparing virtual reality and balance training effects on postural strategies during ball kicking in soccer players with chronic ankle instability. Sci Rep 2024; 14:31448. [PMID: 39733187 PMCID: PMC11682270 DOI: 10.1038/s41598-024-83071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 12/11/2024] [Indexed: 12/30/2024] Open
Abstract
The study aimed to determine if virtual reality (VR) games could enhance neuromuscular control and improve anticipatory and compensatory strategies in ball-kicking for soccer players. It was a single-blind randomized clinical trial involving 32 male soccer players with chronic ankle instability. Participants were divided into two groups: VR games and balance training. The primary outcomes measured were the amplitude and onset time of muscle activities in the peroneus longus (PL), tibialis anterior (TA), soleus (SOL), rectus femoris (RF), biceps femoris (BF), and gluteus medius (GM) in three phases: anticipatory (APA), compensatory 1 (CPA1), and compensatory 2 (CPA2). Secondary outcomes included the Y-balance test and perceived ankle instability. Evaluations were done before and after treatment. Both groups underwent 12 sessions, three times a week, each lasting 60 min. In the VR games group, there was a significant decrease in SOL muscle activity amplitude during CPA2 after treatment (P = 0.033), and the BF muscle activated earlier (P = 0.043). The balance training group showed a significant increase in GM muscle activity amplitude during APA (P = 0.037) and earlier activation of the GM muscle post-treatment (P = 0.050). Additionally, this group demonstrated significant decreases in RF activity during CPA1 and PL activity in CPA1 and CPA2 (P = 0.048, P = 0.030, and P = 0.050, respectively). Between-group comparisons indicated a significant increase in GM muscle activity amplitude during APA and a reduction during CPA1 for the balance training group compared to the VR games group (P = 0.050 and P = 0.012, respectively). Both groups showed significant reductions in perceived ankle instability (VR group: P = 0.002, balance training group: P < 0.001) and improvements on the Y-balance test (VR group: P < 0.021, balance training group: P < 0.033), although neither group showed significant improvement in the anterior direction. Overall, both VR games and balance training effectively enhanced perceived ankle stability and dynamic postural control, with neither approach showing clear superiority. Both groups exhibited improvements in muscle activation timing, though neither outperformed the other. While both interventions led to increased muscle activity amplitude during the anticipatory and compensatory phases, the balance training group achieved somewhat greater improvements. These results suggest that both VR games and balance training are effective rehabilitation approaches for chronic ankle instability, providing comparable benefits for enhancing ankle stability and neuromuscular control, without a distinct advantage of one over the other.RCT Registration: On the Iranian Registry of Clinical Trials (IRCT20230124057197N1). Registration date: 30/06/2023.
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Affiliation(s)
- Rezvane Faghihi
- Physical Therapy Department, Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Khanmohammadi
- Physical Therapy Department, Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, Iran.
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Miyachi R, Nagamori Y, Fujii Y, Kanazawa Y. Immediate Effects of Leg-Press Coordination Training on Ankle Sway in Individuals With Chronic Ankle Instability: A Randomized Controlled Trial. Cureus 2024; 16:e72335. [PMID: 39588424 PMCID: PMC11586250 DOI: 10.7759/cureus.72335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2024] [Indexed: 11/27/2024] Open
Abstract
Objectives This study aimed to determine the effects of leg-press coordination training on immediate ankle sway in individuals with chronic ankle instability (CAI). Methods Participants with CAI (age 19.8 ± 1.0 years, seven men and 17 women) were randomly allocated to a control group (CON), which performed regular leg-press training, or a coordination training group (CT), which performed coordination training using a leg-press device. The main outcome measure was the average angular jerk cost of the ankle joint in the Y-balance test (YBT), and the secondary outcome measures were the maximum ankle and hip joint angles, maximum reach distance in the YBT, ankle proprioception, and weight-bearing dorsiflexion angle. Results A significant group × period (pre- and post-intervention) interaction in the ankle average angular jerk cost was observed in the YBT in anterior reaching and posteromedial reaching ankle plantar flexion/dorsiflexion (anterior reaching: p = 0.03, posteromedial reaching: p < 0.01) as well as in adduction/abduction (posteromedial reaching: p = 0.02). The average ankle angular jerk cost in the CT group was significantly lower at post-intervention than at pre-intervention. Conclusions Leg-press coordination training immediately reduces ankle sway in individuals with CAI.
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Affiliation(s)
- Ryo Miyachi
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, JPN
| | - Yui Nagamori
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, JPN
| | - Yoshinari Fujii
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, JPN
| | - Yuji Kanazawa
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, JPN
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Durdu H, Demir R, Zeren M, Aydin E, Gunaydin ZY, Yigit Z. The Effect of Computerized Wobble Board and Core Stabilization Exercises on Balance Performance and Exercise Capacity in Patients With Heart Failure: A Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:1429-1438. [PMID: 38614379 DOI: 10.1016/j.apmr.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/12/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To investigate the effects of computerized wobble board exercise training (CWBET) and core stabilization exercise training (CSET) on balance performance, and exercise capacity in patients with heart failure (HF). DESING Single-blind randomized controlled prospective study. SETTING Cardiology department of a local university hospital. PARTICIPANTS Fifty-one patients with HF with reduced ejection fraction, whose clinical status and medication had been stable for the previous 3 months, were included (N=51). Nine patients could not complete the follow-up period due to personal reasons. No patient experienced any adverse events during exercise training. INTERVENTIONS Patients were randomized to CWBET, CSET, and control group. CWBET and CSET groups participated in their own exercise programs, 3 days a week for 8 weeks. The control group received no exercise program. MAIN OUTCOME MEASURES All patients were evaluated at baseline and after 8 weeks. Postural stability, static and functional balance, and exercise capacity were evaluated with the Sensamove Balance Test Pro with Miniboard, the one-leg stance test (OLS), the Berg Balance Scale (BBS), and the six-minute walk distance (6MWD), respectively. Core stabilization and health-related quality of life (HRQOL) were assessed with OCTOcore app, and Minnesota Living with Heart Failure Questionnaire, respectively. RESULTS A mixed model repeated-measures ANOVA revealed significant group × time interaction effect for static postural stability performance (P<.001, ηp2=0.472), vertical (P<.001, ηp2=0.513), horizontal performance (P<.001, ηp2=0.467), OLS (P<.001, ηp2=0.474), BBS (P<.001, ηp2=0.440) scores, 6MWD (P<.001, ηp2=0.706), and HRQOL. Post hoc analysis revealed CWBET and CSET groups had similar improvements balance performance, exercise capacity, and HRQOL and both groups significantly improved compared with control group (P<.001). Core stabilization was significantly improved only in CSET group after 8 weeks. CONCLUSION CWBET and CSET programs were equally effective and safe for improving balance performance and exercise capacity in patients with HF.
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Affiliation(s)
- Habibe Durdu
- Istanbul University-Cerrahpasa, Institute of Graduate Studies, Department of Physiotherapy and Rehabilitation, Istanbul, Türkiye
| | - Rengin Demir
- Istanbul University-Cerrahpasa, Cardiology Institute, Department of Cardiology, Istanbul, Türkiye.
| | - Melih Zeren
- Izmir Bakircay University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Izmir, Türkiye
| | - Ertan Aydin
- Giresun University, Faculty of Medicine, Department of Cardiology, Giresun, Türkiye
| | - Zeki Yuksel Gunaydin
- Giresun University, Faculty of Medicine, Department of Cardiology, Giresun, Türkiye
| | - Zerrin Yigit
- Istanbul University-Cerrahpasa, Cardiology Institute, Department of Cardiology, Istanbul, Türkiye
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Matsuura Y, Matsunaga N, Akuzawa H, Oshikawa T, Kaneoka K. Comparison of Muscle Coordination During Front Crawl and Backstroke With and Without Swimmer's Shoulder Pain. Sports Health 2024; 16:89-96. [PMID: 37042038 PMCID: PMC10732115 DOI: 10.1177/19417381231166957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Shoulder pain, known as swimmer's shoulder, is the most common injury for swimmers. Studies that have analyzed muscle activity have focused on the shoulder joint. However, the whole-body muscle coordination of swimmers with swimmer's shoulder is not clear, although swimming requires movements of the upper limbs, trunk, and lower limbs to obtain propulsive force. This study investigated differences in muscle coordination between swimmers with and without swimmer's shoulder during the front crawl and backstroke using muscle synergy analysis. HYPOTHESIS Swimmers with swimmer's shoulder have muscle synergies differing from those without it. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 4. METHODS A total of 20 elite swimmers who regularly swam front crawl and backstroke were included (swimmer's shoulder, n = 8; control, n = 12). Muscle synergy data were analyzed using the nonnegative matrix factorization method and compared between groups. RESULTS For both front crawl and backstroke, there were 2 synergies in the control group and 3 synergies in the swimmer's shoulder group. During recovery, the control group showed coordinated triceps brachii, serratus anterior, upper trapezius, lower trapezius, internal oblique, and external oblique muscles activities; however, in the swimmer's shoulder group, the contribution of the upper limbs decreased and only that of the trunk muscles increased. CONCLUSION A comparison of muscle coordination during the front crawl and backstroke performed by swimmers with and without swimmer's shoulder revealed that coordination differed during the recovery phase. During both front crawl and backstroke, the swimmer's shoulder group could not maintain coordination with the upper limb when the trunk rolled, and split synergy was formed between the upper limbs and trunk. CLINICAL RELEVANCE Because coordination of the upper limbs and trunk is important during the recovery phase of front crawl and backstroke, swimmer's shoulder rehabilitation should introduce exercises to improve their coordination between the upper limbs and the trunk.
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Affiliation(s)
- Yuiko Matsuura
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Matsunaga
- General Education Core Curriculum Division, Seigakuin University, Saitama, Japan
| | - Hiroshi Akuzawa
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomoki Oshikawa
- Faculty of Sport Sciences, Waseda University, Mikajima, Tokorozawa, Saitama, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, Mikajima, Tokorozawa, Saitama, Japan
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Santos PDG, Vaz JR, Correia J, Neto T, Pezarat-Correia P. Long-Term Neurophysiological Adaptations to Strength Training: A Systematic Review With Cross-Sectional Studies. J Strength Cond Res 2023; 37:2091-2105. [PMID: 37369087 DOI: 10.1519/jsc.0000000000004543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Santos, PDG, Vaz, JR, Correia, J, Neto, T, and Pezarat-Correia, P. Long-term neurophysiological adaptations to strength training: a systematic review with cross-sectional studies. J Strength Cond Res 37(10): 2091-2105, 2023-Neuromuscular adaptations to strength training are an extensively studied topic in sports sciences. However, there is scarce information about how neural mechanisms during force production differ between trained and untrained individuals. The purpose of this systematic review is to better understand the differences between highly trained and untrained individuals to establish the long-term neural adaptations to strength training. Three databases were used for the article search (PubMed, Web of Science, and Scopus). Studies were included if they compared groups of resistance-trained with untrained people, aged 18-40 year, and acquired electromyography (EMG) signals during strength tasks. Twenty articles met the eligibility criteria. Generally, strength-trained individuals produced greater maximal voluntary activation, while reducing muscle activity in submaximal tasks, which may affect the acute response to strength training. These individuals also presented lower co-contraction of the antagonist muscles, although it depends on the specific training background. Global intermuscular coordination may be another important mechanism of adaptation in response to long-term strength training; however, further research is necessary to understand how it develops over time. Although these results should be carefully interpreted because of the great disparity of analyzed variables and methods of EMG processing, chronic neural adaptations seem to be decisive to greater force production. It is crucial to know the timings at which these adaptations stagnate and need to be stimulated with advanced training methods. Thus, training programs should be adapted to training status because the same stimulus in different training stages will lead to different responses.
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Affiliation(s)
- Paulo D G Santos
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
| | - João R Vaz
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
- CIPER, Faculty of Human Kinetics, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Monte da Caparica, Portugal; and
| | - Joana Correia
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
| | - Tiago Neto
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Pedro Pezarat-Correia
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon, Portugal
- CIPER, Faculty of Human Kinetics, Lisbon, Portugal
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Bathe C, Fennen L, Heering T, Greif A, Dubbeldam R. Training interventions to reduce the risk of injury to the lower extremity joints during landing movements in adult athletes: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2023; 9:e001508. [PMID: 37304892 PMCID: PMC10254820 DOI: 10.1136/bmjsem-2022-001508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
Abstract
Objective Aim of this systematic review was to summarise training interventions designed to reduce biomechanical risk factors associated with increased risk of lower extremity landing injuries and to evaluate their practical implications in amateur sports. Design Systematic review and meta-analysis. Data sources MEDLINE, Scopus and SPORTDiscus. Eligibility criteria Training intervention(s) aimed at reducing biomechanical risk factors and/or injury rates included the following: (1) prospective or (non-)randomised controlled study design; (2) risk factors that were measured with valid two-dimensional or three-dimensional motion analysis systems or Landing Error Scoring System during jump landings. In addition, meta-analyses were performed, and the risk of bias was assessed. Results Thirty-one studies met all inclusion criteria, capturing 11 different training interventions (eg, feedback and plyometrics) and 974 participants. A significantly medium effect of technique training (both instruction and feedback) and dynamic strengthening (ie, plyometrics with/without strengthening) on knee flexion angle (g=0.77; 95% CI 0.33 to 1.21) was shown. Only one-third of the studies had training interventions that required minimal training setup and additional coaching educations. Conclusion This systematic review highlights that amateur coaches can decrease relevant biomechanical risk factors by means of minimal training setup, for example, instructing to focus on a soft landing, even within only one training session of simple technique training. The meta-analysis emphasises implementing technique training as stand-alone or combined with dynamic strengthening into amateur sport training routine.
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Affiliation(s)
- Chantal Bathe
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
| | - Lena Fennen
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
| | - Theresa Heering
- Coventry University, Coventry, UK
- Deakin University School of Health and Social Development, Melbourne, Victoria, Australia
| | - Alexander Greif
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
| | - Rosemary Dubbeldam
- Movement Science, Westfälische Wilhelms University Münster, Münster, Germany
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Segal AD, Petruska AJ, Adamczyk PG, Silverman AK. Age-specific biomechanical challenges and engagement in dynamic balance training with robotic or virtual real-time visual feedback. J Biomech 2023; 152:111574. [PMID: 37043927 DOI: 10.1016/j.jbiomech.2023.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/24/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Challenging balance training that targets age-related neuromuscular and motor coordination deficits is needed for effective fall prevention therapy. Goal-directed training can provide intrinsically motivating balance activities but may not equally challenge balance for all age groups. Therefore, the purpose of this research was to quantify age-specific effects of dynamic balance training with real-time visual feedback. Kinematics, muscle activity, and user perceptions were collected for forty healthy adults (20 younger, 18-39 years; 20 older, 58-74 years), who performed a single balance training session with or without real-time visual feedback. Feedback involved controlling either a physical mobile robot or screen-based virtual ball through a course with standing tilt motions from an instrumented wobble board. Dynamic balance training was more challenging for older compared to younger adults, as measured by significantly higher dorsiflexor and knee extensor muscle activity and ankle co-contractions (50%-80%, p<0.05). Older participants also performed more motion while training without feedback compared to younger adults (22%-65%, p<0.05). Robotic and virtual real-time visual feedback elicited similar biomechanical adaptations in older adults, reducing motions to similar levels as younger adults and increasing ankle co-contractions (p<0.05). Despite higher muscular demand, perceived physical exertion and high enjoyment levels (Intrinsic Motivation Inventory >0.80) were consistent across groups. However, robotic visual feedback may be more challenging than virtual feedback based on more frequent balance corrections, lower perceived competence, and lower game scores for older compared to younger adults. These findings collectively support the feedback system's potential to provide engaging and challenging at-home balance training across the lifespan.
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Yaserifar M, Oliveira AS. Inter-muscular coordination during running on grass, concrete and treadmill. Eur J Appl Physiol 2023; 123:561-572. [PMID: 36342514 DOI: 10.1007/s00421-022-05083-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
Running is an exercise that can be performed in different environments that imposes distinct foot-floor interactions. For instance, running on grass may help reducing instantaneous vertical impact loading, while compromising natural speed. Inter-muscular coordination during running is an important factor to understand motor performance, but little is known regarding the impact of running surface hardness on inter-muscular coordination. Therefore, we investigated whether inter-muscular coordination during running is influenced by running surface. Surface electromyography (EMG) from 12 lower limb muscles were recorded from young male individuals (n = 9) while running on grass, concrete, and on a treadmill. Motor modules consisting of weighting coefficients and activation signals were extracted from the multi-muscle EMG datasets representing 50 consecutive running cycles using non-negative matrix factorization. We found that four motor modules were sufficient to represent the EMG from all running surfaces. The inter-subject similarity across muscle weightings was the lowest for running on grass (r = 0.76 ± 0.11) compared to concrete (r = 0.81 ± 0.07) and treadmill (r = 0.78 ± 0.05), but no differences in weighting coefficients were found when analyzing the number of significantly active muscles and residual muscle weightings (p > 0.05). Statistical parametric mapping showed no temporal differences between activation signals across running surfaces (p > 0.05). However, the activation duration (% time above 15% peak activation) was significantly shorter for treadmill running compared to grass and concrete (p < 0.05). These results suggest predominantly similar neuromuscular strategies to control multiple muscles across different running surfaces. However, individual adjustments in inter-muscular coordination are required when coping with softer surfaces or the treadmill's moving belt.
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Affiliation(s)
- Morteza Yaserifar
- Department of Exercise Physiology, University of Mazandaran, Babolsar, Mazandaran, Iran
| | - Anderson Souza Oliveira
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, Building 4, 9220, Aalborg Øst, Denmark.
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Matsuura Y, Matsunaga N, Akuzawa H, Kojima T, Oshikawa T, Iizuka S, Okuno K, Kaneoka K. Difference in muscle synergies of the butterfly technique with and without swimmer's shoulder. Sci Rep 2022; 12:14546. [PMID: 36068286 PMCID: PMC9448761 DOI: 10.1038/s41598-022-18624-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate whether muscle synergy differs between swimmers with and without swimmer's shoulder in the butterfly technique. Muscle synergies, which can assess muscle coordination, were analyzed using surface electromyography. Twenty elite swimmers were included in this study (swimmer's shoulder: n = 8; control: n = 12). The motions involved in executing the butterfly technique were classified into the early pull-through, late pull-through, and recovery phases. Muscle synergy data analyzed using the nonnegative matrix factorization method were compared between the two groups. The swimming velocities were 1.66 ± 0.09 m・s −1 and 1.69 ± 0.06 m・s −1 for the control and swimmer's shoulder groups, respectively. Four muscle synergies in both groups were identified: synergy #1, which was involved in the early pull; synergy #2, involved in the late pull; synergy #3, involved in the early recovery; and synergy #4, involved in pre- and posthand entry. Compared to the control group, the swimmer's shoulder group had a small contribution from the pectoralis major (p = 0.032) and a high contribution from the rectus femoris during the early pull phase (p = 0.036). In the late pull phase, the contribution of the lower trapezius muscle in the swimmer's shoulder group was low (p = 0.033), while the contribution of the upper trapezius muscle in the pre- and postentry phases was high (p = 0.032). In the rehabilitation of athletes with swimmer's shoulder, it is therefore important to introduce targeted muscle rehabilitation in each phase.
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Affiliation(s)
- Yuiko Matsuura
- Department of Health and Sports, Niigata University of Health and Welfare, 1398, Shimamicho, Kita-ku, Niigata, Japan.
| | - Naoto Matsunaga
- General Education Core Curriculum Division, Seigakuin University, 1-1, Tosaki, Ageo, Saitama, Japan
| | - Hiroshi Akuzawa
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398, Shimamicho, kita-ku, Niigata, Japan
| | - Tsuyoshi Kojima
- Yamanashi Gakuin University, 2-4-5, Sakaori, Kofu, Yamanashi, Japan
| | - Tomoki Oshikawa
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Satoshi Iizuka
- Department of Sport Sciences, Japan Institute of Sport Sciences, 3-15-1, Nishigaoka Kita-ku, Tokyo, Japan
| | - Keisuke Okuno
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, Japan
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11
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Marcori AJ, Monteiro PHM, Oliveira JA, Doumas M, Teixeira LA. Single Leg Balance Training: A Systematic Review. Percept Mot Skills 2022; 129:232-252. [PMID: 35084234 DOI: 10.1177/00315125211070104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Single leg balance training promotes significant increments in balance control, but previous reviews on balance control have not analyzed this form of balance training. Accordingly, we aimed to review the single leg balance training literature to better understand the effects of applying this training to healthy individuals. We searched five databases-PubMed, EMBASE, Scopus, Lilacs, and Scielo-with the following inclusion criteria: (a) peer-reviewed articles published in English; (b) analysis of adult participants who had no musculoskeletal injuries or diseases that might impair balance control; and (c) use of methods containing at least a pre-test, exclusive single leg balance training, and a post-test assessment. We included 13 articles meeting these criteria and found that single leg balance training protocols were effective in inducing balance control gains in either single- or multiple-session training and with or without progression of difficulty. Balance control gains were achieved with different amounts of training, ranging from a single short session of 10 minutes to multiple sessions totaling as much as 390 min of unipedal balance time. Generalization of balance gains to untrained tasks and cross-education between legs from single leg balance training were consistent across studies. We concluded that single leg balance training can be used in various contexts to improve balance performance in healthy individuals. These results extend knowledge of expected outcomes from this form of training and aid single leg balance exercise prescription regarding volume, frequency, and potential progressions.
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Affiliation(s)
- Alexandre J Marcori
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
| | - Pedro H M Monteiro
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
| | - Júlia A Oliveira
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
| | - Michail Doumas
- School of Psychology, 1596Queen's University, Belfast, Northern Ireland
| | - Luis A Teixeira
- School of Physical Education and Sports, 28133University of São Paulo, São Paulo, Brazil
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Vincent HK, Brownstein M, Vincent KR. Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners. Arthrosc Sports Med Rehabil 2022; 4:e151-e162. [PMID: 35141547 PMCID: PMC8811510 DOI: 10.1016/j.asmr.2021.09.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 12/31/2022] Open
Abstract
This current concept, narrative review provides the latest integrated evidence of the musculoskeletal injuries involved with trail running and therapeutic strategies to prevent injury and promote safe participation. Running activities that comprise any form of off-road running (trail running, orienteering, short-long distance, different terrain, and climate) are relevant to this review. Literature searches were conducted to 1) identify types and mechanisms of acute and chronic/overuse musculoskeletal injuries in trail runners, 2) injury prevention techniques most relevant to running trails, 3) safe methods of participation and rehabilitation timelines in the sport. The majority of acute and chronic trail running-related musculoskeletal injuries in trail running occur in the lower leg, primarily in the knee and ankle. More than 70% are due to overuse, and ankle sprains are the most common acute injury. Key mechanisms underlying injury and injury progression include inadequate neuromotor control-balance-coordination, running through fatigue, and abnormal kinematics on variable terrain. Complete kinetic chain prehabilitation programs consisting of dynamic flexibility, neuromotor strength and balance, and plyometrics exercise can foster stable, controlled movement on trails. Patient education about early musculoskeletal pain symptoms and training adjustment can help prevent injury from progressing to serious overuse injuries. Real-time adjustments to cadence, step length, and knee flexion on the trail may also mitigate impact-related risk for injury. After injury occurs, rehabilitation will involve similar exercise components, but it will also incorporate rest and active rest based on the type of injury. Multicomponent prehabilitation can help prevent musculoskeletal injuries in trail runners through movement control and fatigue resistance.
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Affiliation(s)
- Heather K Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, U.S.A
| | - Michael Brownstein
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, U.S.A
| | - Kevin R Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, U.S.A
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Decoding of Motor Coordination Imagery Involving the Lower Limbs by the EEG-Based Brain Network. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:5565824. [PMID: 34257636 PMCID: PMC8245246 DOI: 10.1155/2021/5565824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022]
Abstract
Compared with the efficacy of traditional physical therapy, a new therapy utilizing motor imagery can induce brain plasticity and allows partial recovery of motor ability in patients with hemiplegia after stroke. Here, we proposed an updated paradigm utilizing motor coordination imagery involving the lower limbs (normal gait imagery and hemiplegic gait imagery after stroke) and decoded such imagery via an electroencephalogram- (EEG-) based brain network. Thirty subjects were recruited to collect EEGs during motor coordination imagery involving the lower limbs. Time-domain analysis, power spectrum analysis, time-frequency analysis, brain network analysis, and statistical analysis were used to explore the neural mechanisms of motor coordination imagery involving the lower limbs. Then, EEG-based brain network features were extracted, and a support vector machine was used for decoding. The results showed that the two employed motor coordination imageries mainly activated sensorimotor areas; the frequency band power was mainly concentrated within theta and alpha bands, and brain functional connections mainly occurred in the right forehead. The combination of the network attributes of the EEG-based brain network and the spatial features of the adjacency matrix had good separability for the two kinds of gait imagery (p < 0.05), and the average classification accuracy of the combination feature was 92.96% ± 7.54%. Taken together, our findings suggest that brain network features can be used to identify normal gait imagery and hemiplegic gait imagery after stroke.
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DeLang MD, Hannon JP, Goto S, Bothwell JM, Garrison JC. Female Adolescent Soccer Players Utilize Different Neuromuscular Strategies Between Limbs During the Propulsion Phase of a Lateral Vertical Jump. Int J Sports Phys Ther 2021; 16:695-703. [PMID: 34123522 PMCID: PMC8169019 DOI: 10.26603/001c.22134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multiplanar dynamic stability is an important unilateral function in soccer performance but has been scarcely examined in female soccer players. The lateral vertical jump task assesses unilateral functional performance, and energy generation contribution examines how each joint (hip, knee, ankle) contributes to the vertical component of the vertical jump phase to measure inter- and intra-limb differences. PURPOSE To examine dominant versus non-dominant limb performance using energy generation contribution of the hip, knee, and ankle during the vertical jump component of the lateral vertical jump. STUDY DESIGN Cross-sectional observational study. METHODS Seventeen healthy, adolescent female soccer players (age 13.4±1.7 years; height 160.6±6.0 cm; mass 53.1±8.2 kg) participated. Quadriceps strength was measured via isokinetic dynamometry. Energy generation contribution (measured from maximal knee flexion to toe off) and vertical jump height were measured during the vertical component of the lateral vertical jump. RESULTS There was no significant difference between limbs for quadriceps strength (p=0.64), jump height (p=0.59), or ankle energy generation contribution (p=0.38). Energy generation contribution was significantly greater in the dominant hip (dominant 29.7±8.6%, non-dominant 18.4±6.3%, p<0.001) and non-dominant knee (dominant 22.8±6.8%, non-dominant 36.2±8.5%, p<0.001). CONCLUSION High demand on coordination and motor control during the lateral vertical jump and inherent limb dominance may explain different intra-limb strategies for task performance despite jump height symmetry. Non-dominant affinity for stability and dominant compensatory performance may neutralize potential asymmetries. Implications for symmetry in observable outcomes such as jump height must consider underlying internal asymmetries. LEVELS OF EVIDENCE 3B. CLINICAL RELEVANCE Symmetrical findings on functional tasks have underlying internal asymmetries observed here in female adolescent soccer players. The lateral vertical jump may highlight these internal asymmetries (hip- versus knee-dominant movement strategies) due to the high coordinative demand to perform the task. Clinicians should be cognizant of underlying, potentially inherent, asymmetries even when observing functional symmetry in a task. WHAT IS KNOWN ABOUT THE SUBJECT Female adolescent soccer players are a high-risk cohort for sustaining anterior cruciate ligament injuries. Limb dominance may play a role in the performance of functional tasks, and limb dominance in soccer players is quite specialized: the dominant limb is the preferred kicking limb, while the non-dominant limb is the preferred stabilizing limb (plant leg). Functional performance in female soccer players has been studied in kicking, dribbling, sprinting, change of direction, and jumping - however, these tasks were measured independent of limb dominance. It remains to be seen how unilateral functional tasks may be affected by limb dominance in female adolescent soccer players. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE This study provides data on functional performance relative to limb dominance in female adolescent soccer players, and captures the lateral vertical jump task in both inter- and intra-limb measures. This highlights that intra-limb strategies to perform a coordinated motor task may be different between limbs, herein attributed to limb dominance. Even if gross motor outputs between limbs are symmetrical (i.e. jump height), the underlying movement strategies to achieve that output may be different (hip- versus knee-dominant movement strategies). These findings are important to research on functional performance measures related to attaining between-limb symmetry, as measures of energy generation contribution open the door for a more thorough understanding of joint-by-joint intra-limb contributions during a functional task.
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Santos PDG, Vaz JR, Correia PF, Valamatos MJ, Veloso AP, Pezarat-Correia P. Intermuscular Coordination in the Power Clean Exercise: Comparison between Olympic Weightlifters and Untrained Individuals-A Preliminary Study. SENSORS 2021; 21:s21051904. [PMID: 33803182 PMCID: PMC7963197 DOI: 10.3390/s21051904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022]
Abstract
Muscle coordination in human movement has been assessed through muscle synergy analysis. In sports science, this procedure has been mainly applied to the comparison between highly trained and unexperienced participants. However, the lack of knowledge regarding strength training exercises led us to study the differences in neural strategies to perform the power clean between weightlifters and untrained individuals. Synergies were extracted from electromyograms of 16 muscles of ten unexperienced participants and seven weightlifters. To evaluate differences, we determined the pairwise correlations for the synergy components and electromyographic profiles. While the shape of activation patterns presented strong correlations across participants of each group, the weightings of each muscle were more variable. The three extracted synergies were shifted in time with the unexperienced group anticipating synergy #1 (−2.46 ± 18.7%; p < 0.001) and #2 (−4.60 ± 5.71%; p < 0.001) and delaying synergy #3 (1.86 ± 17.39%; p = 0.01). Moreover, muscle vectors presented more inter-group variability, changing the composition of synergy #1 and #3. These results may indicate an adaptation in intermuscular coordination with training, and athletes in an initial phase of training should attempt to delay the hip extension (synergy #1), as well as the upper-limb flexion (synergy #2).
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Affiliation(s)
- Paulo D. G. Santos
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal; (P.D.G.S.); (P.F.C.); (M.J.V.); (P.P.-C.)
| | - João R. Vaz
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal; (P.D.G.S.); (P.F.C.); (M.J.V.); (P.P.-C.)
- CIPER, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal;
- Correspondence:
| | - Paulo F. Correia
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal; (P.D.G.S.); (P.F.C.); (M.J.V.); (P.P.-C.)
| | - Maria J. Valamatos
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal; (P.D.G.S.); (P.F.C.); (M.J.V.); (P.P.-C.)
- CIPER, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal;
| | - António P. Veloso
- CIPER, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal;
- Biomechanics and Functional Morphology Laboratory, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal
| | - Pedro Pezarat-Correia
- Neuromuscular Research Lab, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal; (P.D.G.S.); (P.F.C.); (M.J.V.); (P.P.-C.)
- CIPER, Faculty of Human Kinetics, Lisbon University, 1499-002 Cruz Quebrada-Dafundo, Portugal;
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Muscle Synergies Reliability in the Power Clean Exercise. J Funct Morphol Kinesiol 2020; 5:jfmk5040075. [PMID: 33467290 PMCID: PMC7739416 DOI: 10.3390/jfmk5040075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023] Open
Abstract
Muscle synergy extraction has been utilized to investigate muscle coordination in human movement, namely in sports. The reliability of the method has been proposed, although it has not been assessed previously during a complex sportive task. Therefore, the aim of the study was to evaluate intra- and inter-day reliability of a strength training complex task, the power clean, assessing participants' variability in the task across sets and days. Twelve unexperienced participants performed four sets of power cleans in two test days after strength tests, and muscle synergies were extracted from electromyography (EMG) data of 16 muscles. Three muscle synergies accounted for almost 90% of variance accounted for (VAF) across sets and days. Intra-day VAF, muscle synergy vectors, synergy activation coefficients and individual EMG profiles showed high similarity values. Inter-day muscle synergy vectors had moderate similarity, while the variables regarding temporal activation were still strongly related. The present findings revealed that the muscle synergies extracted during the power clean remained stable across sets and days in unexperienced participants. Thus, the mathematical procedure for the extraction of muscle synergies through nonnegative matrix factorization (NMF) may be considered a reliable method to study muscle coordination adaptations from muscle strength programs.
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Ondra L, Svoboda Z. Balance abilities of junior ice hockey players. J Sports Med Phys Fitness 2020; 61:183-187. [PMID: 32734754 DOI: 10.23736/s0022-4707.20.11057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postural control is required during various fast-paced and offensive ice hockey actions, and therefore seems to be an important component in ice hockey performance. METHODS Data were collected from two ice hockey teams with differing performance levels. The higher-performance team consisted of 26 players (with ages of 16.3±0.9 y, heights of 178.26±6.71 cm, and weights of 74.3±9.6 kg). The lower-performance team consisted of 19 players (with ages of 16.2±1.8 y, heights of 176.11±9.81 cm, and weights of 68.7±13.9 kg). Each participant performed six unilateral stances under static conditions on a balance pad placed on a force platform and five bilateral stances under dynamic conditions using a wobble board placed on the force platform. RESULTS The higher-level players performed better in the unilateral static stance task in both the anterior-posterior direction and the medial-lateral direction (with a P value of P<0.001), and total velocity (P=0.001). The higher-level players also performed better in both the anterior-posterior and medial-lateral directions, and total velocity (with P value of P<0.001), in the bilateral dynamic stance task and therefore performed significantly better than the lower-level players. CONCLUSIONS Hockey players who possess a highly developed postural control strategy have a superior ability to compensate for unexpected postural disturbances and collisions, and thus possess a strong competitive advantage. Therefore, testing the balance abilities of hockey players under static and dynamic conditions may be useful for evaluating their competitive performance levels.
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Affiliation(s)
- Lukas Ondra
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic -
| | - Zdenek Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
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Sport Biomechanics Applications Using Inertial, Force, and EMG Sensors: A Literature Overview. Appl Bionics Biomech 2020; 2020:2041549. [PMID: 32676126 PMCID: PMC7330631 DOI: 10.1155/2020/2041549] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022] Open
Abstract
In the last few decades, a number of technological developments have advanced the spread of wearable sensors for the assessment of human motion. These sensors have been also developed to assess athletes' performance, providing useful guidelines for coaching, as well as for injury prevention. The data from these sensors provides key performance outcomes as well as more detailed kinematic, kinetic, and electromyographic data that provides insight into how the performance was obtained. From this perspective, inertial sensors, force sensors, and electromyography appear to be the most appropriate wearable sensors to use. Several studies were conducted to verify the feasibility of using wearable sensors for sport applications by using both commercially available and customized sensors. The present study seeks to provide an overview of sport biomechanics applications found from recent literature using wearable sensors, highlighting some information related to the used sensors and analysis methods. From the literature review results, it appears that inertial sensors are the most widespread sensors for assessing athletes' performance; however, there still exist applications for force sensors and electromyography in this context. The main sport assessed in the studies was running, even though the range of sports examined was quite high. The provided overview can be useful for researchers, athletes, and coaches to understand the technologies currently available for sport performance assessment.
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Schram B, Orr R, Pope R. A Profile of Knee Injuries Suffered by Australian Army Reserve Soldiers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010012. [PMID: 30577566 PMCID: PMC6339105 DOI: 10.3390/ijerph16010012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022]
Abstract
Despite having to perform the same occupational tasks as full-time soldiers, part-time soldiers may have lower levels of physical conditioning and report higher rates of injury per unit exposure to active service. The purpose of this study was to profile the leading body site of injury occurring in part-time soldiers to inform injury prevention strategies. Injury data from the Australian Army Reserve (ARES) spanning a two-year period were obtained from the Department of Defence Workplace Health, Safety, Compensation and Reporting database pertaining to locations, nature, mechanisms, and the activity being performed at the time of injury. Among the 1434 injuries reported by ARES personnel, the knee was the most common injury site (n = 228, 16%). Soft tissue injury due to trauma or unknown causes was the most common nature of knee injury (n = 177, 78%). Combat training was the most common activity being performed when soft tissue injuries occurred at the knee (n = 73, 42%), with physical training the second most common (n = 51, 30%), due to muscular stress (n = 36, 71%) and falls (n = 8, 16%). Targeted intrinsic and extrinsic approaches to injury minimization strategies for soft tissue knee injuries during combat and physical training should be designed.
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Affiliation(s)
- Ben Schram
- Tactical Research Unit, Bond University, Robina 4226, QLD, Australia.
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina 4226, QLD, Australia.
| | - Rodney Pope
- Tactical Research Unit, Bond University, Robina 4226, QLD, Australia.
- School of Community Health, Charles Sturt University, Albury 2640, NSW, Australia.
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