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Kirstin S. Morris, Mark A. Osborne, Megan E. Shephard, David G. Jenkins and Tina L. Skinner

Purpose:

The contributions of the limbs to velocity and metabolic parameters in front-crawl swimming at different intensities have not been identified considering both stroke and kick rate. Consequently, velocity, oxygen uptake (V̇O2), and metabolic cost of swimming with the whole body (swim), the upper limbs only (pull), and lower limbs only (kick) were compared with stroke and kick rate controlled.

Methods:

Twenty elite swimmers completed six 200-m trials: 2 swim, 2 pull, and 2 kick. Swim trials were guided by underwater lights at paces equivalent to 65% ± 3% and 78% ± 3% of participants’ 200-m-freestyle personal-best pace; paces were described as low and moderate, respectively. In the pull and kick trials, swimmers aimed to match the stroke and kick rates, respectively, recorded during the swim trials. V̇O2 was measured continuously, with velocity and metabolic cost calculated for each 200-m effort.

Results:

The velocity contribution of the upper limbs (mean ± SD; low 63.9% ± 6.2%, moderate 59.6% ± 4.2%) was greater than that of the lower limbs to a large extent at both intensities (low ES = 4.40, moderate ES = 4.60). The V̇O2 used by the upper limbs differed between the intensities (low 55.5% ± 6.9%, moderate 51.4% ± 4.0%; ES = 0.74). The lower limbs were responsible for a greater percentage of the metabolic cost than the upper limbs at both intensities (low 56.1% ± 9.5%, ES = 1.30; moderate 55.1% ± 6.6%, ES = 1.55).

Conclusions:

Implementation of this testing protocol before and after a pull- or kick-training block will enable sport scientists to determine how the velocity contributions and/or metabolic cost of the upper- and lower-limb actions have responded to the training program.

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James R. Debenham, William I. Gibson, Mervyn J. Travers, Amity C. Campbell and Garry T. Allison

Context:

Eccentric exercises are increasingly being used to treat lower-limb musculoskeletal conditions such as Achilles tendinopathy. Despite widespread clinical application and documented efficacy, mechanisms underpinning clinical benefit remain unclear. Positive adaptations in motor performance are a potential mechanism.

Objective:

To investigate how an eccentric loading intervention influences measures of stretch-shortening-cycle (SSC) behavior during a hopping task.

Design:

Within-subjects repeated-measures observational study.

Setting:

University motion-analysis laboratory.

Participants:

Healthy adults.

Interventions:

A single intervention of 5 sets of 10 eccentric plantar-flexion contractions at 6 repetitions maximum using a commercial seated calf-raise machine.

Main Outcome Measures:

Lower-limb stiffness, sagittal-plane ankle kinematics, and temporal muscle activity of the agonist (soleus) and antagonist (tibialis anterior) muscles, measured during submaximal hopping on a custom-built sledge-jump system.

Results:

Eccentric loading altered ankle kinematics during submaximal hopping; peak angle shifted to a less dorsiflexed position by 2.9° and ankle angle precontact shifted by 4.4° (P < .001). Lower-limb stiffness increased from 5.9 to 6.8 N/m (P < .001), while surface EMG measures of soleus occurred 14–44% earlier (P < .001) after the loading intervention.

Conclusions:

These findings suggest that eccentric loading alters SSC behavior in a manner reflective of improved motor performance. Decreased ankle excursion, increased lower-limb stiffness, and alterations in motor control may represent a positive adaptive response to eccentric loading. These findings support the theory that mechanisms underpinning eccentric loading for tendinopathy may in part be due to improved “buffering” of the tendon by the neuromuscular system.

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Jean-Francois Esculier, Laurent J. Bouyer and Jean-Sébastien Roy

Context:

Patellofemoral pain (PFP) is one of the most frequent running-related injuries. However, few interventions taking into consideration the specificity of running have been shown to be effective in runners with PFP.

Objective:

To evaluate the effects of a multimodal rehabilitation program including lower-limb-strengthening/motor-control exercises, advice on running biomechanics, and symptoms management on symptoms, strength, and ground-reaction forces in runners with PFP.

Design:

Pre- to post- quasi-experimental.

Setting:

Gait-analysis laboratory and private physical therapy clinic.

Participants:

21 runners with PFP (34.1 ± 6.0 y old, symptoms duration 38.1 ± 45.5 mo).

Intervention:

An 8-wk multimodal rehabilitation program including lower-limb- and core-strengthening and motor-control exercises, as well as advice on running gait and symptoms management.

Main Outcome Measures:

The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) questionnaire and visual analog scales for usual pain (VAS-U), worst pain (VAS-W), and pain during running (VAS-R) were used to assess changes in symptoms and function. Vertical ground-reaction forces (VGRF) during running and lower-limb isometric strength were also measured.

Results:

Statistically and clinically significant improvements (P < .001) were reported on KOS-ADLS (+17.8 pts), VAS-U (−19.2 pts), VAS-W (−28.7 pts), and VAS-R (−32.2 pts) after the intervention. No significant changes in isometric strength were observed. The instantaneous vertical loading rate was decreased after the intervention (P = .002), and this reduction was correlated with changes in KOS-ADLS scores (P = .028).

Conclusion:

This multimodal intervention was successful in reducing pain and improving function of runners with PFP. However, no significant changes in lower-limb strength were observed. It appears that changes in VGRF combined with appropriate training advice could explain the clinical outcomes.

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Daniel Martínez-Silván, Jaime Díaz-Ocejo and Andrew Murray

Purpose:

To analyze the influence of training exposure and the utility of self-report questionnaires on predicting overuse injuries in adolescent endurance athletes.

Methods:

Five adolescent male endurance athletes (15.7 ± 1.4 y) from a full-time sports academy answered 2 questionnaires (Recovery Cue; RC-q and Oslo Sports Trauma Research questionnaire; OSTRC-q) on a weekly basis for 1 season (37 wk) to detect signs of overtraining and underrecovery (RC-q) and early symptoms of lower-limb injuries (OSTRC-q). All overuse injuries were retrospectively analyzed to detect which variations in the questionnaires in the weeks preceding injury were best associated. Overuse incidence rates were calculated based on training exposure.

Results:

Lower-limb overuse injuries accounted for 73% of total injuries. The incidence rate for overuse training-related injuries was 10 injuries/1000 h. Strong correlations were observed between individual running exposure and overuse injury incidence (r 2 = .66), number of overuse injuries (r 2 = .69), and days lost (r 2 = .66). A change of 20% or more in the RC-q score in the preceding week was associated with 67% of the lower-limb overuse injuries. Musculoskeletal symptoms were only detected in advance by the OSTRC-q in 27% of the episodes.

Conclusion:

Training exposure (especially running exposure) was shown to be related to overuse injuries, suggesting that monitoring training load is a key factor for injury prevention. Worsening scores in the RC-q (but not the OSTRC) may be an indicator of overuse injury in adolescent endurance runners when used longitudinally.

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Franck Brocherie, Grégoire P. Millet and Olivier Girard

Purpose:

To compare psychophysiological responses to 6 repeated-sprint sessions in normobaric hypoxia (RSH) and normoxia (RSN) in team-sport athletes during a 2-wk “live high–train low” training camp.

Methods:

While residing under normobaric hypoxia (≥14 h/d, FiO2 14.5–14.2%), 23 lowland elite field hockey players performed, in addition to their usual training, 6 sessions (4 × 5 × 5-s maximal sprints, 25-s passive recovery, 5 min rest) under either RSH (FiO2 ~14.5%) or RSN (FiO2 21%). Sprint 1 and 5 times, physiological strain (heart rate [HR], arterial oxyhemoglobin saturation [SpO2]), and perceptual responses (overall peripheral discomfort, difficulty breathing, and lower-limb discomfort) were monitored.

Results:

During the 1st session, HR increased across sets (P < .001) independently of the conditions, while SpO2 was globally lower (P < .001) for RSH (averaged value: 91.9% ± 1.2%) vs RSN (96.9% ± 0.6%). Thereafter, SpO2 and HR remained similar across sessions for each condition. While 1st-sprint time remained similar, last-sprint time and fatigue index significantly decreased across sets (P < .01) and sessions (P < .05) but not between conditions. Ratings of overall perceived discomfort, difficulty breathing, and lower-limb discomfort were higher (P < .05) in RSH vs RSN at the 1st session. During subsequent sessions, values for overall perceived discomfort (time [P < .001] and condition [P < .05] effects), difficulty breathing (time effect; P < .001), and lower-limb discomfort (condition [P < .001] and interaction [P < .05] effects) decreased to a larger extent in RSH vs RSN.

Conclusion:

Despite higher hypoxia-induced physiological and perceptual strain during the 1st session, perceptual responses improved thereafter in RSH so as not to differ from RSN. This indicates an effective acclimation and tolerance to this innovative training.

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John V. Basmajian

In the symphony of neuromotor performance, the muscles are the powerful woodwinds, the ligaments are the essential string section, and the central nervous system both writes and conducts the performance. Electromyography (EMG) has provided the platform and technology in the past half century to bring appreciation of the superb functions of all the parts of the healthy body in concert. This broad “review” provides vignettes of many aspects of motor controls in the upper and lower limbs explored with EMG by the author and his students.

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Jonathon S. Schofield, Eric Parent, Justin Lewicke, Jason P. Carey, Marwan El-Rich and Samer Adeeb

Sit-to-stand transfer is a common prerequisite for many daily tasks. Literature often assumes symmetric behavior across the left and right side. Although this assumption of bilateral symmetry is prominent, few studies have validated this supposition. This pilot study uniquely quantifies peak joint moments and ground reaction forces (GRFs), using a Euclidian norm approach, to evaluate bilateral symmetry and its relation to lower limb motor-dominance during sit to stand in ten healthy males. Peak joint moments and GRFs were determined using a motion capture system and inverse dynamics. This analysis included joint moment contributions from all three body planes (sagittal, coronal, and axial) as well as vertical and shearing GRFs. A paired, one-tailed t test was used, suggesting asymmetrical joint moment development in all three lower extremity joints as well as GRFs (P < .05). Furthermore, using an unpaired two-tailed t test, asymmetry developed during these movements does not appear to be predictable by participants’ lower limb motor-dominance (P < .025). Consequently, when evaluating sit-to-stand it is suggested the effects of asymmetry be considered in the interpretation of data. The absence of a relationship between dominance and asymmetry prevents the suggestion that one side can be tested to infer behavior of the contralateral.

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George Vagenas and Blaine Hoshizaki

The purpose of this study was to identify the kinematic characteristics of bilateral rearfoot asymmetry during heel–toe running under two experimental conditions: worn (broken-in) running shoes and new (standardized) running shoes. High-speed cinematography (150 fps) was used to film the lower limbs of four male runners in the frontal plane while running on a treadmill at their training pace. Six successive footfalls were analyzed for each subject and selected kinematical variables of the rearfoot function were calculated. Significant asymmetries were found in lower leg angle and Achilles tendon angle at touchdown and at maximum pronation. Total pronation and rearfoot angle were almost symmetric. The angular displacement graphs for the shank and foot revealed a distinct overall asymmetry between the lower limbs in both conditions. The mean values of the kinematical asymmetries were appreciably higher in the new shoe condition. It is proposed that the degree of these asymmetries is subject to changes due to injury, personal running style, and stability of the running shoe. Trends of bilateral dominance specific to rearfoot control in running were identified.

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Michael R.M. McGuigan, Roger Bronks, Robert U. Newton, John C. Graham and David V. Cody

Peripheral arterial disease (PAD) is associated with impaired lower extremity function. This study investigated differences in PAD and control participants and the relationship between lower limb strength and clinical measures of PAD severity. Participants were evaluated by 6-min-walk distance, normal and maximal walking speed over 10 m, isometric plantar-flexion strength, and dynamic dorsi-/plantar-flexion strength. Hemodynamic measures of the lower limbs were recorded at rest and after maximal treadmill testing. PAD participants walked significantly less far during the 6-min walk, and there were large differences in normal and maximal walking speeds. Small to moderate differences were found for isometric plantar-flexion strength. In the diseased legs of the PAD participants, resting systolic hallux photoplethysmography was significantly correlated with isokinetic plantar-flexion strength and onset of claudication pain during the 6-min-walk test. In addition to confirming the documented loss of walking endurance, these data suggest that loss of strength of the plantar flexors is associated with increasing PAD impairment.

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Hiroko Tanabe, Keisuke Fujii and Motoki Kouzaki

We aimed to investigate joint coordination of lower limbs in dancers during tiptoe standing and the relationship between joint coordination and muscle coactivation. Seven female ballet dancers performed tiptoe standing with six leg positions (fi e classical dance positions and one modern dance position) for 10 s. The kinematic data of the metatarsophalangeal (MP), ankle, knee, and hip joints was collected, and surface electromyography (EMG) of over 13 lower limb muscles was conducted. Principal component analysis was performed to determine joint coordination. MP–ankle and ankle–knee had in-phase coordination, whereas knee–hip showed anti-phase coordination in the sagittal plane. In addition, most EMG–EMG coherence around the MP and ankle joints was significant up to 50 Hz when these two joints swayed with in-phase. This suggests that different joint coordination patterns are associated with neural processing related to different muscle coactivation patterns. In conclusion, ballet dancers showed in-phase coordination from the MP to knee joints, which was associated with muscle coactivation to a higher frequency domain (up to 50 Hz) in comparison with anti-phase coordination.