hip extensor musculature in clinical LBP populations arises from the interplay between hip function and LBP. 24 , 25 While LBP can also slow the recovery from muscle fatigue of lumbar spine extensor musculature, 26 – 28 it is not known how LBP affects recovery from hip muscle fatigue. LBP
Daniel Viggiani and Jack P. Callaghan
Jay R. Ebert, Anne Smith, Peter K. Edwards and Timothy R. Ackland
Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. Despite the reported clinical improvement in knee pain and symptoms, little is known on the recovery of knee strength and its return to an appropriate level compared with the unaffected limb.
To investigate the progression of isokinetic knee strength and limb symmetry after MACI.
Private functional rehabilitation facility.
58 patients treated with MACI for full-thickness cartilage defects to the femoral condyles.
MACI and a standardized rehabilitation protocol.
Main Outcome Measures:
Preoperatively and at 1, 2, and 5 y postsurgery, patients underwent a 3-repetition-maximum straight-leg raise test, as well as assessment of isokinetic knee-flexor and -extensor torque and hamstring:quadriceps (H:Q) ratios. Correlation analysis investigated the association between strength and pain, demographics, defect, and surgery characteristics. Linear-regression analysis estimated differences in strength measures between the operated and nonoperated limbs, as well as Limb Symmetry Indexes (LSI) over time.
Peak knee-extension torque improved significantly over time for both limbs but was significantly lower on the operated limb preoperatively and at 1, 2, and 5 y. Mean LSIs of 77.0%, 83.0%, and 86.5% were observed at 1, 2, and 5 y, respectively, while 53.4–72.4% of patients demonstrated an LSI ≤ 90% across the postoperative timeline. Peak knee-flexion torque was significantly lower on the operated limb preoperatively and at 1 year. H:Q ratios were significantly higher on the operated limb at all time points.
While peak knee-flexion and hip-flexor strength were within normal limits, the majority of patients in this study still demonstrated an LSI for peak knee-extensor strength ≤ 90%, even at 5 y. It is unknown how this prolonged knee-extensor deficit may affect long-term graft outcome and risk of reinjury after return to activity.
Michael J. Saunders, Rebecca W. Moore, Arie K. Kies, Nicholas D. Luden and Casey A. Pratt
This study examined whether a carbohydrate + casein hydrolysate (CHO+ProH) beverage improved time-trial performance vs. a CHO beverage delivering ~60 g CHO/hr. Markers of muscle disruption and recovery were also assessed. Thirteen male cyclists (VO2peak = 60.8 ± 1.6 ml · kg−1 · min−1) completed 2 computer-simulated 60-km time trials consisting of 3 laps of a 20-km course concluding with a 5-km climb (~5% grade). Participants consumed 200 ml of CHO (6%) or CHO+ProH beverage (6% + 1.8% protein hydrolysate) every 5 km and 500 ml of beverage immediately postexercise. Beverage treatments were administered using a randomly counterbalanced, double-blind design. Plasma creatine phosphokinase (CK) and muscle-soreness ratings were assessed immediately before and 24 hr after cycling. Mean 60-km times were 134.4 ± 4.6 and 135.0 ± 4.0 min for CHO+ProH and CHO beverages, respectively. All time differences between treatments occurred during the final lap, with protein hydrolysate ingestion explaining a significant (p < .05) proportion of betweentrials differences over the final 20 km (44.3 ± 1.6, 45.0 ± 1.6 min) and final 5 km (16.5 ± 0.6, 16.9 ± 0.6 min). Plasma CK levels and muscle-soreness ratings increased significantly after the CHO trial (161 ± 53, 399 ± 175 U/L; 15.8 ± 5.1, 37.6 ± 5.7 mm) but not the CHO+ProH trial (115 ± 21, 262 ± 88 U/L; 20.9 ± 5.3, 32.2 ± 7.1 mm). Late-exercise time-trial performance was enhanced with CHO+ProH beverage ingestion compared with a beverage containing CHO provided at maximal exogenous oxidation rates during exercise. CHO+ProH ingestion also prevented increases in plasma CK and muscle soreness after exercise.
Chelsea L. Oxendale, Craig Twist, Matthew Daniels and Jamie Highton
While exercise-induced muscle damage (EIMD) after rugby league match play has been well documented, the specific match actions that contribute to EIMD are unclear. Accordingly, the purpose of this study was to investigate the positional demands of elite rugby league matches and examine their relationship with subsequent EIMD.
Twenty-eight performances (from 17 participants) were captured using 10-Hz global positioning systems over 4 competitive matches. Upper- and lower-body neuromuscular fatigue, creatine kinase (CK), and perceived muscle soreness were assessed 24 h before and at 12, 36, and 60 h after matches.
High-intensity running was moderately higher in backs (6.6 ± 2.6 m/min) than in forwards (5.1 ± 1.6 m/min), whereas total collisions were moderately lower (31.1 ± 13.1 vs 54.1 ± 37.0). Duration (r = .90, CI: .77–.96) and total (r = .86, CI: .70–.95) and high-intensity distance covered (r = .76, CI: .51–.91) were associated (P < .05) with increased CK concentration postmatch. Total collisions and repeated high-intensity efforts were associated (P < .05) with large decrements in upper-body neuromuscular performance (r = –.48, CI: –.74 to .02; r = –.49, CI: –.77 to .05, respectively), muscle soreness (r = –.68, CI: –.87 to –.10, r = –.66, CI: –.89 to .21, respectively), and CK concentration (r = .67, CI: .42–.85; r = .73, CI: .51–.87, respectively). All EIMD markers returned to baseline within 60 h.
Match duration, high-intensity running, and collisions were associated with variations in EIMD markers, suggesting that recovery is dependent on individual match demands.
Robin T. Thorpe, Anthony J. Strudwick, Martin Buchheit, Greg Atkinson, Barry Drust and Warren Gregson
To quantify the mean daily changes in training and match load and any parallel changes in indicators of morningmeasured fatigue across in-season training weeks in elite soccer players.
After each training session and match (TL), session ratings of perceived exertion (s-RPE) were recorded to calculate overall session load (RPE-TL) in 29 English Premier League players from the same team. Morning ratings of fatigue, sleep quality, and delayed-onset muscle soreness (DOMS), as well as submaximal exercise heart rate (HRex), postexercise heart-rate recovery (HRR%), and heart-rate variability (HRV) were recorded before match day and 1, 2, and 4 d postmatch. Data were collected for a median duration of 3 wk (range 1–13) and reduced to a typical weekly cycle including no midweek match and a weekend match day. Data were analyzed using withinsubject linear mixed models.
RPE-TL was approximately 600 arbitrary units (AU) (95% confidence interval 546–644) higher on match day than following day (P < .001). RPE-TL progressively decreased by »60 AU per day over the 3 days before a match (P < .05). Morning-measured fatigue, sleep quality, and DOMS tracked the changes in RPE-TL, being 35–40% worse on postmatch day vs prematch day (P < .001). Perceived fatigue, sleep quality, and DOMS improved by 17–26% from postmatch day to 3 d postmatch, with further smaller (7%–14%) improvements occurring between 4 d postmatch and prematch day (P < .01). There were no substantial or statistically significant changes in HRex, HRR%, or HRV over the weekly cycle (P > .05).
Morning-measured ratings of fatigue, sleep quality, and DOMS are clearly more sensitive than HR-derived indices to the daily fluctuations in session load experienced by elite soccer players in a standard in-season week.
Robin T. Thorpe, Anthony J. Strudwick, Martin Buchheit, Greg Atkinson, Barry Drust and Warren Gregson
To determine the sensitivity of a range of potential fatigue measures to daily training load accumulated over the previous 2, 3, and 4 d during a short in-season competitive period in elite senior soccer players (N = 10).
Total highspeed-running distance, perceived ratings of wellness (fatigue, muscle soreness, sleep quality), countermovement-jump height (CMJ), submaximal heart rate (HRex), postexercise heart-rate recovery (HRR), and heart-rate variability (HRV: Ln rMSSD) were analyzed during an in-season competitive period (17 d). General linear models were used to evaluate the influence of 2-, 3-, and 4-d total high-speed-running-distance accumulation on fatigue measures.
Fluctuations in perceived ratings of fatigue were correlated with fluctuations in total high-speed-running-distance accumulation covered on the previous 2 d (r = –.31; small), 3 d (r = –.42; moderate), and 4 d (r = –.28; small) (P < .05). Changes in HRex (r = .28; small; P = .02) were correlated with changes in 4-d total high-speed-running-distance accumulation only. Correlations between variability in muscle soreness, sleep quality, CMJ, HRR%, and HRV and total high-speed-running distance were negligible and not statistically significant for all accumulation training loads.
Perceived ratings of fatigue and HRex were sensitive to fluctuations in acute total high-speed-running-distance accumulation, although sensitivity was not systematically influenced by the number of previous days over which the training load was accumulated. The present findings indicate that the sensitivity of morning-measured fatigue variables to changes in training load is generally not improved when compared with training loads beyond the previous day’s training.
William P. McCormack, Jay R. Hoffman, Gabriel J. Pruna, Tyler C. Scanlon, Jonathan D. Bohner, Jeremy R. Townsend, Adam R. Jajtner, Jeffrey R. Stout, Maren S. Fragala and David H. Fukuda
During the competitive soccer season, women’s intercollegiate matches are typically played on Friday evenings and Sunday afternoons. The efficacy of a 42-h recovery period is not well understood. This investigation was conducted to determine performance differences between Friday and Sunday matches during a competitive season.
Ten NCAA Division I female soccer players (20.5 ± 1.0 y, 166.6 ± 5.1 cm, 61.1 ± 5.8 kg) were monitored with 10-Hz GPS devices across 8 weekends with matches played on Friday evenings and Sunday afternoons. The players were outside backs, midfielders, and forwards. All players had to participate in a minimum of 45 min/match to be included in the study. Average minutes played, total distance covered, total distance of high-intensity running (HIR) (defined as running at a velocity equal to or exceeding 3.61 m/s for longer than 1 s), the number of HIR efforts, and the number of sprints were calculated for each match. Data for Friday vs Sunday matches were averaged and then compared using dependent t tests.
No differences were seen in minutes played, distance rate, or number of sprints between Friday and Sunday matches. A significant (P = .017) decrease in rate of HIR between Friday (25.37 ± 7.22 m/min) and Sunday matches (22.90 ± 5.70 m/min) was seen. In addition, there was a trend toward a difference (P = .073) in the number of efforts of HIR between Friday (138.41 ± 36.43) and Sunday (126.92 ± 31.31).
NCAA Division I female soccer players cover less distance of HIR in games played less than 48 h after another game. This could be due to various factors such as dehydration, glycogen depletion, or muscle damage.
Armand E.O. Bettonviel, Naomi Y.J. Brinkmans, Kris Russcher, Floris C. Wardenaar and Oliver C. Witard
The nutritional status of elite soccer players across match, postmatch, training and rest days has not been defined. Recent evidence suggests the pattern of dietary protein intake impacts the daytime turnover of muscle proteins and, as such, influences muscle recovery. We assessed the nutritional status and daytime pattern of protein intake in senior professional and elite youth soccer players and compared findings against published recommendations. Fourteen senior professional (SP) and 15 youth elite (YP) soccer players from the Dutch premier division completed nutritional assessments using a 24-hr web-based recall method. Recall days consisted of a match, postmatch, rest, and training day. Daily energy intake over the 4-day period was similar between SP (2988 ± 583 kcal/day) and YP (2938 ± 465 kcal/day; p = .800). Carbohydrate intake over the combined 4-day period was lower in SP (4.7 ± 0.7 g·kg-1 BM·day-1) vs. YP (6.0 ± 1.5 g·kg-1 BM·day-1, p = .006) and SP failed to meet recommended carbohydrate intakes on match and training days. Conversely, recommended protein intakes were met for SP (1.9 ± 0.3 g·kg-1 BM·day-1) and YP (1.7 ± 0.4 g·kg-1 BM·day-1), with no differences between groups (p = .286). Accordingly, both groups met or exceeded recommended daily protein intakes on individual match, postmatch, rest and training days. A similar “balanced” daytime pattern of protein intake was observed in SP and YP. To conclude, SP increased protein intake on match and training days to a greater extent than YP, however at the expense of carbohydrate intake. The daytime distribution of protein intake for YP and SP aligned with current recommendations of a balanced protein meal pattern.
Benita J. Lalor, Shona L. Halson, Jacqueline Tran, Justin G. Kemp and Stuart J. Cormack
Australian Football (AF) is an intermittent team sport involving rapid accelerations and decelerations, collisions, and large distances covered at a high intensity. 1 The competitive season can produce high levels of fatigue, and optimizing recovery in order to maximize performance is critical. 1
Ian McGinnis, Justin Cobb, Ryan Tierney and Anne Russ
recovery from concussion, both in athletic and general populations. 4 – 6 The vestibular system’s regulation of balance, spatial orientation, and gaze stability plays a key role in athletic tasks and many activities of daily living. Disruption of the vestibular system can exacerbate other symptoms of