Concurrent activation potentiation improves lower-limb maximal strength but not dynamic balance control in rugby players

Concurrent activation potentiation (CAP) increases athletic performance by activating muscles not involved in the performed activity. Among the CAP strategies, jaw clenching is the most practical to implement in sports contexts. Muscle strength and balance control are essential among rugby players to cope tackles. Besides combat sports, mouthguard has become mandatory also in rugby. Therefore, this study aimed to understand whether mouthguard jaw-clenching could improve rugby players' dynamic balance and quadriceps isometric strength. Thirteen rugby players were tested under maximal-bite (MB) and no-bite (NB) conditions. During standing balance tests, an electro-actuated platform with a force plate screwed on it allowed for the perturbation of the support base of the rugby players. A verbal signal warned the subject that the perturbation was coming, mentally recalling an in-field expected collision. In the first 2.5 s window after the perturbation, the center of pressure (CoP) displacement and mean velocity were measured. The first peak, the maximal oscillations, and the standard deviation of the anterior-posterior CoP trajectory were calculated within the same time window. In the isometric leg-extension test, a custom-built chair instrumented with a uni-axial load cell allowed to collect the maximal strength and rate of force development (RFD). Mouthguard jaw-clenching did not affect CoP-related parameters but increased maximal strength (p < 0.05) and RFD (0-50 ms: p < 0.01; 50-100 ms: p < 0.001; 100-150 ms: p < 0.05) in the isometric leg-extension test. Mouthguard jaw-clenching alone could be useful to increase lower-limb maximal isometric strength and RFD but did not improve dynamic balance performance in a sport-oriented postural balance test.

Trunk muscle activation of core stabilization exercises in subjects with and without chronic low back pain

BACKGROUND

Weakness and atrophy in trunk muscles have been associated with chronic low back pain (CLBP).

OBJECTIVE

This study aimed to identify isometric exercises resulting the highest trunk muscle activity for individuals with and without CLBP.

METHODS

Fourteen males with CLBP and 15 healthy age-matched healthy subjects were recruited for this study. Muscle activity during maximal voluntary isometric contraction (MVIC) was measured for a comparative reference with surface electromyography (sEMG) from six trunk muscles. Thereafter maximum EMG amplitude values were measured during eleven trunk stability exercises. The maximal EMG activity in each exercise relative to the MVICs was analyzed using generalizing estimating equations (GEE) models with the unstructured correlation structure.

RESULTS

The GEE models showed statistically significant differences in muscle activity between exercises within both groups (p< 0.001), with no significant differences between groups (p> 0.05). The highest muscle activity was achieved with the hip flexion machine for multifidus, side pull with a resistance band for lumbar extensors, side and single-arm cable pull exercises for thoracic extensors, rotary plank and the hip flexion machine for abdominal.

CONCLUSION

This study found five isometric trunk exercises that exhibited highest muscle activity depending on muscle tested, with no significant difference between individuals with and without CLBP.

Acute Effects of Combining Whole-Body Electromyostimulation with Resistance Training in Active Women

Strength training elicits benefits both in performance and on a psychological level in women, such as increased muscle strength and improved self-esteem. Whole-body electromyostimulation (WB-EMS) could be a training strategy for enhancing muscular strength. The aim of this study was to assess the acute effects of a single session of WB-EMS superimposed over classic resistance training on isometric strength, endurance strength and flexibility. Furthermore, the safety of the protocol was assessed by monitoring the levels of creatine kinase (CK) 48 h after the training protocol was completed. Sixteen active women (aged 22.06 ± 1.88) were randomly assigned to an experimental group (EG) (n = 8) and a control group (CG) (n = 8). The EG performed four sets of 12 repetitions of three strength exercises with superimposed WB-EMS, while the CG performed the same protocol without WB-EMS. RM-ANOVA showed a significant time*group interaction on posterior kinetic chain extensors' mean and peak strength in the EG (F(1,14) = 10.036; p = 0.007; and F(1,14) = 20.719; p < 0.001; respectively). A significant time*group interaction was found in the sit and reach test for the EG (F(1,14) = 10.362; p = 0.006). Finally, ANOVA performed on the CK levels showed no significant difference between the groups (F(1,14) = 0.715; p = 0.412). WB-EMS training led to an immediate improvement in strength performance and flexibility, and this protocol was shown to be safe in terms of CK levels, 48 h after completing the training protocol.

Isometric Shoulder Testing Using a Forcemeter Is a Reliable Method of Strength Evaluation

Isometric strength testing using a digital dynamometer is reliable for muscle function evaluation. It allows us to objectify manual strength assessment measurement. We tested intra- and inter-observer reliability of a user-friendly efficient digital dynamometer-the Forcemeter-equipped with a computer program to monitor the measurements and to store the data. Abduction, forward flexion, and external and internal rotation of both shoulders were tested three times in 20 healthy volunteers with no record of shoulder trauma. Isometric contracture was recorded in newtons. The first and the third test were carried out by Examiner A (intra-rater reliability); the second test, by Examiner B (inter-rater reliability). Good reliability was shown for intra-class correlation coefficient (ICC) values which mean moderate to high correlations (r = 0.66-0.93) for both examiners. Moderate to high correlations (r = 0.72-0.91) were found for comparisons between the results obtained by Examiner A.

Can Clinicians Trust Objective Measures of Hip Muscle Strength From Portable Dynamometers? A Systematic Review With Meta-analysis and Evidence Gap Map of 107 Studies of Reliability and Criterion Validity Using the COSMIN Methodology

OBJECTIVE: To summarize the evidence on reliability and criterion validity of hip muscle strength testing using portable dynamometers. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from inception to March 2023. STUDY SELECTION CRITERIA: We included studies investigating reliability or criterion validity of hip flexor, extensor, abductor, adductor, or internal/external rotator strength testing with portable dynamometers in injury-free individuals or those with pelvic/lower limb musculoskeletal disorders. DATA SYNTHESIS: We performed meta-analyses for each muscle group, position, and method of fixation. We rated pooled results as sufficient (>75% of studies with correlations ≥0.70), insufficient (>75% of studies with correlations <0.70), or inconsistent (sufficient/insufficient results). We assessed the quality of evidence, created evidence gap maps, and made clinical recommendations. RESULTS: We included a total of 107 studies (reliability 103, validity 14). The intrarater and interrater reliability for hip muscle strength testing across different positions and methods of fixation was sufficient (intraclass correlation coefficient = 0.78-0.96) with low- to high-quality evidence. Criterion validity was less investigated and mostly inconsistent (very low-to moderate-quality evidence) with a wide range of correlations (r = 0.40-0.93). CONCLUSION: Hip muscle strength testing using portable dynamometers is reliable. The use of portable dynamometers as clinical surrogates for measuring strength using an isokinetic dynamometer requires further investigation. Clinicians testing hip muscle strength with portable dynamometers should use external fixation seated for hip flexors, prone or supine for hip extensors, side-lying or supine for abductors and adductors, and prone and seated for internal and external rotators. J Orthop Sports Phys Ther 2023;53(11):655-672. Epub 3 October 2023. doi:10.2519/jospt.2023.12045.

Handgrip Strength Is Associated with Specific Aspects of Vascular Function in Individuals with Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS) is a disorder associated with an increased risk for the development of diabetes mellitus and its complications. Lower isometric handgrip strength (HGS) is associated with an increased risk of cardiometabolic diseases. However, the association between HGS and arterial stiffness parameters, which are considered the predictors of morbidity and mortality in individuals with MetS, is not well defined.

OBJECTIVE

To determine the association between HGS and HGS asymmetry on components of vascular function in adults with MetS.

METHODS

We measured handgrip strength normalized to bodyweight (HGS/kg), HGS asymmetry, body composition, blood glucose, lipid profile, blood pressure, pulse wave velocity (PWV), reflection coefficient (RC), augmentation index @75 bpm (AIx@75) and peripheral vascular resistance (PVR) in 55 adults with a diagnosis of MetS between 25 and 54 years old.

RESULTS

Mean age was 43.1 ± 7.0 years, 56.3% were females. HGS/kg was negatively correlated with AIx@75 (r = -0.440), p < 0.05, but these associations were not significant after adjusting for age and sex. However, when interaction effects between sex, HGS/kg and age were examined, we observed an inverse relationship between HGS/kg and AIx@75 in the older adults in the sample, whereas in the younger adults, a weak direct association was found. We also found a significant association between HGS asymmetry and PVR (beta = 30, 95% CI = 7.02; 54.2; p <0.012).

CONCLUSIONS

Our findings suggest that in people with MetS, maintaining muscle strength may have an increasingly important role in older age in the attenuation of age-related increases in AIx@75-a marker of vascular stiffness-and that a higher HGS asymmetry could be associated with a greater vascular resistance.

The Addition of Sprint Interval Training to Field Lacrosse Training Increases Rate of Torque Development and Contractile Impulse in Female High School Field Lacrosse Players

Field lacrosse requires sudden directional changes and rapid acceleration/deceleration. The capacity to perform these skills is dependent on explosive muscle force production. Limited research exists on the potential of sprint interval training (SIT) to impact explosive muscle force production in field lacrosse players. The purpose of this study is to examine SIT, concurrent to field-lacrosse-specific training, on the rate of torque development (RTD), contractile impulse, and muscle function in female high school field lacrosse players (n = 12; 16 ± 1 yrs.). SIT was performed three times per week, concurrent to field-lacrosse-specific training, for 12 weeks. Right lower-limb muscle performance was assessed pre-, mid-, and post-SIT training via isometric and isokinetic concentric knee extensor contractions. Outcomes included RTD (Nm·s^-1), contractile impulse (Nm·s), and peak torque (Nm). RTD for the first 50 ms of contraction improved by 42% by midseason and remained elevated at postseason (p = 0.004, effect size (ES) = -577.3 to 66.5). Contractile impulse demonstrated a training effect across 0-50 ms (42%, p = 0.004, ES = -1.4 to 0.4), 0-100 ms (33%, p = 0.018, ES = 3.1 to 0.9), and 0-200 ms (22%, p = 0.031, ES = -7.8 to 1.6). Isometric (0 rad·s^-1) and concentric (3.1 rad·s^-1) strength increased by 20% (p = 0.002, ES = -60.8 to -20.8) and 9% (p = 0.038, ES = -18.2 to 0.0) from SIT and field-lacrosse-specific training, respectively (p < 0.05). SIT, concurrent to field-lacrosse-specific training, enhanced lower-limb skeletal muscle performance, which may enable greater sport-specific gains.

Influence of muscle strength, power, and rapid force capacity on maximal club head speed in male national level golfers

This study investigated the relationships between maximal club head speed (CHS) and physiological and anthropometric parameters in 21 national-level male golfers (age: 21.9 ± 3.9 years; handicap: +1.1 ± 1.7). Maximal isometric strength (MVC) was measured during isometric mid-thigh pull and bench press, while MVC and rate of force development (RFD) were measured during isometric leg press. Power, lower limb stiffness, positive impulse, jump height and RFDdyn were measured during countermovement jump (CMJ). Moreover, rotational trunk power, active range of motion (AROM) and anthropometrics were determined. Comparisons were made between participants with high (FTG) and low (STG) CHS, respectively. FTG demonstrated greater isometric mid-thigh pull and isometric bench press MVC, leg press RFD, rotational trunk power, and CMJ parameters (except RFDdyn) as well as reduced hip AROM compared to STG (P < 0.01). CHS was positively correlated to isometric mid-thigh pull and isometric bench press MVC, leg press RFD, rotational trunk power and CMJ parameters (P < 0.01). In conclusion, strong positive correlations were observed between maximal CHS and maximal strength and power parameters. Consequently, improving maximal neuromuscular strength and power may be considered of importance for golfers, as greater CHS and accompanying driving distance may lead to competitive advantages.

The impact of blood flow restricted electrical stimulations on recovery from muscle damage

BACKGROUND

Both electrical stimulations (E-STIM) and blood flow restriction (BFR) have been shown to treat symptoms of exercise-induced muscle damage, but little is known about their combined effects which was the purpose of this study.

METHODS

Individuals completed one set of eccentric elbow flexion exercises to induce muscle damage. Forty-eight hours later, E-STIM was applied using an interferential current administered to both arms for 20 min; however, only one arm completed the E-STIM protocol while also undergoing repeated bouts of BFR (full occlusion for 2 min separated by a 1-min rest intervals). Discomfort and isometric strength were assessed immediately before the damaging exercise, immediately before the treatments, and 0, 10, and 30 min posttreatment.

RESULTS

A total of 22 individuals (11 females) completed the study. There were no interactions with respect to discomfort (BF₁₀  = 0.008) or isometric strength (BF₁₀  = 0.009) indicating that the addition of BFR did not alter the effectiveness of E-STIM. There was a main effect of time indicating that the damaging exercise was successful at depressing torque (pre: 284 N, post: 199 N; BF₁₀  = 2.70e9) and inducing discomfort (pre: 0 au, post: 6.4 au; BF₁₀  = 3.21e17). While isometric strength did not recover with the E-STIM treatments, discomfort was reduced at each the immediate post (5.3 au; BF₁₀  = 56 294) 10-min post (5.0 au; BF₁₀  = 46 163), and 30-min post (4.9 au; BF₁₀  = 707 600) time points.

CONCLUSION

E-STIM may be useful for treating discomfort, but does not appear capable of recovering strength associated with muscle damage. The efficacy of E-STIM would not appear to be enhanced if performed under BFR.

Effects of post-exercise cold-water immersion on resistance training-induced gains in muscular strength: a meta-analysis

The aim of this review was to perform a meta-analysis examining the effects of cold-water immersion (CWI) coupled with resistance training on gains in muscular strength. Four databases were searched to find relevant studies. Their methodological quality and risk of bias were evaluated using the PEDro checklist. The effects of CWI vs. control on muscular strength were examined in a random-effects meta-analysis. Ten studies (n = 170; 92% males), with 11 comparisons across 22 groups, were included in the analysis. Studies were classified as of good or fair methodological quality. The main meta-analysis found that CWI attenuated muscular strength gains (effect size [ES]: -0.23; 95% confidence interval [CI]: -0.45, -0.01; p = 0.041). In the analysis of data from studies applying CWI only to the trained limbs, CWI attenuated muscular strength gains (ES: -0.31; 95% CI: -0.61, -0.01; p = 0.041). In the analysis of data from studies using whole-body CWI, there was no significant difference in muscular strength gains between CWI and control (ES: -0.08; 95% CI: -0.53, 0.38; p = 0.743). In summary, this meta-analysis found that the use of CWI following resistance exercise sessions attenuates muscular strength gains in males. However, when CWI was applied to the whole body, there was no significant difference between CWI and control for muscular strength. Due to the attenuated gains in muscular strength found with single limb CWI, the use and/or timing of CWI in resistance training should be carefully considered and individualized.

Reliability of a Custom Device Used to Measure Isometric Knee Flexor and Extensor Strength in Standing Position

Background: Assessing lower limb strength in the field is problematic, as the "gold standard assessment" with isokinetic strength is cumbersome, and the device is costly and not transportable and keeps the angle of the hip at around 90°. Methods: We evaluated isometric muscle strength in a standing position with the help of an exoskeleton that holds the subject and makes the test easily repeatable. Results: The optimal device angles for hip and knee were, respectively, 20° and 80° for flexor tests and 30° and 40° for extensor tests. Test-retest reliability was very high for the right knee extensor (ICC 0.96-0.98), left knee extensor (ICC 0.96-0.97), right knee flexor (ICC 0.91-0.96), and left knee flexor (ICC 0.96-0.97). Furthermore, the typical error in percent (T.E.%) ranged from 2.50 to 5.50%, and the change in the mean in percent ranged from 0.84 to 7.72%, making it possible to determine even a slight variation in force. Conclusions: this new method could represent a valid alternative for assessing strength, due to the high reliability and the favorable joint position, particularly in football.

The Effects of Body Tempering on Force Production, Flexibility and Muscle Soreness in Collegiate Football Athletes

There has been limited research to explore the use of body tempering and when the use of this modality would be most appropriate. This study aimed to determine if a body tempering intervention would be appropriate pre-exercise by examining its effects on perceived soreness, range of motion (ROM), and force production compared to an intervention of traditional stretching. The subjects for this study were ten Division 1 (D1) football linemen from Sacred Heart University (Age: 19.9 ± 1.5 years, body mass: 130.9 ± 12.0 kg, height: 188.4 ± 5.1 cm, training age: 8.0 ± 3.5 years). Subjects participated in three sessions with the first session being baseline testing. The second and third sessions involved the participants being randomized to receive either the body tempering or stretching intervention for the second session and then receiving the other intervention the final week. Soreness using a visual analog scale (VAS), ROM, counter movement jump (CMJ) peak force and jump height, static jump (SJ) peak force and jump height, and isometric mid-thigh pull max force production were assessed. The results of the study concluded that body tempering does not have a negative effect on muscle performance but did practically reduce perceived muscle soreness. Since body tempering is effective at reducing soreness in athletes, it can be recommended for athletes as part of their pre-exercise warmup without negatively effecting isometric or dynamic force production.

Acute Effects of Static Self-Stretching Exercises and Foam Roller Self-Massaging on the Trunk Range of Motions and Strength of the Trunk Extensors

Although the effectiveness of static self-stretching exercises (SSSEs) and foam roller self-massaging (FRSM) in joint range of motion and muscle strength of the lower limbs has been extensively investigated, little is known about their effectiveness on the posterior trunk muscles. The present study aimed to investigate the acute effects of two 7-min SSSEs and FRSM intervention protocols on the range of trunk movements and the strength of the trunk extensors. Twenty-five healthy active males (n = 14) and females (n = 11) performed each intervention separately, one week apart. The range of motion (ROM) of the trunk-hip flexion (T-HF), the ROM of the trunk side-flexion (TSF) and rotation (TR) bilaterally, as well as the isometric maximum strength (TESmax) and endurance (TESend) of the trunk extensors were measured before and after each intervention. The ROMs of T-HF, TSF, and TR were significantly increased following both SSSEs and FRSM. The TESmax and TESend were also significantly increased after FRSM, but decreased following SSSEs. While both interventions were effective in increasing the range of motion of the trunk, a single 7-min session of FRSM presented more advantages over a similar duration SSSEs protocol due to the increase in the strength of the trunk extensors it induced.

The Relationship between Speed and Strength in the Beach Volleyball Serve

The objective of this study was to analyze the relationship between isometric force produced in different joints and its effects on the power kick serve speed in beach volleyball as a predictive aspect to improve sports performance. Seven athletes competing at national and international levels (mean ± standard deviation; age: 21.6 ± 3.20 years; body height: 1.87 ± 0.08 cm; body mass 80.18 ± 7.11 kg) were evaluated using maximum isometric force contractions (i.e., spinal and knee extension, grip by a hand dynamometer (handgrip), internal shoulder rotation, shoulder flexion, elbow flexion and extension, and wrist flexion). Speed of the ball was recorded with a pistol radar and force was measured with a strain gauge. Results showed a relationship between isometric force developed in the internal rotation of the shoulder and speed of the ball (r = 0.76*; p < 0.05). In the remaining isometric exercises, positive low to moderate correlations were found in the spine and knee extension (r = 0.56; p = 0.200) and elbow flexion (r = 0.41; p = 0.375). On the other hand, the remaining isometric exercises obtained weak or non-significant correlations. Force developed in the internal rotation of the shoulder highly correlated with the speed of the power kick, explaining, together with the elbow flexion and the extension of the knee and back, much of the variability of the power kick of beach volleyball athletes.

The Acute Effects of a Swimming Session on the Shoulder Rotators Strength and Balance of Age Group Swimmers

The purpose of this study was to analyze the acute effects of a standardized water training session on the shoulder rotators strength and balance in age group swimmers, in order to understand whether a muscle-strengthening workout immediately after the water training is appropriate. A repeated measures design was implemented with two measurements performed before and after a standardized swim session. 127 participants were assembled in male (n = 72; age: 16.28 ± 1.55 years, height: 174.15 ± 7.89 cm, weight: 63.97 ± 6.51 kg) and female (n = 55; age: 15.29 ± 1.28 years, height: 163.03 ± 7.19 cm, weight: 52.72 ± 5.48 kg) cohorts. The isometric torque of the shoulder internal (IR) and external (ER) rotators, as well as the ER/IR ratios, were assessed using a hand-held dynamometer. Paired sample t-tests and effect sizes (Cohen's d) were used (p ≤ 0.05). No significant differences were found on the shoulder rotators strength or balance in males after training. Females exhibited unchanged strength values after practice, but there was a considerable decrease in the shoulder rotators balance of the non-dominant limb (p < 0.01 d = 0.366). This indicates that a single practice seems not to affect the shoulders strength and balance of adolescent swimmers, but this can be a gender specific phenomenon. While muscle-strengthening workout after the water session may be appropriate for males, it can be questionable regarding females. Swimming coaches should regularly assess shoulder strength levels in order to individually identify swimmers who may or may not be able to practice muscle strengthening after the water training.

Morphology of the Patellar Tendon and the Contractility Response of the Quadriceps: Symmetry and Gender Analysis

The purpose of the study was to describe the differences between the dominant and non-dominant leg regarding contractility response and quadriceps strength and the morphology and stiffness of the patellar tendon (PT) in a group of physically active men and women. Fifty physically active subjects (36 men and 14 women) were evaluated for morphology and stiffness of the PT, contractility response of the rectus femoris of the quadriceps, isometric strength of the quadriceps and hamstrings, and isokinetic strength (concentric and eccentric) at 60°/s of the knee extensors. The measurements were made on the subject's dominant and non-dominant leg. The men showed a greater thickness of the PT in both legs compared to the women. Regarding the contractility response, the women recorded a 10.1 ± 16.2% (p = 0.038) greater contraction time (ct) in the dominant versus the non-dominant leg and the men recorded 11.9% (p = 0.040) higher values in the dominant leg compared to the women. In all the absolute strength measurements the men recorded higher values (p < 0.05) than the women, however, when the values were normalised with respect to the muscle mass of the leg these differences disappeared. The dominant leg showed values of isometric strength and eccentric strength at 60°/s (p < 0.05) greater than the non-dominant leg. The reference values provided in this study of the knee extensors and PT may be useful for detecting possible muscular or tendinous anomalies.

Effect of Handgrip Training in Extreme Heat on the Development of Handgrip Maximal Isometric Strength among Young Males

The aim of this study was to evaluate the acute and adaptive effects of passive extreme heat (100 ± 3 °C) exposition in combination with a strength training protocol on maximal isometric handgrip strength. Fifty-four untrained male university students participated in this investigation. Twenty-nine formed the control group (NG) and 25 the heat-exposed group (HG). All the participants performed a 3-week isotonic handgrip strength training program twice a week with a training volume of 10 series of 10 repetitions with 45-s rest between series, per session. All the subjects only trained their right hand, leaving their left hand untrained. HG performed the same training protocol in hot (100 ± 3 °C) conditions in a dry sauna. Maximal isometric handgrip strength was evaluated each training day before and after the session. NG participants did not experience any modifications in either hand by the end of the study while HG increased maximal strength values in both hands (p < 0.05), decreased the difference between hands (p < 0.05), and recorded higher values than the controls in the trained (p < 0.05) and untrained (p < 0.01) hands after the intervention period. These changes were not accompanied by any modification in body composition in either group. The performance of a unilateral isotonic handgrip strength program in hot conditions during the three weeks induced an increase in maximal isometric handgrip strength in both hands without modifications to bodyweight or absolute body composition.

Not as simple as it seems: Front foot contact kinetics, muscle function and ball release speed in cricket pace bowlers

This study investigated the relationship between front foot contact (FFC) ground reaction forces (GRF) during the delivery stride, lower-limb strength, eccentric dexterity and power, and ball release speed (BRS) among pace bowlers. Thirteen high-level male pace bowlers performed double and single leg drop landings; isometric mid-thigh pull; countermovement jump; and pace bowling (two-over bowling spell measuring BRS and FFC GRF). The relationship between assessed variables and BRS was determined via frequentist and Bayesian multiple linear regression. The model including peak braking force was the most probable given the data (Bayes Factor=1.713) but provided only weak evidence in comparison to the null model. The results of frequentist and Bayesian modelling were comparable with peak braking force explaining 23.3% of the variance in BRS (F_{(1, 11)}=4.64, P=0.054). Results indicate pace bowlers with greater peak braking GRF during FFC generally elicit higher BRS. However, the weak relationship between peak braking force and BRS, and the lack of a linear relationship between BRS and other variables, highlights the complexities and inter-individual variability inherent to pace bowling at a high-level. A more individual-focused analysis revealed varied strategies within pace bowlers to deliver the outcome (e.g., BRS) and should be considered in future study designs.

Changes in Maximal Strength and Home Run Performance in NCAA Division I Baseball Players Across 3 Competitive Seasons: A Descriptive Study

The purpose of this longitudinal, descriptive study was to observe changes in maximal strength measured via isometric clean grip mid-thigh pull and home runs (total and home runs per game) across three years of training and three competitive seasons for four National Collegiate Athletic Association (NCAA) Division 1 baseball players. A one-way repeated measures analysis of variance (ANOVA) was performed, revealing significant univariate effects of time for peak force (PF) (p = 0.003) and peak force allometrically scaled (PFa) (p = 0.002). Increases in PF were noted from season 1 to season 2 (p = 0.031) and season 3 (p = 0.004), but season 2 was not significantly different than season 3 (p = 0.232). Additionally, increases in PFa were noted from season 1 to season 2 (p = 0.010) and season 3 (p < 0.001), but season 2 was not significantly different than season 3 (p = 0.052). Home runs per game rose from the 2009 (0.32) to 2010 season (1.35) and dropped during the 2011 season (1.07). A unique aspect of the study involves 2010 being the season in which ball-bat coefficient of restitution (BBCOR) bats were introduced to the NCAA competition.

DESCRIPTIVE PROFILE OF SHOULDER RANGE OF MOTION AND STRENGTH IN YOUTH ATHLETES PARTICIPATING IN OVERHEAD SPORTS

Background

The unilateral and repetitive nature of overhead sports, often result in a biomechanical overload of the upper extremity. Understanding the musculoskeletal shoulder range of motion (ROM) and strength patterns in the youth sports of baseball, softball, and tennis could assist injury prevention screening and further the development of conditioning and rehabilitation programs.

Purpose

To generate a descriptive profile of shoulder musculoskeletal characteristics and determine whether bilateral differences in shoulder ROM exist in youth baseball, softball, and tennis athletes. A secondary aim was to determine whether shoulder rotational adaptations are correlated with playing position, sport, or years of experience.

Study Design

Descriptive Laboratory.

Methods

A total of 136 competitive youth overhead athletes (baseball: n = 51,12.8 ± 0.9yrs; softball: n = 63,12.3 ± 1.1yrs; and tennis: n = 22,12.5 ± 0.9yrs) participated. Bilateral shoulder internal (IR) and external (ER) passive ROM and external rotation strength were measured using an inclinometer and handheld dynamometer.

Results

Significant differences (p<.001) in bilateral shoulder ROM and ER strength were found between the athletes in the three sports. Post-hoc test revealed tennis athletes had greater bilateral shoulder ROM than both baseball and softball athletes, but baseball and softball athletes had greater bilateral ER strength than tennis athletes. There were no differences between baseball and softball athletes. Additionally, tennis athletes had greater bilateral internal rotation and total ROM but less ER strength than baseball pitchers, baseball positional athletes, softball pitchers, and softball positional athletes. There were no significant differences between positions and baseball and softball athletes. There were no significant correlations between playing position, sport, or years of experience.

Conclusion

The results of this study showed differences in shoulder passive ROM and strength adaptations between youth tennis, baseball, and softball athletes. The descriptive nature of this study is impactful as it presents specific ROM adaptions seen in this population. Future research is needed to further evaluate if the "at risk" ROM identified in older populations holds true in the youth population.

Level of Evidence

Diagnosis, Level 3b.

Effects of Maximal Strength Training on Perceived-Fatigue and Functional Mobility in Persons with Relapsing-Remitting Multiple Sclerosis

Background and objectives: Fatigue is one of the most disabling symptoms that limit daily life activities in persons with multiple sclerosis (pwMS). This study aimed to evaluate the effects of maximal strength training (MST) on perceived-fatigue and functional mobility in pwMS. Materials and Methods: 26 participants with MS were balanced according to their pre-intervention fatigue scores and distributed into an MST group (n = 13) and a control group (CG; n = 13). The MST group completed eight weeks using high loads, evaluating detraining after ten weeks. Quadriceps and hamstring isokinetic (QPT_IK; HPT_IK) and isometric (QPT_IM; HPT_IM) peak torques were assessed using an isokinetic dynamometer. Effect size differences were estimated with the Hedges' g index (d_g ). Fatigue was evaluated through the Fatigue Severity Scale (FSS), while functional mobility was assessed via the Timed Up and Go Test (TUG). Results: The MST significantly improved all the strength measurements after the intervention (Δ6.43-29.55%; p < 0.05) compared to the control group. FSS showed a significant reduction (59.97%, d_g = 5.41, large). The MST group also reduced the TUG time (19.69%; d_g = 0.93, large) compared to the control group. Improvements caused by the intervention did not remain after a 10-week follow-up, with decreases in strength performance from 4.40% to 13.86% (d_g = 0.24-0.56, small to moderate), 112.08% in the FSS (d_g = -3.88, large), and 16.93% in TUG (d_g = -1.07, large). Conclusions: MST (up to 90% 1RM) seems to be a feasible and useful way to obtain clinically relevant improvements in the perceived-fatigue symptoms and functional mobility. Still, symptom improvements decrease after a 10-week detraining period.

Isometric Mid-Thigh Pull Performance in Rugby Players: A Systematic Literature Review

The isometric mid-thigh pull (IMTP) is a multi-joint test of whole-body force production relevant to rugby players. "Rugby AND (mid-thigh pull OR midthigh pull OR mid thigh pull" were searched in PubMed, Sportdiscus, Academic Search Premier, CINAHL Plus with Full Text, and Google Scholar; the final date of search was 24 January 2018. Data extraction from 24 articles included subject characteristics, force data, and IMTP testing procedures. Select ranges of peak forces reported were: Youth: 1162-2374 N; Academy: 1855-3104 N; Professional: 2254-3851 N. Rate of force development (RFD) at 100 and 200 ms ranged from 5521 to 11,892 N and 5403 to 8405 N, respectively, among professional rugby players. Studies' research design were of moderate quality, but most studies lacked detailed reporting of IMTP procedures. Variability of force characteristics derived from the IMTP within similar populations (e.g., approximately 200% difference in peak force between samples of professional rugby league players) as well as large and unexpected overlaps between dissimilar populations, limit conclusions about force production capabilities relative to playing level, likely due to limitations and lack of standardization of IMTP procedures. Greater uniformity in IMTP testing procedures and reporting is needed. This manuscript provides a guide for reporting needs when presenting results from an IMTP in research.

Association Between Knee- and Hip-Extensor Strength and Running-Related Injury Biomechanics in Collegiate Distance Runners

CONTEXT

Running-related injuries are common in distance runners. Strength training is used for performance enhancement and injury prevention. However, the association between maximal strength and distance-running biomechanics is unclear.

OBJECTIVE

To determine the relationship between maximal knee- and hip-extensor strength and running biomechanics previously associated with injury risk.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 36 collegiate distance runners (26 men, 10 women; age = 20.0 ± 1.5 years, height = 1.74 ± 0.09 m, mass = 61.97 ± 8.26 kg).

MAIN OUTCOME MEASURE(S)

Strength was assessed using the 1-repetition maximum (1RM) back squat and maximal voluntary isometric contractions of the knee extensors and hip extensors. Three-dimensional running biomechanics were assessed overground at a self-selected speed. Running variables were the peak instantaneous vertical loading rate; peak forward trunk-lean angle; knee-flexion, internal-rotation, and -abduction angles and internal moments; and hip-extension, internal-rotation, and -adduction angles and internal moments. Separate stepwise linear regression models were used to examine the associations between strength and biomechanical outcomes (ΔR2) after accounting for sex, running speed, and foot-strike index.

RESULTS

Greater 1RM back-squat strength was associated with a larger peak knee-flexion angle (ΔR2 = 0.110, ΔP = .045) and smaller peak knee internal-rotation angle (ΔR2 = 0.127, ΔP = .03) and internal-rotation moment (ΔR2 = 0.129, ΔP = .03) after accounting for sex, speed, and foot-strike index. No associations were found between 1RM back-squat strength and vertical loading rate, trunk lean, or hip kinematics and kinetics. Hip- and knee-extensor maximal voluntary isometric contractions were also not associated with any biomechanical variables.

CONCLUSIONS

Greater 1RM back-squat strength was weakly associated with a larger peak knee-flexion angle and smaller knee internal-rotation angle and moment in collegiate distance runners. Runners who are weaker in the back-squat exercise may exhibit running biomechanics associated with the development of knee-related injuries.

Cardiovascular and Muscular Response to NO LOAD Exercise with Blood Flow Restriction

Changes in muscle thickness (MT), isometric torque, and arterial occlusion pressure (AOP) were examined following four sets of twenty unilateral elbow flexion exercise. Participants performed four sets of maximal voluntary contractions with no external load throughout a full range of motion of a bicep curl with and without the application of blood flow restriction (BFR). For torque there was an interaction (p = 0.012). The BFR condition had lower torque following exercise (56.07 ± 17.78 Nm) compared to the control condition (58.67 ± 19.06 Nm). For MT, there was a main effect for time (p < 0.001). MT increased from pre (3.52 ± .78cm) to post (3.68 ± 81cm) exercise and remained increased above baseline 15 min post-exercise. For AOP, there was an interaction (p = 0.027). The change in AOP was greater in the BFR condition (16.6 ± 13.42mmHg) compared to the control (11.1 ± 11.84 mmHg). NO LOAD exercise with BFR let to greater reductions in torque and an exaggerated cardiovascular response compared to exercise alone. There were no differences in swelling. These results suggest that the application of BFR to NO LOAD exercise may result in greater fatigue.

An examination of changes in muscle thickness, isometric strength and body water throughout the menstrual cycle

PURPOSE

The purpose of this study was to examine the changes in muscle size and strength throughout the menstrual cycle in females and to compare these values to a control group of time-matched males.

METHODS

12 males and 16 females visited the laboratory on four occasions. Measures of muscle thickness (MTH), isometric strength and body water were taken during the menstrual phase, ovulation phase and luteal phase of the menstrual cycle. Males scheduled their visits based on a mock menstrual cycle. In addition, participants were asked to complete 4 sets of biceps curls to volitional failure in one arm to examine swelling during each visit.

RESULTS

For MTH there was no interaction (p = .73); however, there was a main effect for sex with males having higher MTH values compared to females [4.07 (0.67) versus. 2.73 (0.42) cm, (p < .001)] at all time points. For changes in MTH (swelling) there was no interaction (p = .28). However, there was a main effect for sex, with males demonstrating greater changes in MTH compared to females [0.53(0.11) versus. 0.40 (0.10) cm, (p < .001)]. Similarly, for total body water, there was no interaction (p = .66). However, males had greater total body water compared to females [49.6 (6.8) versus. 32.3(3.9) kg, p < .001)] at all time points. Finally, for isometric strength, there was no interaction (p = .23). However, there was a main effect for sex. Males had higher isometric strength values compared to females [285 (42) versus. 156(36) N (p < .001)].

CONCLUSIONS

Phase of the menstrual cycle does not appear to influence MTH, isometric strength or total body water.

Inspiratory and Lower-Limb Strength Importance in Mountain Ultramarathon Running. Sex Differences and Relationship with Performance

The study was aimed at comparing lower-limb strength and respiratory parameters between male and female athletes and their interaction with performance in a 107 km mountain ultramarathon. Forty seven runners (29 males and 18 females; mean ± SD age: 41 ± 5 years) were enrolled. Lower-limb strength assessment comprised a squat jump test, an ankle rebound test, and an isometric strength test. Respiratory assessment included pulmonary function testing and the measurement of maximal inspiratory pressure. Male athletes performed largely better in the squat jump (26 ± 4 vs. 21 ± 3 cm; p < 0.001; d = 1.48), while no sex differences were found in the other two lower-limb tests. Concerning the respiratory parameters, male athletes showed largely greater values in pulmonary expiratory variables: forced vital capacity (5.19 ± 0.68 vs. 3.65 ± 0.52 L; p < 0.001; d = 2.53), forced expiratory volume in 1 s (4.24 ± 0.54 vs. 2.97 ± 0.39 L; p < 0.001; d = 2.69), peak expiratory flow (9.9 ± 1.56 vs. 5.89 ± 1.39 L/min; p < 0.001; d = 2.77) and maximum voluntary ventilation in 12 s (171 ± 39 vs. 108 ± 23 L/min; p < 0.001; d = 1.93); while no sex differences were identified in maximal inspiratory pressure. Race time was associated with ankle rebound test performance (r = −0.390; p = 0.027), isometric strength test performance (r = −0.349; p = 0.049) and maximal inspiratory pressure (r = −0.544; p < 0.001). Consequently, it seems that athletes competing in mountain ultramarathons may benefit from improving lower-limb isometric strength, ankle reactive strength and inspiratory muscle strength. Nevertheless, further interventional studies are required to confirm these exploratory results. In addition, the fact that the magnitude of the sex difference for isometric strength was minor, as compared with the other strength tests, could represent one of the factors explaining why the performance gap between males and females is reduced in ultramarathons.

Effects of Chemotherapy Treatment on Muscle Strength, Quality of Life, Fatigue, and Anxiety in Women with Breast Cancer

The study aimed to evaluate the effects of chemotherapy treatment on muscle strength, quality of life, fatigue, and anxiety in women with breast cancer. Nineteen women who were undergoing a chemotherapy treatment (breast cancer treatment [BCT] group, 52.2 ± 13.1 years) and 18 women without cancer (control [CNT] group, 55.8 ± 8.4 years) answered questionnaires for evaluation of fatigue (Fatigue Scale), quality of life (Short-Form Healthy Survey [SF-36] questionnaire), and anxiety (State-Trait Anxiety Inventory [IDATE]) levels. Muscle strength was also assessed by an isometric grip test and an isokinetic knee extension test. Physical limitations, social and emotional domains of quality of life were lower in the BCT group in comparison to the CNT group (p = 0.002; p = 0.003; p = 0.0003, respectively). The other domains did not differ between groups (p > 0.05). There were no differences in fatigue and anxiety levels between both the BCT and CNT groups (p > 0.05). Additionally, isometric grip strength was higher in the CNT group when compared to the BCT group (p = 0.048). However, there were no differences between the BCT and CNT groups for peak torque and total work at both 60°.s-1 (p = 0.95 and p = 0.61, respectively) and 180°.s-1 (p = 0.94 and p = 0.72, respectively). These results suggest that three cycles of chemotherapy treatment may impair handgrip isometric strength and quality of life in women with breast cancer.

Does the Grip Width Affect the Bench Press Performance of Paralympic Powerlifters?

PURPOSE

To verify the effects of using different grip widths in bench press performance in Paralympic powerlifting athletes.

METHODS

Twelve experienced Paralympic powerlifting male athletes (25.40 [3.30] y, 70.30 [12.15] kg) participated in the study. Maximal dynamic strength and maximal isometric strength (MIS) were determined. Then, mean propulsive velocity (MPV) using 25%, 50%, and 100% of maximal dynamic strength load and time to achieve 30%, 50%, and 100% of MIS were assessed with 4 different grip widths, specifically the biacromial distance (BAD: 42.83 [12.84] cm), 1.3 BAD (55.68 [16.70] cm), 1.5 BAD (63.20 [18.96] cm), and 81 cm. Electromyographic analysis was performed during MIS assessment in the pectoralis major sternal portion, anterior deltoid, triceps brachii long head, and pectoralis major clavicular portion.

RESULTS

Large differences were found between MPV performed with different grip widths using 25% of maximal dynamic strength load (P = .02, ηp2=.26). The 1.5 BAD grip tended to show greater force generation and MPV. Moreover, the time needed to achieve 30%, 50%, and 100% of MIS differed between grip widths (P = .03, ηp2=.24), with the lowest values obtained in the 1.5 BAD. Despite the nonstatistical differences that were found, grip widths caused moderate effects on muscle myoelectric activation, showing greater values for pectoralis major clavicular portion and pectoralis major sternal portion, for the 1.3 BAD and 1.5 BAD, respectively. The 1.5 BAD the grip width tended to show greater MPV values and faster contractile responses.

CONCLUSIONS

These results highlighted the importance of choosing the specific grip width for improvement of performance in Paralympic powerlifting athletes, by increasing velocity of movement and force production in a shorter time, with greater activation of primary muscles.

Reliability and Validity of a Novel Wearable Device for Measuring Elbow Strength

Muscle strength is an important clinical outcome in rehabilitation and sport medicine, but options are limited to expensive but accurate isokinetic dynamometry (IKD) or inexpensive but less accurate hand-held dynamometers (HHD). A wearable, self-stabilizing, limb strength measurement device (LSMD) was developed to fill the current gap in portable strength measurement devices. The purpose of this study was to evaluate the reliability and validity of the LSMD in healthy adults. Twenty healthy adults were recruited to attend two strength testing sessions where elbow flexor and extensor strength was measured with the LSMD, with HHD and with IKD in random order, by two raters. Outcomes were intra-rater repeatability, inter-rater reproducibility and inter-session reproducibility using intra-class correlation coefficients (ICC). Limits of agreement and weighted least products regression were used to test the validity of the LSMD relative to the criterion standard (IKD), and calibration formulas derived to improve measurement fidelity. ICC values for the LSMD were >0.90 for all measures of reliability and for both muscle groups, but over-predicted extensor strength and under-predicted flexor strength. Validity was established by transforming the data with the criterion standard-based calibration. These data indicate that the LSMD is reliable and conditionally valid for quantifying strength of elbow flexors and extensors in a healthy adult population.

Intra-Trial Reliability and Usefulness of Isometric Mid-Thigh Pull Testing on Portable Force Plates

The aim of this study was to assess the intra-trial reliability and usefulness of portable force plates and a customised Isometric Mid-Thigh Pull rig. Twenty males (age: 24.1 ± 2.5 years, body height: 177.7 ± 0.09 cm, body mass: 88.4 ± 17.9 kg) with weightlifting experience ± 12 months attended 1 familiarisation session and 1 testing session where 4 isometric mid-thigh pulls were performed. Maximum force, absolute peak force (PF), relative PF, allometrically scaled PF, and force (150, 200, 250 ms) were deemed reliable (ICC ≥ 0.91 and CV ≤ 9.8%) based on predetermined criteria (ICC ≥ 0.8 and CV ≤ 10%). The impulse and the rate of force development (RFD) were deemed unreliable (ICC ≤ 0.91 and CV ≥ 10 %) at all time points. Maximum force, absolute PF, relative PF to body weight and body mass, rand allometrically scaled PF, had a typical error (TE) lower than the smallest worthwhile change small effect (SWC0.2) and moderate effect (SWC0.5) and were rated as good with regard to usefulness. The TE for force at selected time points (150, 200, 250 ms) was also higher than the SWC0.2, achieving a rating of marginal, but TE was higher than SWC0.5, achieving a rating of good with regard to usefulness. Portable force plates and customised rigs can reliably determine peak force and force output at different time points and for detecting the SWC in maximum and absolute force measures, greater familiarisation may be required to establish reliability of other variables such as the impulse and the RFD.

Reliability and validity of three isometric back extensor strength assessments with different test postures

Objective

To compare the test-retest reliability and validity of three simple maximal isometric back extensor strength (BES) assessment protocols with different test postures, and to recommend an optimal clinical protocol to quantify BES.

Methods

Asymptomatic adults, aged over 45 years, were assessed for maximal isometric BES using external fixation of dynamometers, with the subject in standing, prone and sitting positions, respectively. Measurements were repeated at a one-week interval to examine test-retest reliability. Validation was performed by comparing with results obtained from isokinetic dynamometer assessments.

Results

Out of a total of 60 included participants, intra-class correlation coefficients (ICC) were 0.92, 0.93 and 0.90 in standing, prone and sitting positions, respectively. Correlation analyses revealed acceptable convergent validity in the standing and prone position (r = 0.50 and 0.54, respectively), whereas tests conducted in the sitting position showed a relatively low validity (r = 0.32). Among the three protocols, measurement error was lowest in the prone position.

Conclusions

Maximal isometric BES assessment in the prone position was shown to be the most reliable and valid protocol, and may be considered the preferred option for assessing BES in clinical practice.

Upper Extremity Musculoskeletal Characteristics and the Kerlan-Jobe Orthopaedic Clinic Questionnaire Score in Collegiate Baseball Athletes

CONTEXT

Upper extremity (UE) musculoskeletal injuries are common in baseball athletes due to the increased demand placed on the UE. The link between risk factors for UE musculoskeletal injuries and baseball athletes' perceived UE function and pain, as measured by the Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire, is unclear.

OBJECTIVE

To (1) describe the musculoskeletal characteristics of the UE (posture, range of motion, flexibility, and isometric strength) in a population of baseball athletes and (2) determine the predictive capability of UE musculoskeletal characteristics for the KJOC score in these athletes.

DESIGN

Cohort study.

SETTING

Athletic training room.

PATIENTS OR OTHER PARTICIPANTS

A total of 37 male National Collegiate Athletic Association Division I baseball athletes (age = 20.10 ± 1.27 years, height = 186.96 ± 7.64 cm, mass = 90.60 ± 10.69 kg).

INTERVENTION(S)

Athletes self-reported all shoulder musculoskeletal injuries and completed the KJOC questionnaire. Postural assessment consisted of forward head and shoulder posture. Flexibility tests characterized glenohumeral internal and external rotation, posterior shoulder tightness, and pectoralis minor length. Strength tests involved the lower and middle trapezius, rhomboid, glenohumeral internal and external rotation, pectoralis major, serratus anterior, supraspinatus, and upper trapezius.

MAIN OUTCOME MEASURE(S)

All 10 KJOC questions were summed for an overall score out of 100. Questions 1 through 5 were summed for a pain score; questions 6 through 10 were summed for a function score. All data were assessed for normality. A stepwise multiple regression model was fit to determine if the predictor variables assessed could predict the KJOC score. We set the α level a priori at .05.

RESULTS

For the KJOC total score, a 1-year history of shoulder injury accounted for 7.80% of the variance in the KJOC total score (P = .07). For KJOC questions 1 through 5, a history of UE injury in the year before testing and posterior shoulder tightness accounted for 14.40% of the variance in the KJOC total score (P = .047).

CONCLUSIONS

The link between a history of UE musculoskeletal injuries and the KJOC score highlights the need for continued focus on self-perceived pain and function after UE musculoskeletal injury.

Scaling isometric mid-thigh pull maximum strength in division I Athletes: are we meeting the assumptions?

This study examined the validity of various scaling methods, isometric mid-thigh pull (IMTP) peak force using various scaling methods, and the relationships between IMTP peak force and countermovement jump height.  Fifty-one collegiate baseball and soccer athletes performed two maximal IMTPs.  Absolute peak force was compared between teams and when data were scaled using ratio (RS), traditional allometric (ALLO_Trad), and fitted allometric (ALLO_Fit) scaling.  ALLO_Trad and ALLO_Fit validity was violated because different derived exponents existed for baseball (b = 0.20) and soccer (b = 1.20).  Soccer athletes produced greater RS peak force compared to baseball (p = 0.012), while no difference existed with absolute, ALLO_Trad or ALLO_Fit (all p > 0.05) peak force.  Moderate relationships existed between body mass and absolute (r = 0.402, p = 0.003) and RS (r = -0.328, p = 0.019) peak force, while trivial relationships existed with ALLO_Trad and ALLO_Fit (both r < -0.10, p > 0.05).  Trivial relationships existed between countermovement jump height and absolute, RS, ALLO_Trad, and ALLO_Fit (all r < 0.20, p > 0.05) peak force.  The current dataset violated allometric scaling assumptions, making it inappropriate to use ALLO_Trad and ALLO_Fit scaling.  Practitioners must understand the assumptions, limitations, and purpose of scaling methods.

A Comparison of the Isometric Midthigh Pull and Isometric Squat: Intraday Reliability, Usefulness, and the Magnitude of Difference Between Tests

PURPOSE

To examine the reliability and usefulness of the isometric midthigh pull (IMTP) and isometric squat (ISqT) performed at the same knee and hip angles. The scores produced in each test were compared to determine the magnitude of differences between tests.

METHODS

Twenty-six male and female athletes (age, 23.6 [4.3] y; height, 1.75 [0.07] m; and body mass, 68.8 [9.7] kg) performed 2 maximal repetitions of the IMTP and ISqT following a specific warm-up.

RESULTS

Maximum force, absolute peak force (PF), relative PF, allometrically scaled PF, rate of force development (0-200 and 0-250 ms), and impulse (0-300 ms) were deemed reliable (intraclass correlation coefficient [ICC] ≥.86 and coefficient of variation [CV] ≤9.4%) in the IMTP and ISqT based on predetermined criteria (ICC ≥.8 and CV ≤10%). Impulse (0-200 and 0-250 ms) was reliable in the ISqT (ICC ≥.92 and CV ≤9.9%). Participants produced significantly (P < .05) greater PF and impulse (0-300 ms) during the ISqT compared with the IMTP. When split by sex, female participants produced significantly greater PF (P = .042) during the ISqT, with no significant differences among male participants (P = .245). Both tests are capable of detecting changes in performance in maximum force and absolute PF.

CONCLUSIONS

Both tests are reliable for non-time-dependent maximal strength measures when measured at the same knee and hip angles. The ISqT may be preferred when coaches want to test an athlete's true maximum lower-limb strength, especially female athletes.

The Athletic Shoulder (ASH) test: reliability of a novel upper body isometric strength test in elite rugby players

Objectives

Lower limb isometric tests are used to assess strength and strength asymmetries and monitor reductions in muscle force that may contribute to loss of performance and increase injury risk. Isometric tests in the upper body may be appropriate to monitor neuromuscular performance of the shoulder joint in sports involving contact and overhead actions. The aim of this study was to determine the reliability of a novel upper body isometric strength test.

Methods

Eighteen elite rugby players (age 22.4±4.6 years; body mass 95.5±13.4 kg) were tested on consecutive days. Maximal isometric contractions using both limbs against a force platform were assessed at three angles of abduction (180°, ‘I’; 135°, ‘Y’ and 90°, ‘T’), in a prone lying position. To evaluate interday reliability, intraclass coefficients (ICC) were calculated for mean net peak force (NPF) and highest NPF achieved in any trial (peak NPF). Intratrial variability was assessed using coefficient of variation (CV), and the standard error of measurement (SEM) was used to calculate minimal detectable change (MDC).

Results

Interday reliability for NPF was excellent in all test positions (ICC 0.94–0.98). The test demonstrated high absolute reliability values (SEM 4.8–10.8) and interday measurement error was below 10% in all test positions (CV 5.0–9.9%) except for the non-dominant arm I-position (CV 11.3%). Minimum detectable change was between 13.2 and 25.9 N.

Conclusion

The Athletic Shoulder test demonstrated excellent reliability for each test position supporting its use as a reliable tool to quantify the ability to produce and transfer force across the shoulder girdle.

Higher Training Frequency Is Important for Gaining Muscular Strength Under Volume-Matched Training

Background: This study investigated the effect of volume-matched strength training programs with different frequency and subsequent detraining on muscle size and strength.

Methods: During a training period of 11 weeks, untrained subjects (age: 22.3 ± 0.9 years, height: 173.1 ± 4.8 cm and body mass: 66.8 ± 8.4 kg) performed knee-extension exercise at 67% of their estimated one-repetition maximum either one session per week (T1 group: 6 sets of 12 repetitions per session; n = 10) or three sessions per week (T3 group: 2 sets of 12 repetitions per session; n = 10). Rating of perceived exertion (RPE) and muscle stiffness were measured as an index of muscle fatigue and muscle damage, respectively. The magnitude of muscle hypertrophy was assessed with thigh circumference and the quadriceps muscle thickness. The changes in muscle strength were measured with isometric maximum voluntary contraction torque (MVC).

Results: During the training period, RPE was significantly higher in the T1 than in the T3 (p < 0.001). After 11 weeks of training, both groups exhibited significant improvements in thigh circumference, muscle thickness, and MVC compared with baseline values. However, there was a significant group difference in MVC improvement at week 11 (T1: 43.5 ± 15.5%, T3: 65.2 ± 23.2%, p < 0.05). After 6 weeks of detraining, both groups showed the significant decreases in thigh circumference and muscle thickness from those at the end of training period, while no significant effect of detraining was observed in MVC.

Conclusion: These results suggest that three training sessions per week with two sets are recommended for untrained subjects to improve muscle strength while minimizing fatigue compared to one session per week with six sets.

Sex comparisons of non-local muscle fatigue in human elbow flexors and knee extensors

OBJECTIVES

To examine non-local muscle fatigue (NLMF) in both contralateral homologous and non-related heterogonous muscles for both sexes.

METHODS

Ten men and nine women participated in this study. After the familiarization visit, subjects completed four separate randomly sequenced experimental visits, during which the fatiguing interventions (six sets of 30-second maximal isometric contractions) were performed on either their right elbow flexors or knee extensors. Before (Pre-) and after (Post-) the fatiguing interventions, the isometric strength and the corresponding surface electromyographic (EMG) amplitude were measured for the non-exercised left elbow flexors or knee extensors.

RESULTS

For the non-exercised elbow flexors, the isometric strength decreased for both sexes (sex combined mean±SE: Pre vs. Post=339.67±18.02 N vs. 314.41±16.37 N; p⟨0.001). For the non-exercised knee extensors, there is a time × sex interaction (p=0.025), showing a decreased isometric knee extension strength for men (Pre vs. Post =845.02±66.26 N vs. 817.39±67.64 N; p=0.019), but not for women.

CONCLUSIONS

The presence of NMLF can be affected by factors such as sex and muscle being tested. Women are less likely to demonstrate NLMF in lower body muscle groups.

Upper Extremity Muscular Strength in Push-Pull Tasks: Model Approach Towards Task Design

BACKGROUND

Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries.

AIM

To investigate the upper extremity strength in generic push-pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation.

SETTINGS AND DESIGN

The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study.

MATERIALS AND METHODS

In all, 100 men were recruited (Group 1: 18-39 years and Group 2: 40-60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push-pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt-Winters time-series model.

STATISTICAL ANALYSIS

Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used.

RESULTS

Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial.

CONCLUSION

The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace.

Immediate effects of cervical unilateral anterior-posterior mobilisation on shoulder pain and impairment in post-operative arthroscopy patients

BACKGROUND

Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and function. However, despite common clinical-use, no study reports the effect of unilateral anterior-posterior (A-P) cervical mobilisation on shoulder pain and function, and particularly in patients after arthroscopic shoulder surgery.

OBJECTIVE

Examine the immediate effect of single-level Grade III cervical unilateral A-P mobilisation on shoulder pain, flexion and abduction range of motion (ROM) and external rotator strength compared to placebo cervical unilateral A-P light touch pressure.

METHODS

Single session intervention with a crossover design in 32 (15 women) postoperative arthroscopic shoulder patients.

RESULTS

Immediate and superior treatment effects were shown for A-P cervical mobilisation in improving flexion ROM, isometric strength of external rotation, and pain intensity during flexion (all p< 0.05) when compared to the placebo. However, effects may not be considered clinically meaningful.

CONCLUSION

Unilateral A-P mobilisation applied to the cervical spine shows a tendency toward positively influencing post-arthroscopy shoulder pain and function. Further study examining cervical mobilisations directed in different planes to influence shoulder motion appear warranted.

Front Crawl Swimming Performance and Bi-Lateral Force Asymmetry during Land-Based and Tethered Swimming Tests

The aims of this study were to investigate whether land-based and tethered swimming strength tests can explain swimming performance in 200-meter front crawl and, whether these tests were able to identify bilateral symmetry in force production. In the first session, eighteen swimmers completed a maximum effort 200 m front crawl swim (swimming performance) and 15 seconds maximal effort tethered front crawl swim. In the second session, participants performed the upper extremity isometric strength test. Peak force production of tethered swimming and isometric strength tests were significantly correlated for the strongest and weakest sides (r = 0.58 and r = 0.63, respectively; p < 0.05), but only peak force production during tethered swimming correlated with 200 m swimming performance time (r = -0.55, p < 0.05). Bilateral asymmetries in peak force and rate of force development were similar between the tethered swimming and isometric strength tests (peak force: 13%, p = 0.24; rate of force development: 15%, p = 0.88) However, both tests detected significant difference of peak force and rate of force development between body sides. The tethered swimming test can partially explain the 200 m front crawl swimming performance. In addition, the land-based and tethered swimming tests may be used to identify bilateral asymmetry of swimming.

The Efficacy of Wrestling-Style Compression Suits to Improve Maximum Isometric Force and Movement Velocity in Well-Trained Male Rugby Athletes

Purpose: The prevalence of compression garment (CG) use is increasing with athletes striving to take advantage of the purported benefits to recovery and performance. Here, we investigated the effect of CG on muscle force and movement velocity performance in athletes. Methods: Ten well-trained male rugby athletes wore a wrestling-style CG suit applying 13-31 mmHg of compressive pressure during a training circuit in a repeated-measures crossover design. Force and velocity data were collected during a 5-s isometric mid-thigh pull (IMTP) and repeated countermovement jump (CMJ), respectively; and time to complete a 5-m horizontal loaded sled push was also measured. Results: IMTP peak force was enhanced in the CG condition by 139 ± 142 N (effect size [ES] = 0.36). Differences in CMJ peak velocity (ES = 0.08) and loaded sled-push sprint time between the conditions were trivial (ES = -0.01). A qualitative assessment of the effects of CG wear suggested that the likelihood of harm was unlikely in the CMJ and sled push, while a beneficial effect in the CMJ was possible, but not likely. Half of the athletes perceived a functional benefit in the IMTP and CMJ exercises. Conclusion: Consistent with other literature, there was no substantial effect of wearing a CG suit on CMJ and sprint performance. The improvement in peak force generation capability in an IMTP may be of benefit to rugby athletes involved in scrummaging or lineout lifting. The mechanism behind the improved force transmission is unclear, but may involve alterations in neuromuscular recruitment and proprioceptive feedback.

Effects of a Six-Week Strength Training Programme on Change of Direction Performance in Youth Team Sport Athletes

This study investigated the effects of eccentric phase-emphasis strength training (EPE) on unilateral strength and performance in 180- and 45-degree change of direction (COD) tasks in rugby union players. A 12-week cross-over design was used to compare the efficacy of resistance training executed with 3 s eccentric duration (EPE, n = 12) against conventional strength training, with no constraints on tempo (CON, n = 6). Players in each condition were categorised as ‘fast’ (FAST) or ‘slow’ (SLOW) using median trial times from baseline testing. Players recorded greater isometric strength improvements following EPE (ES = −0.54 to 1.80). Whilst these changes were not immediate, players improved in strength following cessation. Improvements in 180-degree COD performance was recorded at all test-points following EPE (ES = −1.32 to −0.15). Improvements in 45-degree COD performance were apparent for FAST following CON (ES = −0.96 to 0.10), but CON was deleterious for SLOW (ES = −0.60 to 1.53). Eccentric phase-emphasis strength training shows potential for sustained strength enhancement. Positive performance changes in COD tasks were category- and condition-specific. The data indicate the greatest improvement occurred at nine weeks following resistance training in these players. Performance benefits may also be specific to COD task, player category, and relative to emphasis on eccentric phase activity.

Preconditioning by light-load eccentric exercise is equally effective as low-level laser therapy in attenuating exercise-induced muscle damage in collegiate men

Background/objective

Previous studies have already reported an independent effect of light-load eccentric exercise (10% eccentric exercise contraction [EEC]) and low-level laser therapy (LLLT) as a protective measure against more strenuous eccentric exercise. However, the difference between these two interventions is largely unknown. Therefore, the present study aimed to compare the preconditioning effect of 10% EEC vs. LLLT on subjective, physiological, and biochemical markers of muscle damage in elbow flexors in collegiate men.

Methods

All 36 enrolled subjects were randomly assigned to either 10% EEC or LLLT group. Subjects in 10% EEC group performed 30 repetitions of an eccentric exercise with 10% maximal voluntary contraction strength 2 days prior to maximal eccentric exercise bout, whereas subjects in LLLT group were given LLLT. All the indirect markers of muscle damage were measured pre-exercise and at 24, 48, and 72 hours after the exercise-induced muscle damage protocol.

Results

The muscle soreness was reduced in both groups (p = 0.024); however, soreness was attenuated more in LLLT group at 48 hours (33.5 vs. 42.7, p = 0.004). There was no significant difference between the effect of 10% EEC and LLLT groups on other markers of muscle damage like a maximum voluntary isometric contraction (p = 0.47), range of motion (p = 0.16), upper arm circumference (p = 0.70), creatine kinase (p = 0.42), and lactate dehydrogenase (p = 0.08). Within-group analysis showed both interventions provided similar protection over time.

Conclusion

This study indicated that light-load eccentric exercise confers similar protective effect against subsequent maximal eccentric exercise as LLLT. Both the treatments could be used reciprocally based on the patient preference, costs, and feasibility of the equipment.

Acute fatigue, and perceptual responses to resistance exercise

INTRODUCTION

Despite assumptions, there is an absence of research on acute fatigue responses to high- and low-load and advanced technique resistance exercise.

METHODS

Trained males (n = 8; age 27.2 ± 7.4 years, height 180.0 ± 6.6 cm, weight: 86.6 ± 10.3 kg) were assessed for decrement in maximal voluntary isometric torque (MVIT) and perceived effort and discomfort after heavier load (HL; 80% MVIT), lighter load (LL; 30% MVIT), forced repetition (FR), and breakdown set (BD) training protocols.

RESULTS

Analyses revealed a significant reduction in MVIT (P < 0.05) with a significant between-condition effect, and significant post-hoc pairwise comparisons between LL and both HL (P = 0.044) and FR (P = 0.013). There were no significant between-condition effects for effort or discomfort (P > 0.05).

DISCUSSION

Fatigue as a decrement in force production appears to follow a more complex relationship than simply 100% minus the force requirements of the task relative to a maximal voluntary contraction. Muscle Nerve 56: E141-E146, 2017.

Development, validity and reliability of a new pressure air biofeedback device (PAB) for measuring isometric extension strength of the lumbar spine

This study describes the development of a new portable muscle testing device, using air pressure as a biofeedback and strength testing tool. For this purpose, a pressure air biofeedback device (PAB^®) was developed to measure and record the isometric extension strength of the lumbar multifidus muscle in asymptomatic and low back pain (LBP) persons. A total of 42 subjects (age 47.58 years, ±18.58) participated in this study. The validity of PAB^® was assessed by comparing a selected measure, air pressure force in millibar (mb), to a standard criterion; calibrated weights in kilograms (kg) during day-to-day tests. Furthermore, clinical trial-to-trial and day-to-day tests of maximum voluntary isometric contraction (MVIC) of L5 lumbar multifidus were done to compare air pressure force (mb) to electromyography (EMG) in microvolt (μV) and to measure the reliability of PAB^®. A highly significant relationship were found between air pressure output (mb) and calibrated weights (kg). In addition, Pearson correlation calculations showed a significant relationship between PAB^® force (mb) and EMG activity (μV) for all subjects (n = 42) examined, as well as for the asymptomatic group (n = 24). No relationship was detected for the LBP group (n = 18). In terms of lumbar extension strength, we found that asymptomatic subjects were significantly stronger than LBP subjects. The results of the PAB^® test differentiated between LBP and asymptomatic subject's lumbar isometric extension strength without any risk to the subjects and also indicate that the lumbar isometric extension test with the new PAB^® device is reliable and valid.

The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis

STUDY DESIGN

Secondary analysis of a randomized controlled trial.

BACKGROUND

The use of external supports has been questioned because they may lead to weakness in the surrounding muscles. To our knowledge, there is no investigation into the effect of knee supports or braces on quadriceps muscle strength and quadriceps inhibition in individuals with patellofemoral joint (PFJ) osteoarthritis (OA).

OBJECTIVES

To investigate the effects of a flexible knee support on quadriceps maximum voluntary contraction (MVC) and arthrogenous muscle inhibition (AMI) in patients with PFJ OA.

METHODS

The study included 108 participants who had at least 3 months of patellofemoral pain and a Kellgren-Lawrence score of 2 or 3 for PFJ OA. The participants were randomized to a group that wore a flexible knee support (brace) or a group that did not wear a support (no brace) in a 6-week randomized controlled trial, followed by an open-label trial, in which all participants wore the brace for a total of 12 weeks. Quadriceps MVC, measured isometrically, and quadriceps AMI, measured by twitch interpolation, were assessed at the 6-week and 12-week time points.

RESULTS

After 6 weeks, MVC did not differ between the brace and no-brace groups (9.09 Nm; 95% confidence interval [CI]: -4.89, 23.07; P = .20). Arthrogenous muscle inhibition significantly decreased in the brace group (-8.62%; 95% CI: -13.90%, -3.33%; P = .002). After 12 weeks, in all of the participants who wore a flexible knee support, MVC increased by 7.98 Nm (95% CI: 2.52, 13.45; P = .004) and AMI decreased (-8.42%; 95% CI: -11.48%, -5.36%; P<.001). Although statistically significant, these results have doubtful clinical significance.

CONCLUSION

A patellofemoral flexible knee support in participants with PFJ OA does not have an adverse effect on quadriceps MVC or AMI. Using a knee support should not be discouraged because of concerns about deleterious effects on quadriceps strength and inhibition.

LEVEL OF EVIDENCE

Therapy, level 1b.

The Gluteus Medius Vs. Thigh Muscles Strength Ratio and Their Relation to Electromyography Amplitude During a Farmer's Walk Exercise

The strength ratio between hamstrings and quadriceps (H/Q) is associated with knee injuries as well as hip abductor muscle (HAB) weakness. Sixteen resistance trained men (age, 32.5 ± 4.2 years) performed 5 s maximal isometric contractions at 75° of knee flexion/extension and 15° of hip abduction on a dynamometer. After this isometric test they performed a Farmer’s walk exercise to find out if the muscle strength ratio predicted the electromyography amplitude expressed as a percentage of maximum voluntary isometric contraction (%MVIC). The carried load represented a moderate intensity of 75% of the exercise six repetitions maximum (6RM). Electromyography data from the vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF) and gluteus medius (Gmed) on each leg were collected during the procedure. The groups selected were participants with H/Q ≥ 0.5, HQ < 0.5, HAB/H ≥ 1, HAB/H < 1, HAB/Q ≥ 0.5 and HAB/Q < 0.5. One way ANOVA showed that Gmed activity was significantly greater in the group with HAB/H < 1 (42 ± 14 %MVIC) as compared to HAB/H ≥ 1 (26 ± 10 %MVIC) and HAB/Q < 0.5 (47 ± 19 %MVIC) compared to HAB/Q ≥ 0.5 (26 ± 12 %MVIC). The individuals with HAB/H < 1 were found to have greater activation of their Gmed during the Farmer’s walk exercise. Individuals with HAB/Q < 0.5 had greater activation of the Gmed. Gmed strength ratios predict the muscle involvement when a moderate amount of the external load is used. The Farmer’s walk is recommended as an exercise which can strengthen the gluteus medius, especially for individuals with a HAB/H ratio < 1 and HAB/Q < 0.5.

Electromyographic activity after latissimus dorsi transfer: testing of coactivation as a simple tool to assess latissimus dorsi motor learning

BACKGROUND

The purpose of this study was to investigate coactivation (CoA) testing as a clinical tool to monitor motor learning after latissimus dorsi tendon transfer.

METHODS

We evaluated 20 patients clinically with the American Shoulder and Elbow Surgeons (ASES) and University of California-Los Angeles (UCLA) outcomes scores, visual analog scale, active external rotation (aER), and isometric strength testing in abduction and external rotation. Measurements of aER were performed while the latissimus dorsi was activated in its new function of external rotation with concomitant activation (coactivation) of its native functions (adduction and extension). Bilateral surface electromyographic (EMG) activity was recorded during aER measurements and the strength testing procedure (EMG activity ratio: with/without CoA). Patients were divided into two groups (excellent/good vs fair/poor) according to the results of the ASES and UCLA scores.

RESULTS

The mean follow-up was 57.8 ± 25.2 months. Subdivided by clinical scores, the superior outcome group lost aER with CoA, whereas the inferior outcome group gained aER (UCLA score: -2.2° ± 7.4° vs +4.3° ± 4.1°; P = .031). Patients with inferior outcomes in the ASES score showed higher latissimus dorsi EMG activity ratios (P = .027), suggesting an inadequate motor learning process. Isometric strength testing revealed that the latissimus dorsi transfer had significantly greater activity compared with the contralateral side (external rotation, P = .008; abduction, P = .006) but did not have comparable strength (external rotation, P = .017; abduction, P = .009).

CONCLUSIONS

Patients with inferior clinical results were more likely to be dependent on CoA to gain external rotation. Therefore, CoA testing may be used as a tool to evaluate the status of postoperative motor learning after latissimus dorsi transfer.

Motor impairment factors related to brain injury timing in early hemiparesis. Part I: expression of upper-extremity weakness

BACKGROUND

Extensive neuromotor development occurs early in human life, but the time that a brain injury occurs during development has not been rigorously studied when quantifying motor impairments.

OBJECTIVE

This study investigated the impact of timing of brain injury on the magnitude and distribution of weakness in the paretic arm of individuals with childhood-onset hemiparesis.

METHODS

A total of 24 individuals with hemiparesis were divided into time periods of injury before birth (PRE-natal, n = 8), around the time of birth (PERI-natal, n = 8), or after 6 months of age (POST-natal, n = 8). They, along with 8 typically developing peers, participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks using a multiple-degree-of-freedom load cell to quantify torques in 10 directions. A mixed-model ANOVA was used to determine the effect of group and task on a calculated relative weakness ratio between arms.

RESULTS

There was a significant effect of both time of injury group (P < .001) and joint torque direction (P < .001) on the relative weakness of the paretic arm. Distal joints were more affected compared with proximal joints, especially in the POST-natal group.

CONCLUSIONS

The distribution of weakness provides evidence for the relative preservation of ipsilateral corticospinal motor pathways to the paretic limb in those individuals injured earlier, whereas those who sustained later injury may rely more on indirect ipsilateral corticobulbospinal projections during the generation of torques with the paretic arm.

Effects of aging and sex on voluntary activation and peak relaxation rate of human elbow flexors studied with motor cortical stimulation

Data are equivocal on whether voluntary activation is preserved or decreased in old compared to young adults. Further, data are scant on the effect of age on the rate of muscle relaxation when the muscle is contracting voluntarily. Assessment of both measures with transcranial magnetic stimulation (TMS) yields information which cannot be obtained with traditional peripheral nerve stimulation. Hence, voluntary activation and peak relaxation rate of the elbow flexors were assessed with TMS during repeated maximal efforts in 30 men and 28 women between the ages of 22-84 years. Voluntary activation was similar for the two sexes (P = 0.154) and was not affected by age in men (96.2 ± 2.7 %; P = 0.887) or women (95.1 ± 3.0 %; P = 0.546). Men had a significantly faster peak rate of relaxation than women in absolute units (-880.0 ± 223.2 vs. -360.2 ± 78.5 Nm/ s, respectively; P < 0.001) and when normalized to subject strength (-12.5 ± 2.1 vs. -8.7 ± 1.0 s(-1), respectively; P < 0.001). Absolute and normalized relaxation rates slowed with age in men (P = 0.002 and P = 0.006, respectively), but not women (P = 0.142 and P = 0.950, respectively). Across the age range studied, all subjects, regardless of age or sex, were able to achieve high voluntary activation scores for the elbow flexors (~95 %). In contrast, peak relaxation rate was markedly faster in men than women and slowed with age in men but not women. Normalization of relaxation rates to strength did not affect the influence of age or sex.