Proprioception and neuromuscular control at return to sport after ankle surgery with the modified Broström procedure

The modified Broström procedure (MBP) is an initial treatment for symptomatic chronic ankle instability (CAI) patients. This study aimed to compare the proprioception and neuromuscular control ability of both affected and unaffected ankles at the time of return to sports after MBP for patients with scores of normal controls. 75 individuals (40 who underwent MBP, 35 normal controls) participated. The dynamic balance test scores were significantly higher in the affected ankle of the patients than in the controls (1.5 ± 0.6° vs. 1.1 ± 0.4°, p < 0.003). The time to peak torque for dorsiflexion (60.8 ± 13.9 ms vs. 52.2 ± 17.5 ms, p < 0.022) and eversion (68.9 ± 19.1 ms vs. 59.3 ± 21.1 ms, p < 0.043) was significantly delayed in the affected ankle of the patients than in the controls. The dynamic balance test and time to peak torque in CAI patients remained significantly reduced at the time of return-to-sport after MBP. Clinicians and therapists should be aware of potential deficits in proprioception and neuromuscular control when determining the timing of return to sports after MBP.

Microbiopsy Sampling for Examining Age-Related Differences in Skeletal Muscle Fiber Morphology and Composition

Introduction: The increasingly popular microbiopsy is an appealing alternative to the more invasive Bergström biopsy given the challenges associated with harvesting skeletal muscle in older populations. Parameters of muscle fiber morphology and composition derived from the microbiopsy have not been compared between young and older adults.Purpose: The purpose of this study was to examine muscle fiber morphology and composition in young (YM) and older (OM) males using the microbiopsy sampling technique. A secondary aim was to determine if specific strength is associated with serum levels of C-terminal agrin fragment [CAF; an indicator of neuromuscular junction (NMJ) degradation].Methods: Thirty healthy, YM (n = 15, age = 20.7 ± 2.2 years) and OM (n = 15, age = 71.6 ± 3.9 years) underwent ultrasound imaging to determine whole-muscle cross-sectional area (CSA) of the vastus lateralis and rectus femoris as well as isometric and isokinetic (60°⋅s–1 and 180°⋅s–1) peak torque testing of the knee extensors. Microbiopsy samples of the vastus lateralis were collected from 13 YM and 11 OM, and immunofluorescence was used to calculate CSA and proportion of type I and type II fibers.Results: Peak torque was lower in OM at all velocities (p ≤ 0.001; d = 1.39–1.86) but only lower at 180°⋅s–1 (p = 0.003; d = 1.23) when normalized to whole-muscle CSA. Whole-muscle CSA was smaller in OM (p = 0.001; d = 1.34), but atrophy was not present at the single fiber level (p &gt; 0.05). Per individual, ∼900 fibers were analyzed, and type I fiber CSA was larger (p = 0.05; d = 0.94) in OM which resulted in a smaller type II/I fiber CSA ratio (p = 0.015; d = 0.95). CAF levels were not sensitive to age (p = 0.159; d = 0.53) nor associated with specific strength or whole-muscle CSA in OM.Conclusion: The microbiopsy appears to be a viable alternative to the Bergström biopsy for histological analyses of skeletal muscle in older adults. NMJ integrity was not influential for age-related differences in specific strength in our healthy, non-sarcopenic older sample.

Improving Walking Economy With an Ankle Exoskeleton Prior to Human-in-the-Loop Optimization

Lower limb robotic exoskeletons have shown the capability to enhance human locomotion for healthy individuals or to assist motion rehabilitation and daily activities for patients. Recent advances in human-in-the-loop optimization that allowed for assistance customization have demonstrated great potential for performance improvement of exoskeletons. In the optimization process, subjects need to experience multiple types of assistance patterns, thus, leading to a long evaluation time. Besides, some patterns may be uncomfortable for the wearers, thereby resulting in unpleasant optimization experiences and inaccurate outcomes. In this study, we investigated the effectiveness of a series of ankle exoskeleton assistance patterns on improving walking economy prior to optimization. We conducted experiments to systematically evaluate the wearers' biomechanical and physiological responses to different assistance patterns on a lightweight cable-driven ankle exoskeleton during walking. We designed nine patterns in the optimization parameters range which varied peak torque magnitude and peak torque timing independently. Results showed that metabolic cost of walking was reduced by 17.1 ± 7.6% under one assistance pattern. Meanwhile, soleus (SOL) muscle activity was reduced by 40.9 ± 19.8% with that pattern. Exoskeleton assistance changed maximum ankle dorsiflexion and plantarflexion angle and reduced biological ankle moment. Assistance pattern with 48% peak torque timing and 0.75 N·m·kg−1 peak torque magnitude was effective in improving walking economy and can be selected as an initial pattern in the optimization procedure. Our results provided a preliminary understanding of how humans respond to different assistances and can be used to guide the initial assistance pattern selection in the optimization.

Relationship between Isokinetic Knee Strength and Speed, Agility, and Explosive Power in Elite Soccer Players

The aim of this study was to determine the relationship between the isokinetic characteristics of knee extensors and flexors with selected motor abilities: Speed, agility, and explosive power of lower extremities of professional football players in the preparation period of a yearly training cycle. Twenty-one players (age: 24.5 ± 3.9 years; body mass: 76.7 ± 4.7 kg and body height: 183.5 ± 5.5 cm) playing in the highest Polish soccer league participated in the study. The isokinetic concentric torque of the knee extensors and flexors was measured at 300°/s, 180°/s, and 60°/s velocities. Sprint performance was assessed in the 30 m sprint test (standing start). The forward, lateral, and backward movements were assessed using the T-Test of agility. Explosive power was quantified by performing the squat jump (SJ) and countermovement (CMJ), using the force platform. Due to sport-specific demands of soccer activities measured in this experiment, the relationships between peak torque (PT) and the 30 m sprint, T-Test of agility, and power of vertical jumps (SJ and CMJ) were low or medium at speeds of 60°/s and 300°/s. One of the main reasons for the lack of high dependence of the above-mentioned factors are that the measurements were performed during the initial training period where the level of individual abilities is at a low level. Additionally, this experiment may also indicate that the measurement of isokinetic knee flexion and extension peak is effective when performed at the correct angular velocity in relation to the evaluation of the intended motion structure.

Effect of the kinesio taping application method for the activation and strength of gastrocnemius muscles in healthy adults

The objective of this study was to verify the effect of kinesio-taping (KT) application of the origin for muscle insertion (O>I) and insertion for muscle origin (I>O) in healthy participants, through surface electromyography and peak torque of gastrocnemius muscles. A total of 69 participants with an average age of 22.9±5.2 years were evaluated, 41 women with an average age of 22.0±5.1 years, BMI 25.1±4.6 kg/m2, and 28 men with an average age of 22.0±5.1 years, BMI 23.1±3.3 kg/m2, randomized under three conditions: O>I, I>O and no KT (control), repeated three times with five-minute rest between sessions. The peak torque of the gastrocnemius lateral (GML) and medial (GMM) muscles was evaluated at speeds 30º/s 60º/s 120º/s and muscle activity through surface electromyography. Repeated-measurement ANOVA showed effect only on the variable speed (F=767,1; p<0.001) and the variables condition (F=0.010; p=0.990) and interaction (F=0.199; p=0.892) were not significant. In electromyography, Root mean Square (RMS) did not differ in the conditions evaluated, presenting standard behavior without significant differences. The KT application regardless of being O>I or I>O muscular, did not alter the muscle recruitment or contribute to the increase in peak torque performance during the three speeds.

Ratio of maximum hamstring torque to maximum quadriceps torque in professional basketball and soccer players

Purpose: The aim of the study was to determine the differences between football players and basketball players in the mean absolute values ​​of maximum torque flexors and extensors, ratio of maximum hamstring torque to maximum quadriceps torque dominant (DOM) non-dominant (ND) leg and differences in bilateral imbalance of flexor muscles and knee extensors. Material and methods: The research included a sample of 39 professional athletes. The first subsample included 19 professional basketball players while the second subsample included 20 professional soccer players. Results: Based on the results of the torques of the extensors in the knee joint of the DOM and ND legs, it was established that there is no statistically significant difference between basketball players and football players. However, a statistically significant difference was found in the torque flexors of the knee joint DOM (p≤0.01) and ND (p≤0.00) of the leg between basketball players and football players. On the other hand, the results of the research indicate that the difference between basketball players and football players in the ratio of Hamstrings peak torque to Quadriceps peak torque was recorded only in the ND leg (p≤0.02), while the difference in the DOM leg is not statistically significant. The results of our study indicate that basketball players have a higher percentage of imbalances compared to football players, especially in m. hamstrings. Conclusion: This study provides normative data on populations specific to soccer and basketball, but does not provide evidence of the ability of the isokinetic assessment of lower extremity muscle strength to predict injuries to football players and basketball players.

Resistance Training Improves Muscle Strength and Function, Regardless of Protein Supplementation, in the Mid- to Long-Term Period after Gastric Bypass

Inadequate protein intake and low levels of physical activity are common long-term sequelae after bariatric surgery and can negatively affect muscle strength (MS) and physical function (PF). The study investigated the effects of resistance training with or without protein supplementation on MS and PF. The study, which involved a 12-week controlled trial (n = 61) of individuals 2–7 years post-Roux-en-Y gastric bypass (RYGB), comprised four groups: whey protein supplementation (PRO; n = 18), maltodextrin placebo (control [CON]; n = 17), resistance training combined with placebo (RTP; n = 11), and resistance training combined with whey protein supplementation (RTP+PRO; n = 15). An isokinetic dynamometer was used to measure MS (peak torque at 60°/s and 180°/s). PF was measured with the 30-s sit-to-stand (30-STS), 6-min walk (6-MWT), and timed up-and-go (TUG) tests. There were improvements in the absolute and relative-to-bodyweight peak torque at 60°/s and 180°/s, TUG, 6-MWT and 30-STS in the RTP and RTP+PRO groups, but not in the CON and PRO groups. Changes in MS were significantly correlated with changes in PF between the pre- and post-intervention periods. A supervised resistance training program, regardless of protein supplementation, improved MS and PF in the mid-to-long-term period after RYGB and can lead to clinical benefits and improved quality of life.

A 12-Week Randomized Double-Blind Placebo-Controlled Clinical Trial, Evaluating the Effect of Supplementation with a Spinach Extract on Skeletal Muscle Fitness in Adults Older Than 50 Years of Age

The aim of a 12-week randomized double-blind placebo-controlled study was to assess the effect of daily supplementation with a natural extract of Spinacia oleracea L. (4 × 500 mg capsules/day; total 2 g per day) combined with a moderate-intensity training program (1 h session/3 times a week) on skeletal muscle fitness in adults over 50 years of age. Muscle strength assessed by isokinetic and isometric dynamometry improved significantly in the experimental (n = 23) and the placebo (n = 22) groups, but the magnitude of improvement was higher in the experimental group, with between-group differences in almost all variables, including isokinetic at 60° s−1 in knee extension, peak torque (p < 0.007); total work per repetition maximum (p < 0.009); isokinetic at 180°s−1 in knee extension, peak torque (p < 0.002); total work (p < 0.007); total work per repetition maximum (p < 0.005); average power (p < 0.027); isometric in knee extension, peak torque (p < 0.005); and average peak torque (p < 0.002). Similar findings were observed for muscle quality. Changes in quality of life (SF-36) were not found, except for improvements in the role physical (p < 0.023) and role emotional (p < 0.001) domains, likely as a result of the physical training sessions. A nutritional survey did not revealed changes in dietary habits. No adverse events were recorded. In subjects over 50 years of age, moderate-intensity strength training combined with daily supplementation for 12 weeks with a natural extract of Spinacia oleracea L. improved muscle-related variables and muscle quality. Maintaining muscle health is a key component of healthy aging.

ISOKINETIC PROFILES AND REFERENCE VALUES OF PROFESSIONAL SOCCER PLAYERS

ABSTRACT Introduction: Isokinetics is a tool commonly used in professional soccer. There is ongoing debate among researchers as to the isokinetic reference values a player should have. Objectives: To determine the absolute peak torque (PT) and average work of professional soccer players in relation to their positions on the field, and to establish the reference values for these variables. Methods: Purposeful sampling was used to select 289 professional soccer players. The sample included 32 goalkeepers, 100 defenders, 98 midfielders, and 59 strikers. The participants were measured preseason. The players were asked to perform a 10-minute warm-up on an exercise bike, and then to perform 5 repetitions at low speed, 10 at medium speed, and 25 at high speed, with 30 to 40-s of rest between each set of repetitions. The contraction method was concentric-concentric in a dynamometer Isomed 2000. Results: The average age, weight, and height of the players was 21.9 years, 74.3 kilograms, and 1.8 meters, respectively. The goalkeepers presented higher PT at the 3 measured speeds, and the higher average work at 180°/s and 240°/s in relation to defenders and midfielders. The strikers presented higher average work at 240°/s in relation to midfielders, and higher PT in relation to the defenders and midfielders. Absolute values were shown and reference values were established. Conclusions: The goalkeepers and strikers were the players that showed the greatest differences in their favor in relation to the other positions. The peak torque values and average work were described in relation to the player's position on the field. This study resulted in the creation of a tool for health professionals working with professional soccer players, providing reference values for these players in relation to their position on the field that can be used as benchmarks, by health professionals, to optimize soccer players’ performance. Level of evidence II, Prospective comparative study.

EFFECT OF FATIGUE ON EXPLOSIVE STRENGTH AND MUSCLE ARCHITECTURE OF THE VASTUS LATERALIS

ABSTRACT Introduction: There has been little research on changes in rate of torque development (RTD) and muscle architecture. This study evaluated the effect of fatigue on RTD and muscle architecture of the vastus lateralis (VL). Methods: Seventeen volunteers (25.5 ± 6.2 years; 177.2 ± 12.9 cm; 76.4 ± 13.1 kg) underwent isokinetic knee extension assessment at 30°/s to obtain the peak torque (PT-ISK), before and after a set of intermittent maximal voluntary isometric contractions (MVIC) (15 reps – 3 s contraction, 3 s rest) used to promote muscle fatigue, monitored by the median frequency (MDF) of the electromyography from the VL, rectus femoris and vastus medialis muscles. Before and after the fatigue protocol, ultrasound images of the VL were obtained to measure muscle thickness (MT), fascicle length (FL), and fascicle angle (FA). The peak isometric torque (PT-ISM) and the RTDs in 50 ms windows were calculated for each MVIC. The RTDs were reported as absolute values and normalized by the PT-ISM. Results: Fatigue was confirmed due to significant reductions in MDF in all three muscles. After the fatigue protocol, the PT-ISK was reduced from 239.0±47.91 to 177.3±34.96 Nm, and the PT-MVIC was reduced from 269.5±45.63 to 220.49±46.94 Nm. All the RTD absolute values presented significant change after the fatigue protocol. However, the normalized RTD did not demonstrate any significant differences. No significant differences were found in the muscle architecture of the VL. Conclusions: The reduction in explosive strength occurred concomitantly with the reduction in maximum strength, as evidenced by the lack of changes in normalized TDT. Level of Evidence III.