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Samuel C. Fischer, Darren Q. Calley, and John H. Hollman

Clinical Scenario : Low back pain is a common condition for the general population with 29% of adults having low back pain within the last 3 months. A deadlift is described as a free weight exercise in which a barbell is lifted from the floor in a continuous motion by extending the knees and hips. For those without low back pain, the deadlift was found to have the highest muscle activation of paraspinal musculature compared with other exercises. There are a limited number of studies that investigate the usefulness of incorporating deadlifts as part of a rehabilitation program for low back pain. Clinical Question: For those who live with low back pain, is an exercise routine that includes a deadlift a viable treatment option to improve pain and/or function? Summary of Key Findings: The literature search yielded 3 total studies meeting the inclusion and exclusion criteria: 1 randomized control trial, 1 secondary analysis of a randomized control trial, and 1 cohort study. Exercise programs that include deadlifts can yield improvements in both pain and function for those living with low back pain but were not found to be more beneficial than low load motor control exercises. Those with lower pain levels and higher baseline lumbar extension strength may be most appropriate to participate in an exercise program that includes deadlifts. Further research is needed to compare exercise programs that include deadlifts to other interventions for those living with low back pain. Clinical Bottom Line: There is minimal evidence that exercise programs that included deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures. Strength of Recommendation: Level B evidence exists that exercise programs that include deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures.

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Bethany Northeast and Tom Clifford

This systematic review and meta-analysis examined the effects of creatine supplementation on recovery from exercise-induced muscle damage, and is reported according to the PRISMA guidelines. MEDLINE and SPORTDiscus were searched for articles from inception until April 2020. Inclusion criteria were adult participants (≥18 years); creatine provided before and/or after exercise versus a noncreatine comparator; measurement of muscle function recovery, muscle soreness, inflammation, myocellular protein efflux, oxidative stress; range of motion; randomized controlled trials in humans. Thirteen studies (totaling 278 participants; 235 males and 43 females; age range 20–60 years) were deemed eligible for analysis. Data extraction was performed independently by both authors. The Cochrane Collaboration Risk of Bias Tool was used to critically appraise the studies; forest plots were generated with random-effects model and standardized mean differences. Creatine supplementation did not alter muscle strength, muscle soreness, range of motion, or inflammation at each of the five follow-up times after exercise (<30 min, 24, 48, 72, and 96 hr; p > .05). Creatine attenuated creatine kinase activity at 48-hr postexercise (standardized mean difference: −1.06; 95% confidence interval [−1.97, −0.14]; p = .02) but at no other time points. High (I2; >75%) and significant (Chi2; p < .01) heterogeneity was identified for all outcome measures at various follow-up times. In conclusion, creatine supplementation does not accelerate recovery following exercise-induced muscle damage; however, well-controlled studies with higher sample sizes are warranted to verify these conclusions. Systematic review registration (PROSPERO CRD42020178735).

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Scott Benson Street, Matthew Rawlins, and Jason Miller

Clinical Scenario: Ankle fractures are a frequent occurrence, and they carry the potential for syndesmosis injury. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Presently, the gold standard for treating an ankle syndesmosis injury is to insert a metallic screw through the fibula and into the tibia. This technique requires a second intervention to remove the hardware, but also carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope, has gained popularity in treating ankle syndesmosis injuries. The TightRope involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. Clinical Question: In patients suffering from ankle syndesmosis injuries, is the Tightrope ankle syndesmosis fixation system more effective than conventional screw fixation at improving return to work, pain, and patient-reported outcome measures? Summary of Key Findings: Five studies were selected to be critically appraised. The PEDro checklist was used to score 2 randomized control trials, and the Downs & Black checklist was used to score the cohort study on methodology and consistency. Two systematic reviews were also appraised. All 5 articles demonstrated support for using the TightRope fixation. Clinical Bottom Line: There is moderate evidence to support the use of the TightRope syndesmosis fixation system, as it provides both clinician- and patient-reported outcomes that are similar to those using the conventional metallic screw, with a shortened time to recover and return to activity. Strength of Recommendation: Grade A evidence exists in support of using the TightRope fixation system in place of the metallic screw following ankle syndesmosis injury.

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Tomoko Aoki and Koji Kadota

The present study examined the effects of daily activities of the hands on finger motor function in older adults. Maximum tapping frequency with each finger during single-finger tapping and alternate movements of index–middle, middle–ring, and ring–little finger pairs during double-finger tapping were compared between older adults who used their hands actively in their daily lives and those who did not. The active participants had significantly faster tapping rates for the ring finger in the single-finger tapping and the middle–ring finger pair in the double-finger tapping than did the inactive participants. Thus, daily activity of the hands in older adults could be effective at preventing the loss of dynamic motor function in individual fingers, especially with greater difficulty in movement, resulting from the degeneration with age.

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Alexandre Nehring, Thiago Teixeira Serafim, Elisa Raulino Silva, Fábio Sprada de Menezes, Nicola Maffulli, Luciana Sayuri Sanada, and Rodrigo Okubo

Context: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time. Objective: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention. Design: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups. Setting: Institutional physiotherapy clinic. Participants: A total of 40 university students (18–30 y), who had no symptoms, participated. Intervention: Foam roller for 30 seconds and 2 minutes for group 2. Main Outcome Measures: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention. Results: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT. Conclusions: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

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Miguel Sánchez-Moreno, David Rodríguez-Rosell, David Díaz-Cueli, Fernando Pareja-Blanco, and Juan José González-Badillo

Purpose: This study analyzed the effects of 3 training interventions: 1 isolated endurance training (ET) and 2 concurrent training (CT), which differed in the velocity loss (VL) magnitude allowed during the resistance training (RT) set: 15% (VL15) versus 45%, on strength and endurance running performance. Methods: A total of 33 resistance- and endurance-trained men were randomly allocated into 3 groups: VL15, VL 45%, and ET. ET was similar across all groups. The CT groups differed in the VL allowed during the RT set. Before and after the 8-week training program the following tests were performed: (1) running sprints, (2) vertical jump, (3) progressive loading test in the squat exercise, and (4) incremental treadmill running test up to maximal oxygen uptake. Results: Significant differences (P < .001) in RT volume (approximately 401 vs 177 total repetitions for VL 45% and VL15, respectively) were observed. Significant “group” × “time” interactions were observed for vertical jump and all strength-related variables: the CT groups attained significantly greater gains than ET. Moreover, a significant “group” × “time” interaction (P = .03) was noted for velocity at maximal oxygen uptake. Although all groups showed increases in velocity at maximal oxygen uptake, the VL15 group achieved greater gains than the ET group. Conclusions: CT interventions experienced greater strength gains than the ET group. Although all groups improved their endurance performance, the VL15 intervention resulted in greater gains than the ET approach. Therefore, moderate VL thresholds in RT performed during CT could be a good strategy for concurrently maximizing strength and endurance development.

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Jennifer A. Bunn, Bradley J. Myers, and Mary K. Reagor

Purpose: To statistically evaluate the internal and external load metrics in different types of lacrosse drills. Methods: A total of 25 Division I collegiate female lacrosse players wore a heart rate monitor and a global positioning system during preseason training sessions. Seven measures determined training load, 2 internal measures and 5 external measures, across 5 different types of drills: stickwork, small-sided games, individual skills, conditioning, and team drills. Principal component analysis was used to determine which internal and external load variables were most associated with each drill type. Results: Stickwork extracted 2 principal components, explaining 45% and 17% of the variance. Small-sided games extracted 1 principal component, explaining 51% of the variance. Individual skills extracted 2 components, explaining 39% and 22% of the variance. Conditioning extracted 2 components, explaining 44% and 24% of the variance. Team drills extracted 2 components, explaining 52% and 18% of the variance. Conclusions: In 4 out of 5 training modes, the inclusion of both internal and external training-load measures was necessary to accurately decipher training load. For most drills, the first component is related to measures of external load, and the second component described the balance between internal and external load measures. Small-sided games extracted only external measures including the following: accelerations, total distance, and average speed. These results show that a combination of internal and external load measures is required to determine training load during certain training modes. This information can help coaches make decisions about desired training load for practice sessions.

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Luis A. Marco-Contreras, Beatriz Bachero-Mena, David Rodríguez-Rosell, and Juan J. González-Badillo

Purpose: To analyze the relationships between the evolution of training-load values and countermovement jump (CMJ) as an indicator of stress and fatigue in a high-level 800-m runner during a whole season, including indoor (ID) and outdoor season (OD). Methods: Over 42 weeks, daily training load was quantified as the result of the product of the intensity and volume, and it was termed load index (LI). CMJ was measured in every running session after warm-up and immediately after the last effort of the session. Other jump-related variables such as CMJ height loss, average weekly CMJ, initial CMJ of the next consecutive session, and initial CMJ of the following week were studied. Results: A significant negative relationship was observed between LI and weekly CMJ (ID: r = −.68, P < .001, common variance [CV] = 46%; OD: r = −.73, P < .001, CV = 53%), initial CMJ of the following week (OD: r = −.71, P < .01, CV = 50%), and CMJ height loss (ID: r = −.58, P < .01, CV = 34%; OD: r = −.52, P < .01, CV = 27%). A significant positive relationship was observed between LI and initial CMJ of the next consecutive session when LI values were <8 (OD: r = .72; P < .01, CV = 52%). However, from values ≥8, the relationship turned into a significant negative one (ID: r = −.74; P < .01, CV = 55%; OD: r = −64, P < .01, CV = 41%). Conclusions: CMJ may be a valid indicator of the degree of stress or fatigue generated by specific training sessions of a competitive athlete within a single session, a week, or even the following week. There could be an individual limit LI value from which the training volume does not allow a positive effect on high-speed actions such as a CMJ in the next consecutive session.

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Ibai Guridi Lopategui, Julen Castellano Paulis, and Ibon Echeazarra Escudero

Purpose: The objectives of the present study were (1) to analyze the internal and external load profile of training and competition carried out by semiprofessional football players during a 27-week period and (2) to examine the possible link between this type of periodization and players’ fitness status and their readiness to compete. Methods: Training and match data were obtained from 26 semiprofessional football players belonging to the reserve squad of a Spanish La Liga club during the 2018/19 season. For the purpose of this study, the distribution of external and internal load during a typical training microcycle, with 6 or 7 days between matches, was analyzed. Five types of sessions were considered: strength, duration, velocity, preofficial match, and official match. Results: The results showed a different internal and external load profile for each type of session, with the load being consistently higher during matches when compared with training sessions (28.9%–94% higher), showing significant differences in all the variables. There was a clear tapering strategy in the last days of the week to arrive with enough freshness to compete, shown by the decrease of the values in the 2 days before the match (15%–83% reduction, depending on the variable). Furthermore, the horizontal alternation of the load allowed the players to maintain their fitness level during the 27-week period. Conclusions: Our findings suggest that this weekly periodization approach could help achieve a double conditional target, allowing a short tapering strategy to face the match with enough freshness and serving as a strategy for maintaining or optimizing players’ physical performance during the season.

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Kadhiresan R. Murugappan, Ariel Mueller, Daniel P. Walsh, Shahzad Shaefi, Akiva Leibowitz, and Todd Sarge

Rapid weight loss or “weight cutting” is a common but potentially harmful practice used in mixed martial arts competition. Following the official weigh-in, competitors refeed and rehydrate themselves in a process known as rapid weight gain (RWG) to realize a potential competitive advantage. While data from surveys and small series have indicated the majority of mixed martial arts athletes engage in rapid weight loss, there is a lack of officially collected data from sanctioning organizations describing its prevalence. The present investigation represents a summary of the data collected between December 2015 and January 2018 by the California State Athletic Commission. In total, 512 professional mixed martial artists (455 males and 57 females) were included. Of these, 503 (98%) athletes gained body mass between weigh-in and their bouts. Total RWG between weigh-in and competition was 5.5 ± 2.5 kg, corresponding to an 8.1% ± 3.6% body mass increase. Total RWG was 5.6 ± 2.5 kg (8.1% ± 3.6%) for males and 4.5 ± 2.3 kg (8.0% ± 3.8%) for females. More than one quarter of men and one third of women gained >10% body mass between weigh-in and competition. Athletes from leading international promotions gained more absolute, but not relative, body mass than those from regional promotions. Our findings indicate RWG is nearly ubiquitous in professional , with a similar prevalence in male and female athletes. Trends based on promotion suggest a larger magnitude of RWG in presumably more experienced and/or successful mixed martial artists from leading international promotions.