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Michael P. Godard, David L. Williamson, David A. Porter, Gregory A. Rowden and Scott W. Trappe

This investigation examined alterations in neuromuscular drive for dynamic and static muscle contractions, muscle strength, and cross-sectional area (CSA) with a 12-week progressive resistance-training program (PRT). Nine healthy men (70.0 ± 1.7 years) were evaluated for maximal and submaximal neuromuscular drive (integrated electromyography [IEMG]), whole-muscle strength, isokinetic power, and thigh CSA. The results demonstrated no significant differences pre- to post-PRT in the submaximal IEMG signals (p > .05). IEMG increased (p < .05) for the maximal static contraction (29% ± 12%) and isokinetic velocities concentrically and eccentrically. There was an increase (p < .05) in maximal static strength (27% ± 5%), isokinetic concentric and eccentric strength, muscle power, IRM (47% ± 6%), and CSA (6% ± 1%; p < .05). The results reveal significant neuromuscular-drive alterations in concentric and eccentric dynamic contractions with PRT in older men and indicate that their neuromuscular drive contributes significantly to improving their concentric and eccentric skeletal-muscle strength.

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T. Brock Symons, Anthony A. Vandervoort, Charles L. Rice, Tom J. Overend and Greg D. Marsh

Because of the need for efficient, consistent strength measurements, the test–retest reliability of concentric, isometric, and eccentric strength; concentric work; and concentric power was determined in older women without a familiarization session. The reliability of measures derived from a single peak score were compared with those derived from an averaged score. On 2 occasions 25 older women with a mean age of 72 ± 6 years performed 3 submaximal knee extensions and 5 maximal contractions on an isokinetic dynamometer at 90°/s (CON), 0°/s, and –90°/s on both lower limbs. Statistical analyses for peak and averaged values (best 3 contractions of 5) exhibited good relative reliability (ICCs > .88), except for CON power. Typical error as a coefficient of variation and ratio limits of agreement for peak and averaged score values were larger than desired, with CON power scores demonstrating unacceptable error ranges. Although relative reliability of this 1-session assessment protocol was acceptable, further research is needed to determine whether additional practice trials could enhance absolute reliability.

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Yin-Chou Lin, Angela Thompson, Jung-Tang Kung, Liang-Wei Chieh, Shih-Wei Chou and Jung-Charng Lin

Context:

Elbow injuries are widely reported among baseball players. The elbow is susceptible to injury when elbow-flexor and -extensor forces are imbalanced during pitching or throwing. Assessment of muscle-strength ratios may prove useful for diagnosing elbow injury.

Objective:

The purpose of this study was to assess the relationship between the elbow-flexor and -extensor functional isokinetic ratios and elbow injury in baseball players.

Design:

Retrospective study.

Setting:

Biomechanics laboratory.

Participants:

College baseball players with (n = 9) and without (n = 12) self-reported elbow pain or loss of strength were recruited.

Intervention and Main Outcome Measures:

Trials were conducted using a dynamometer to assess dominant-arm flexor and extensor concentric and eccentric strength at angular velocities of 60° and 240°/s. Functional isokinetic ratios were calculated and compared between groups.

Results:

Regression analysis revealed that a ratio of biceps concentric to triceps concentric strength greater than 0.76 (the median value) significantly predicted elbow injury (P = .01, odds ratio of injury = 24). No other ratios or variables (including position played) were predictive of injury status.

Conclusions:

These findings suggest that the ratio of biceps concentric to triceps concentric functional strength strongly predicts elbow-injury status in baseball players. Assessment of this ratio may prove useful in a practical setting for training purposes and both injury diagnosis and rehabilitation.

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Kris Beattie, Brian P. Carson, Mark Lyons and Ian C. Kenny

Maximum- and reactive-strength qualities both have important roles in athletic movements and sporting performance. Very little research has investigated the relationship between maximum strength and reactive strength. The aim of this study was to investigate the relationship between maximum-strength (isometric midthigh-pull peak force [IMTP PF]) and reactive-strength (drop-jump reactive-strength index [DJ-RSI]) variables at 0.3-m, 0.4-m, 0.5-m, and 0.6-m box heights. A secondary aim was to investigate the between- and within-group differences in reactive-strength characteristics between relatively stronger athletes (n = 11) and weaker athletes (n = 11). Forty-five college athletes across various sports were recruited to participate in the study (age, 23.7 ± 4.0 y; mass, 87.5 ± 16.1 kg; height, 1.80 ± 0.08 m). Pearson correlation results showed that there was a moderate association (r = .302–.431) between maximum-strength variables (absolute, relative, and allometric scaled PF) and RSI at 0.3, 0.4, 0.5 and 0.6 m (P ≤ .05). In addition, 2-tailed independent-samples t tests showed that the RSIs for relatively stronger athletes (49.59 ± 2.57 N/kg) were significantly larger than those of weaker athletes (33.06 ± 2.76 N/kg) at 0.4 m (Cohen d = 1.02), 0.5 m (d = 1.21), and 0.6 m (d = 1.39) (P ≤ .05). Weaker athletes also demonstrated significant decrements in RSI as eccentric stretch loads increased at 0.3-m through 0.6-m box heights, whereas stronger athletes were able to maintain their reactive-strength ability. This research highlights that in specific sporting scenarios, when there are high eccentric stretch loads and fast stretch-shortening-cycle demands, athletes’ reactive-strength ability may be dictated by their relative maximal strength, specifically eccentric strength.

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Timothy F. Tyler, Brandon M. Schmitt, Stephen J. Nicholas and Malachy P. McHugh

Context:

Hamstring-strain injuries have a high recurrence rate.

Objective:

To determine if a protocol emphasizing eccentric strength training with the hamstrings in a lengthened position resulted in a low recurrence rate.

Design:

Longitudinal cohort study.

Setting:

Sports-medicine physical therapy clinic.

Participants:

Fifty athletes with hamstring-strain injury (age 36 ± 16 y; 30 men, 20 women; 3 G1, 43 G2, 4 G3; 25 recurrent injuries) followed a 3-phase rehabilitation protocol emphasizing eccentric strengthening with the hamstrings in a lengthened position.

Main Outcome Measures:

Injury recurrence; isometric hamstring strength at 80°, 60°, 40°, and 20° knee flexion in sitting with the thigh flexed to 40° above the horizontal and the seat back at 90° to the horizontal (strength tested before return to sport).

Results:

Four of the 50 athletes sustained reinjuries between 3 and 12 mo after return to sport (8% recurrence rate). The other 42 athletes had not sustained a reinjury at an average of 24 ± 12 mo after return to sport. Eight noncompliant athletes did not complete the rehabilitation and returned to sport before initiating eccentric strengthening in the lengthened state. All 4 reinjuries occurred in these noncompliant athletes. At time of return to sport, compliant athletes had full restoration of strength while noncompliant athletes had significant hamstring weakness, which was progressively worse at longer muscle lengths (compliance × side × angle P = .006; involved vs noninvolved at 20°, compliant 7% stronger, noncompliant 43% weaker).

Conclusion:

Compliance with rehabilitation emphasizing eccentric strengthening with the hamstrings in a lengthened position resulted in no reinjuries.

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Timothy L. Uhl, Thomas Rice, Brianna Papotto and Timothy A. Butterfield

Context:

The role of the rotator cuff is to provide dynamic stability to the glenohumeral joint. Human and animal studies have identified sarcomerogenesis as an outcome of eccentric training indicated by more torque generation with the muscle in a lengthened position.

Objective:

The authors hypothesized that a home-based eccentric-exercise program could increase the shoulder external rotators’ eccentric strength at terminal internal rotation (IR).

Design:

Prospective case series.

Setting:

Clinical laboratory and home exercising.

Participants:

10 healthy subjects (age 30 ± 10 y).

Intervention:

All participants performed 2 eccentric exercises targeting the posterior shoulder for 6 wk using a home-based intervention program using side-lying external rotation (ER) and horizontal abduction.

Main Outcome Measures:

Dynamic eccentric shoulder strength measured at 60°/s through a 100° arc divided into 4 equal 25° arcs (ER 50–25°, ER 25–0°, IR 0–25°, IR 25–50°) to measure angular impulse to represent the work performed. In addition, isometric shoulder ER was measured at 5 points throughout the arc of motion (45° IR, 30° IR, 15° IR, 0°, and 15° ER). Comparison of isometric and dynamic strength from pre- to posttesting was evaluated with a repeated-measure ANOVA using time and arc or positions as within factors.

Results:

The isometric force measures revealed no significant differences between the 5 positions (P = .56). Analysis of the dynamic eccentric data revealed a significant difference between arcs (P = .02). The percentage-change score of the arc of IR 25–50° was found to be significantly greater than that of the arc of IR 0–25° (P = .007).

Conclusion:

After eccentric training the only arc of motion that had a positive improvement in the capacity to absorb eccentric loads was the arc of motion that represented eccentric contractions at the longest muscle length.

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Martin Buchheit, Yannick Cholley, Mark Nagel and Nicholas Poulos

Purpose:

To examine the effect of body mass (BM) on eccentric knee-flexor strength using the Nordbord and offer simple guidelines to control for the effect of BM on knee-flexor strength.

Methods:

Data from 81 soccer players (U17, U19, U21, senior 4th French division, and professionals) and 41 Australian Football League (AFL) players were used for analysis. They all performed 1 set of 3 maximal repetitions of the bilateral Nordic hamstring exercise, with the greatest strength measure used for analysis. The main regression equation obtained from the overall sample was used to predict eccentric knee-flexor strength from a given BM (moderate TEE, 22%). Individual deviations from the BM-predicted score were used as a BM-free index of eccentric knee- flexor strength.

Results:

There was a large (r = .55, 90% confidence limits .42;.64) correlation between eccentric knee-flexor strength and BM. Heavier and older players (professionals, 4th French division, and AFL) outperformed their lighter and younger (U17–U21) counterparts, with the soccer professionals presenting the highest absolute strength. Professional soccer players were the only ones to show strength values likely slightly greater than those expected for their BM.

Conclusions:

Eccentric knee-flexor strength, as assessed with the Nordbord, is largely BM-dependent. To control for this effect, practitioners may compare actual test performances with the expected strength for a given BM, using the following predictive equation: Eccentric strength (N) = 4 × BM (kg) + 26.1. Professional soccer players with specific knee-flexor-training history and enhanced neuromuscular performance may show higher than expected values.

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Alison R. Valier, Ryan S. Averett, Barton E. Anderson and Cailee E. Welch Bacon

Clinical Scenario:

Shoulder pain is a common musculoskeletal complaint and is often associated with shoulder impingement. The annual incidence of shoulder pain is estimated to be 7% of all injuries, and is the third-most-common type of musculoskeletal pain. Initial treatment of shoulder impingement follows a conservative plan and emphasizes rehabilitation programs as opposed to surgical interventions. Shoulder rehabilitation programs commonly focus on strengthening the muscles of the shoulder complex and, more specifically, the rotator cuff. The rotator cuff is a primary dynamic stabilizer of the glenohumeral joint, using both eccentric and concentric contractions. The posterior rotator cuff, including teres minor and infraspinatus, works eccentrically to decelerate the arm during overhead throwing. Exercises to strengthen the rotator cuff and the surrounding dynamic stabilizers of the shoulder girdle vary and include activities such as internal and external rotation, full-can lifts, and rhythmic stabilizations. Traditionally, shoulder rehabilitation programs have focused on isotonic concentric contractions. Common strengthening exercises typically involve movements that result in shortening the muscle length while simultaneously loading the muscles. However, recent attention has been given to eccentric exercises, which involve lengthening of the muscle during loading, for the treatment of a variety of different tendinopathies including those of the Achilles and patellar tendons. The eccentric, or lengthening, motion is thought to be beneficial for people who are involved in activities that place eccentric stress on their shoulder, such as overhead throwers. Based on studies related to the Achilles tendon, eccentric exercise may positively influence the tendon structure by increasing collagen production and decreasing neovascularization. The changes that occur as a result of eccentric exercises may improve function, strength, and performance and decrease pain more than concentric programs, producing better patient outcomes. Although eccentric strength training has been shown to provide strength gains, there are no clear guidelines as to the inclusion of this form of exercise training in shoulder rehabilitation programs for the purposes of improving function and decreasing pain.

Focused Clinical Question:

Does adding an eccentric-exercise component to the rehabilitation program of patients with shoulder impingement improve shoulder function and/or decrease pain?

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Theofanis Tzatzakis, Konstantinos Papanikolaou, Dimitrios Draganidis, Panagiotis Tsimeas, Savvas Kritikos, Athanasios Poulios, Vasiliki C. Laschou, Chariklia K. Deli, Athanasios Chatzinikolaou, Alexios Batrakoulis, Georgios Basdekis, Magni Mohr, Peter Krustrup, Athanasios Z. Jamurtas and Ioannis G. Fatouros

eccentric strength of DL and NDL at 48 hours were lower than in C ( P  < .05) (Table  6 ). In SEPT/1:8, KF eccentric strength of DL at 24 and 48 hours and KF eccentric strength of NDL were lower than in C ( P  < .05). However, no differences were observed between the 2 SEPT trials. Table 6 Changes in

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Neil Chapman, John Whitting, Suzanne Broadbent, Zachary Crowley-McHattan and Rudi Meir

, the eccentric strength (torque) during stretch increased as velocity increased from 15 deg/s up to 120 deg/s and plateaued in velocities greater than this value. Eccentric strength at 15 deg/s was 20% and 40% greater than isometric strength in young and old men, respectively, while at 360 deg