Hybrid neuromuscular training promotes musculoskeletal adaptations in inactive overweight and obese women: A training-detraining randomized controlled trial.

This study investigated the effects of a 10-month high-intensity interval-type neuromuscular training programme on musculoskeletal fitness in overweight and obese women. Forty-nine inactive females (36.4 ± 4.4 yrs) were randomly assigned to either a control (N = 21), a training (N = 14, 10 months) or a training-detraining group (N = 14, 5 months training followed by 5 months detraining). Training used progressive loaded fundamental movement patterns with prescribed work-to-rest intervals (1:2, 1:1, 2:1) in a circuit fashion (2-3 rounds). Muscular strength and endurance, flexibility, passive range of motion (PRoM), static balance, functional movement screen (FMS) and bone mass density (BMD) and content (BMC) were measured at pre-, mid-, and post-intervention. Ten months of training induced greater changes than the controls in (i) BMD (+1.9%, p < 0.001) and BMC (+1.5%, p = 0.023) ii) muscular strength (25%-53%, p = 0.001-0.005); iii) muscular endurance (103%-195%, p < 0.001); and iv) mobility (flexibility: 40%, p < 0.001; PRoM [24%-53%, p = 0.001-0.05;]; balance: 175%, p = 0.058; FMS: +58%, p < 0.001). The response rate to training was exceptionally high (86-100%). Five months of detraining reduced but not abolished training-induced adaptations. These results suggest that a hybrid-type exercise approach integrating endurance-based bodyweight drills with resistance-based alternative modes into a real-world gym setting may promote musculoskeletal fitness in overweight and obese women.

Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

CONTEXT: The effects of an exercise program (EP) for the treatment of patellofemoral pain syndrome (PFPS) are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear. OBJECTIVE: To evaluate the effects of OMT versus EP on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with PFPS. DESIGN: This is a randomized controlled trial. SETTING: Human performance laboratory. PARTICIPANTS: A total of 82 runners with PFPS participated in this study. INTERVENTIONS: The participants were randomized into 3 groups: OMT, EP, and control group. The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. The EP group performed specific exercises for lower limbs. The control group received no intervention. MAIN OUTCOME MEASURES: The main evaluations were pain through the visual analog scale, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up. RESULTS: There was a significant pain decrease in the OMT and EP groups when compared with the control group. OMT group showed increased functionality, decreased PPMF, and increased PTF. The range of motion for hip extension increased only in the EP group. CONCLUSION: Both OMT and EP are effective in treating runners with PFPS.

Dry Needling for Hamstring Flexibility: A Single-Blind Randomized Controlled Trial.

CONTEXT: Hamstring muscle tightness is one of the most common problems in athletic and healthy people. Dry needling (DN) was found to be an effective approach for improving muscle flexibility, but there is no study to compare this approach with static stretching (SS) as a common technique for the increase of muscle length. OBJECTIVE: To compare the immediate effects of DN and SS on hamstring flexibility in healthy subjects with hamstring tightness. STUDY DESIGN: A single-blind randomized controlled trial. SETTING: A musculoskeletal physiotherapy clinic at Tehran University of Medical Sciences. SUBJECTS: Forty healthy subjects (female: 32, age range: 18-40 y) with hamstring tightness were randomly assigned into 2 groups of DN and SS. INTERVENTION: The DN group received a single session of DN on 3 points of the hamstring muscles, each for 1 minute. The SS group received a single session of SS of the hamstrings, consisting of 3 sets of 30-second SS with a 10-second rest between sets in the active knee extension test (AKET) position. MAIN OUTCOME MEASURES: The AKET, muscle compliance, passive peak torque, and stretch tolerance were measured at the baseline, immediately, and 15 minutes after the interventions. RESULTS: Improvements in all outcomes was better for the DN group than for the SS group. DN increased muscle compliance significantly 15 minutes after the intervention, but it did not improve in the SS group. CONCLUSION: DN is effective in improving hamstring flexibility compared with SS. One session of DN can be an effective treatment for hamstring tightness and increase hamstring flexibility. The improvements suggest that DN is a novel treatment for hamstring flexibility.

Outcome of 24 Weeks of Combined Schroth and Pilates Exercises on Cobb Angle, Angle of Trunk Rotation, Chest Expansion, Flexibility and Quality of Life in Adolescents with Idiopathic Scoliosis.

BACKGROUND This study aimed to quantify the outcomes of combining Schroth and Pilates exercises on the Cobb angle, angle of trunk rotation (ATR), chest expansion, flexibility (trunk flexion), and quality of life (QoL) in adolescents with mild and moderate idiopathic scoliosis. MATERIAL AND METHODS Sixty-nine adolescents with idiopathic scoliosis aged 10-17 years, presenting with a Cobb angle of 10-45º were enrolled in this study. The treatment protocol, including selected exercises from Schroth and Pilates methods, was performed over 24 weeks and consisted of 2 periods of 2-week treatment regimens performed daily for 60 minutes. Each of treatment periods was then followed by the same home program treatment for 10 weeks. Cobb angle (x-rays), ATR (Scoliometer), chest expansion (cm), trunk flexion (cm, distance between C7 to S2 with measuring tape), and QoL (SRS-22r Scoliosis Research Society Questionnaire) were assessed pre-treatment, at 12 week, and at 24 weeks. RESULTS Significant improvements (P<0.05) were found in both groups of patients wearing and not wearing a brace for Cobb angle (from 21.97±4.99° to 18.11±6.39°; from 14.19±3.11° to 11.66±2.73°), angle of trunk rotation (from 7.19±1.36° to 5.36±1.66°; from 4.72±1.04° to 3.58±0.94°), chest expansion (from 2.56±0.84 cm to 3.46±0.72 cm; from 2.57±0.87 cm to 3.52±0.72 cm), trunk flexion (from 9.55±1.95 cm to 14.33±2.40 cm; from 9.82±2.61 cm to 13.98±2.18 cm) and QoL (from 3.50±0.27 to 3.82±0.2; from 3.42±0.24 to 3.78±0.23) respectively. CONCLUSIONS This study showed that combined exercises provided benefit on the Cobb angle, ATR, chest expansion, trunk flexion and QoL in adolescents with mild and moderate idiopathic scoliosis.

Accidentalidad vial: efectos de la calidaddel sueño en el funcionamiento ejecutivo deconductores de transporte público urbano / Road accident: effects of sleep quality on the executiveFunctioning of urban public transport drivers

El propósito de este estudio fue comprender cómo la calidad del sueño, los cam-bios de las funciones ejecutivas y su posible asociación con la accidentalidad vial en los conductores de servicio de transporte público urbano son temas fundamentales para los escenarios de prevención de accidentes en las ciudades. Esta investigación se desarrolló con un diseño cuantitativo-analítico, observacional, prospectivo y re-trospectivo, para evaluar estos tres puntos, a saber: la calidad de sueño, el funciona-miento ejecutivo y su relación con la siniestralidad de tránsito. A partir de un sondeo preliminar, realizado en trabajadores de servicio público y urbano en el 2010, se hizo una segunda evaluación en 2016 para examinar la trazabilidad de los cambios observables en los tres factores delimitados. Nuestro estudio pudo determinar que la perturbación del sueño sugiere una tendencia al deterioro en la ejecución de tareas que exigen flexibilidad y planificación, lo cual contribuye a aumentar la accidentali-dad vial entre los conductores de servicio público.

The objective of this study is to understand how sleep quality, changes in executive functions and the possible association with the presence of traffic accidents in ur-ban public transport service drivers is fundamental in accident prevention context in cities. This research developed a quantitative-analytical, observational, prospective and retrospective design, to evaluate three essential points: sleep quality, executive function and their relationship with the traffic accident rate of drivers. From a pre-liminary observation of public service and urban drivers made in 2010, a second evaluation was made up to 2016, to examine the three chosen factors. Our study was able to determine that the effect on sleep quality suggests a trend towards a de-terioration in flexibility and planning tasks, which contributes to an increase in road accidents among public service drivers

Exercise Interventions for Improving Flexibility in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis.

Background and objectives: People with multiple sclerosis (MS) often experience limitations in joint range of motion, which is linked to spasticity and continued inactivity. Low flexibility levels in this population have been linked to postural problems and muscular pain. Therefore, the purpose of this study was to conduct a systematic review and a meta-analysis aimed at identifying the characteristics and methodological quality of investigations studying the effects of exercise interventions on the flexibility levels of people with MS. Materials and Methods: Three electronic databases (MEDLINE/PubMed, SPORTDiscus and Scopus) were systematically searched up to May 2019 for intervention studies focused on the effects of exercise on the flexibility levels of people with MS. A meta-analysis, including randomized controlled trials (RCT), which reported information regarding the effects of exercise on flexibility, was also conducted. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database, and the Quality Assessment Tool for Before-After Studies, with no control group. The quality of the information reported, regarding the programs conducted, was assessed by means of the Consensus on Exercise Reporting Template (CERT) scale. Results: Seven studies, four RCTs and three uncontrolled investigations were finally selected. The methodological quality of the RCTs was considered "poor" in one study, and "good" and "excellent" in two studies and one investigation, respectively. The three uncontrolled studies showed a methodological quality between "fair" and "poor". Following the CERT scale, four studies were graded as "high" and three as "low". Findings from the meta-analysis indicated no significant effects on hamstring flexibility, or the range of motion in the hips, knees or ankles. Conclusions: There is preliminary evidence from individual studies which indicates that people with MS can improve their lower limb flexibility following participation in physical exercise programs, but the meta-analysis did not confirm these findings.

Age differences in emotion regulation strategy use, variability, and flexibility: An experience sampling approach.

Life span developmental theories suggest that as individuals age, they accumulate knowledge about how to deploy emotion regulation (ER) strategies effectively and learn how to match their ER strategy use with changes in situational demands. Using an event-contingent experience sampling design wherein 150 adults Age 18 to 89 years reported on 64,213 social interactions (M = 427.41, SD = 145.66) during 9 weeks of daily life, this study examines (a) age-related differences in individuals' usual ER strategy use (reappraisal, suppression) during everyday social interactions, (b) age-related differences in how much individuals' use of these two strategies varies across social situations-ER variability, and (c) age-related differences in the extent to which ER strategy use covaries with relational (close vs. nonclose others) and emotional (happy, sad) contextual features of those social situations-ER flexibility. In line with a small body of prior work, usual ER strategy use did not differ across adulthood and ER variability was lower at older ages. Results from multilevel models of intraindividual covariation suggested that individuals flexibly matched their ER strategy implementation to changes in emotional context-especially when interacting with close others. The results also provided evidence that the intraindividual covariation between relational context and use of suppression was weaker at older ages. Beyond these specific findings, this study demonstrated the utility of experience sampling designs, event-contingent reports, and the measurement/modeling of intraindividual variation and covariation for study of emotional development across the life span. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Readiness for En Pointe Work in Young Ballet Dancers Are There Proven Screening Tools and Training Protocols for a Population at Increased Risk of Injury?

To progress to a high level in classical ballet, en pointe is a requirement. The aim of this literature review was to evaluate the available evidence relating to readiness for dancing en pointe, including injury rates in the adolescent dancer population, screening tools, and pre-pointe training methods. It has been emphasized that young dancers are a demographic at increased risk of injury, especially as they progress through the growth spurt and increase their training hours. Dancers are commonly screened at the pre-pointe level, but unfortunately the majority of evidence resulting from this process, as reported in the literature, is subjective in nature. Hence, there is large variance regarding an appropriate time or level to commence en pointe training, and it remains unclear what dance teachers should be looking for in making this decision. A further paucity of evidence is demonstrated with regard to pre-pointe training protocols or instruction; in this review, no published literature was found on the topic. As such, there is a clear need for further study of pre-pointe screening and en pointe training protocols.

Standing task difficulty related increase in agonist-agonist and agonist-antagonist common inputs are driven by corticospinal and subcortical inputs respectively.

In standing, coordinated activation of lower extremity muscles can be simplified by common neural inputs to muscles comprising a functional synergy. We examined the effect of task difficulty on common inputs to agonist-agonist (AG-AG) pairs supporting direction specific reciprocal muscle control and agonist-antagonist (AG-ANT) pairs supporting stiffness control. Since excessive stiffness is energetically costly and limits the flexibility of responses to perturbations, compared to AG-ANT, we expected greater AG-AG common inputs and a larger increase with increasing task difficulty. We used coherence analysis to examine common inputs in three frequency ranges which reflect subcortical/spinal (0-5 and 6-15 Hz) and corticospinal inputs (6-15 and 16-40 Hz). Coherence was indeed higher in AG-AG compared to AG-ANT muscles in all three frequency bands, indicating a predilection for functional synergies supporting reciprocal rather than stiffness control. Coherence increased with increasing task difficulty, only in AG-ANT muscles in the low frequency band (0-5 Hz), reflecting subcortical inputs and only in AG-AG group in the high frequency band (16-40 Hz), reflecting corticospinal inputs. Therefore, common neural inputs to both AG-AG and AG-ANT muscles increase with difficulty but are likely driven by different sources of input to spinal alpha motor neurons.

Inherent versus induced protein flexibility: Comparisons within and between apo and holo structures.

Understanding how ligand binding influences protein flexibility is important, especially in rational drug design. Protein flexibility upon ligand binding is analyzed herein using 305 proteins with 2369 crystal structures with ligands (holo) and 1679 without (apo). Each protein has at least two apo and two holo structures for analysis. The inherent variation in structures with and without ligands is first established as a baseline. This baseline is then compared to the change in conformation in going from the apo to holo states to probe induced flexibility. The inherent backbone flexibility across the apo structures is roughly the same as the variation across holo structures. The induced backbone flexibility across apo-holo pairs is larger than that of the apo or holo states, but the increase in RMSD is less than 0.5 Å. Analysis of χ1 angles revealed a distinctly different pattern with significant influences seen for ligand binding on side-chain conformations in the binding site. Within the apo and holo states themselves, the variation of the χ1 angles is the same. However, the data combining both apo and holo states show significant displacements. Upon ligand binding, χ1 angles are frequently pushed to new orientations outside the range seen in the apo states. Influences on binding-site variation could not be easily attributed to features such as ligand size or x-ray structure resolution. By combining these findings, we find that most binding site flexibility is compatible with the common practice in flexible docking, where backbones are kept rigid and side chains are allowed some degree of flexibility.

Quantitative Measures Utilized in Determining Pointe Readiness in Young Ballet Dancers.

While an important step in a young dancer's ballet career is the transition to pointe work, there is much controversy as to when her body is physically prepared to meet the increased demands of this development. Pointe screening protocols are being used by many in both the dance studio and dance science communities, but these protocols have not yet been standardized. The purpose of this study was to evaluate objectively the attributes of ballet dancers who are pre-pointe compared to those who have recently begun pointe training, and secondarily to correlate these quantitative findings with qualitative evaluations by the dancers' teachers. Participants were 49 healthy young female dancers with at least 1 year of formal ballet training. Twentyeight were pre-pointe students (age: 10.21 ± 1.17 years; height: 124.05 ± 13.45 cm; weight: 39.13 ± 13.18 kg; and 6.04 ± 1.84 years dance experience), and 21 were pointe students (age: 11.42 ± 0.81 years; height: 136.91 ± 16.04 cm; weight: 40.79 ± 8.77 kg; and 6.45 ± 2.07 years dance experience). Six dependent variables were evaluated: non-weightbearing (NWB) plantar flexion (PF) and dorsiflexion (DF) range of motion (ROM); weightbearing lunge test (WBL); relevé endurance (heel raise test); PF isometric strength; Airplane test; and Star Excursion Balance Test (SEBT) in three directions. These tests were broken into three categories for statistical analysis: ROM (NWB PF and DF, WBL), muscular capacity (relevé endurance, PF isometric strength), and balance (Airplane, SEBT). The analysis demonstrated that the pointe group performed significantly better than the pre-pointe group on the muscular capacity and balance testing (p < 0.01). Calculations for both tests indicated that 15 continuous single-leg relevés and two repetitions of the Airplane test may be the best cut-off levels when using these tests as part of a pre-pointe screening protocol. In conclusion, the relevé endurance test and the Airplane test are appropriate for use in differentiating between pre-pointe and pointe dancers.

Childhood socioeconomic position and physical capability in late-middle age in two birth cohorts from the Copenhagen aging and midlife biobank.

This study examines the association between childhood socioeconomic position and objective physical capability including new functional measures of potential relevance to a population in late-middle age. The study population covers two Danish birth cohorts followed-up in the Copenhagen Aging and Midlife Biobank (age 48-58 years, 2009-2011, N = 4,204). Results from linear regression models revealed that being born in higher socioeconomic position was associated with higher jump height: Paternal occupational class four = 0.19 cm (95% confidence interval (CI): -0.44, 0.82), three = 0.59 cm (95% CI: -0.02, 1.19), two = 1.29 cm (95% CI: 0.64, 1.94), and one = 1.29 cm (95% CI: 0.45, 2.13) (reference = five); medium parental social class = 0.88 cm (95% CI: 0.03, 1.72) and high = 1.79 cm (95% CI: 0.94, 2.63) (reference = low). Higher childhood socioeconomic position was also associated with better chair rise performance and hand grip strength, while among women it was related to reduced flexibility: Medium parental social class = -1.31 cm (95% CI: -3.05, 0.42) and high = -2.20 cm (95% CI: -3.94, -0.47) (reference = low); unwed mother = 1.75 cm (95% CI: 0.36, 3.14) (reference = married). Overall, the findings suggest that higher childhood socioeconomic position is primarily related to moderately better scores in the most strenuous physical capability measures and hand grip strength among healthy adults in late-middle age.

Footwear for self-managing knee osteoarthritis symptoms: protocol for the Footstep randomised controlled trial.

BACKGROUND: Knee osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability globally, and abnormal knee loading is central to disease pathogenesis. Clinical guidelines recommend clinicians provide advice regarding appropriate footwear for people with knee OA, yet there is little research comparing the effects of different footwear on knee OA symptoms. Research suggests that wearing flat flexible shoes is associated with lower knee joint loads compared to stable supportive shoe styles. This two-arm pragmatic, comparative effectiveness randomised controlled trial will compare the effects of daily use of flat flexible shoes and stable supportive shoes on knee OA clinical outcomes, over 6 months. METHODS: 164 people with symptomatic medial tibiofemoral OA of moderate to severe radiographic severity (Kellgren and Lawrence Grade 3 & 4) will be recruited from the community. Following baseline assessment, participants will be randomly allocated to receive either i) flat flexible shoes or; ii) stable supportive shoes. Participants will choose two different pairs of shoes from a selection that fulfil the criteria in their allocated shoe class. Limited disclosure will blind participants to group allocation. Participants will be instructed to wear their allocated shoes daily for 6 months (minimum of 6 h/day), after which participants will be reassessed. The primary outcomes are knee pain severity on walking (measured by numerical rating scale) and self-reported physical function (measured by the Western Ontario and McMaster Universities Osteoarthritis Index), assessed at baseline and 6 months. Secondary outcomes include additional measures of knee pain, function, sport and recreation participation and quality-of-life (measured using subscales of the Knee Osteoarthritis Outcome Score), as well as pain at other sites (measured by numerical rating scale), self-reported global ratings of change in pain and physical function (measured by 7-point rating scale), and physical activity levels (measured by Physical Activity Scale for the Elderly). DISCUSSION: This study will determine whether daily wear of flat flexible shoes improves clinical outcomes in the management of knee OA, compared to stable supportive shoes. Findings will assist clinicians in providing evidence-based advice regarding appropriate footwear for people with knee OA to self-manage symptoms. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN12617001098325 . Registered 28/07/2017.

Effect of whole-body vibration on neuromuscular performance: A literature review.

BACKGROUND: Whole-body vibration (WBV) is a neuromuscular training method that has recently received popularity in health and fitness centers, as an additional or substitute method to conventional training and therapy, in order to improve muscle strength and power. OBJECTIVE: The purpose of this review is to critically observe the effect of WBV training on neuromuscular performance in view of its ability to enhance the muscles strength, power, and flexibility; and also to investigate the influence of the different vibration characteristics (viz., method of application of vibration, frequency, and amplitude) and exercise protocols on the effect of this training. METHOD: For this review 24 studies or articles were examined, and based on exclusion and inclusion criteria, 5 studies were finally selected; and an attempt was made to uncover the factors influencing the improvement in neuromuscular performance as a result of WBV intervention. During the review, it was considered to include and discuss as many characteristics as possible, such as, knee extension, knee flexion, counter movement jump (CMJ), squat exercise, and jumping height (JH). RESULT: Whole-body vibration, along with additional exercise training, has a potential to induce substantial improvement in neuromuscular performance. CONCLUSION: Whole-body vibration can bring about improvement in muscles strength, power, and flexibility. The main factors associated with the improvement in muscles performance are range of amplitude and frequency, type of vibration and its method of application, training intensity, exercise protocol, and the characteristics of the participants.

An In Vitro Biomechanical Study on Ovine Rib Flexibility With Increasing Deconstruction-As an Alternative to Rib Resection for Costoplasty.

STUDY DESIGN: An in vitro biomechanical study into the effect of rib deconstruction on the flexibility in ovine ribs, using three-point bending. OBJECTIVE: To examine the feasibility and possible effectiveness of a more conservative costoplasty using an in vitro animal model. SUMMARY OF BACKGROUND DATA: Costoplasty remains useful in the treatment of adolescent idiopathic scoliosis, rib hump, and associated chest wall deformities. However, traditional costoplasty increases morbidity and blood loss. METHODS: Ribs 2-10 were dissected from four fresh half ovine rib cages. The ribs were randomly allocated to Groups 1 to 4. The ribs underwent deconstruction, 10 mm from the lateral tubercle and 30 mm long, according to their group: Group 1 = control; Group 2 = convex cortical bone removed; Group 3 = convex cortical and cancellous bone removed; Group 4 = all but the ventral cortex is removed. Flexibility was tested by loading the concave side of each rib while fixed at the rib head and equidistant from the center of the resected area. The ribs were deformed at 0.5 mm/s up to a maximum load of 9.99 kg or fracturing. Load was plotted against displacement to find the load/displacement coefficient for each group. Statistical analysis was by an analysis of variance with Tukey's honestly significant difference post hoc testing. RESULTS: The load/displacement coefficients were as follows: Group 1 = 131.93 (±27.52) N/mm, Group 2 = 93.36 (±40.71) N/mm, Group 3 = 88.66 (±25.84) N/mm, and Group 4 = 29.69 (±29.11) N/mm. Group 4 was significantly less stiff than Groups 1, 2, and 3 (p < .01). No ribs in Groups 1, 2, and 4 fractured. Five of 8 ribs in Group 3 fractured during loading. CONCLUSIONS: Deconstructing the rib down to the concave side significantly increases the flexibility by approximately 4.5 times. Despite large removal of bone, it retains the ability to withstand 10 kg of load without fracture.

Association of body flexibility and carotid atherosclerosis in Japanese middle-aged men: a cross-sectional study.

OBJECTIVE: This study examined the associations of body flexibility with carotid arterial remodelling, including intima-media thickness (IMT) and plaque formation in middle-aged men. METHODS: The subjects of this cross-sectional study included 1354 Japanese men aged 35-59 years without histories of stroke or cardiac diseases. The arm extensibility test, which can estimate flexibility of the upper extremity (composed of shoulder external rotation and forearm supination), and the sit-and-reach test were performed. Common carotid IMT and plaque formation (≥1.1 mm) were estimated by ultrasound. RESULTS: The proportion of subjects who fully completed the arm extensibility test was 55.0%, and who had plaques in the common carotid artery was 37.8%. IMT was associated with poor arm extensibility (ß=-0.073, 95% CI -0.02224 to -0.00041, P=0.004), while plaque formation was associated with poor sit-and-reach (OR 0.98579, 95% CI 0.97257 to 0.99919, P=0.038) after adjustment by all covariates. CONCLUSIONS: This study demonstrated that poor upper extremity and trunk flexibility were associated with characteristics of early onset of atherosclerosis. Furthermore, these associations were independent of covariates such as age, blood pressure, blood lipids glucose levels and abdominal fat accumulation, handgrip strength and lifestyle, including sleeping, drinking, exercise and smoking habits. Poor flexibility may reflect subclinical atherosclerosis in middle-aged men.

Association of prospective lower extremity musculoskeletal injury and musculoskeletal, balance, and physiological characteristics in Special Operations Forces.

OBJECTIVES: Previous research has examined lower extremity (LE) musculoskeletal injury (MSI) patterns and risk factors in Special Operations Forces (SOF) trainees, conventional military personnel, and athletes; however, it is unclear if SOF have the same patterns/risk factors. This study aimed to determine the association of musculoskeletal, balance, and physiological characteristics with LE MSI in SOF. DESIGN: Cohort study. METHODS: A total of 726 Air Force (N=140), Navy Sea, Air, and Land (N=301), and Special Warfare Combatant Crewmen (N=285) SOF (age=25.72±4.77years, height=178.34±6.63cm, weight=84.28±9.03kg) participated in laboratory testing, including: LE muscular strength and flexibility; balance; body composition; anaerobic power/capacity; and aerobic capacity. Medical charts were reviewed for LE MSI 365days following laboratory testing. Participants were assigned by injury status and laboratory data stratified by tertile. Chi-square statistics were calculated to determine the frequency of LE MSI across tertiles for each characteristic. RESULTS: There was a significant association between LE MSI and: ankle inversion strength (weaker side: Χ(2)=17.703; stronger side: Χ(2)=18.911; p≤0.001); ankle eversion/inversion strength ratio (lower side: Χ(2)=13.456; higher side: Χ(2)=16.885; p≤0.001); hamstring flexibility (less flexible: Χ(2)=19.930; more flexible Χ(2)=15.185; p≤0.001); gastrocnemius-soleus flexibility (less flexible: Χ(2)=7.889, p=0.019); dynamic balance asymmetry (Χ(2)=7.444, p=0.024); Vestibular and Preference ratios (Χ(2)=9.124, p=0.010 and Χ(2)=6.572, p=0.037, respectively); and aerobic capacity (Χ(2)=13.935, p=0.001). CONCLUSIONS: Characteristics associated with LE MSI are unique in SOF. Human performance program initiatives should include efforts to optimize ankle strength and flexibility, maintain moderate hamstring flexibility, expand dynamic balance strategies, and maximize aerobic capacity to reduce LE MSI risk.

Self-Mobilization Using a Foam Roller Versus a Roller Massager: Which Is More Effective for Increasing Hamstrings Flexibility?

Clinical Scenario: Increasing the length of the muscle-tendon unit may prevent musculotendinous injury. Various methods have been proposed to increase muscle-tendon flexibility, including self-mobilization using foam rollers or roller massagers, although the effectiveness of these devices is uncertain. This review was conducted to determine if the use of foam rollers or roller massagers to improve hamstrings flexibility is supported by moderate- to high-quality evidence. CLINICAL QUESTION: Are foam rollers or roller massagers effective for increasing hamstrings flexibility in asymptomatic physically active adults? Summary of Key Findings: The literature was searched for studies on the effects of using foam rollers or roller massagers to increase hamstrings flexibility in asymptomatic physically active adults. Four randomized controlled trials were included; 2 studies provided level 2 or 3 evidence regarding foam rollers and 2 studies provided level 2 or 3 evidence regarding roller massagers. Both roller-massager studies reported increases in hamstrings flexibility after treatment. Data from the foam-roller studies did not demonstrate a statistically significant increase in hamstrings flexibility, but 1 study did demonstrate a strong effect size. Clinical Bottom Line: The reviewed moderate-quality studies support the use of roller massagers but provide limited evidence on the effectiveness of foam rolling to increase hamstrings flexibility in asymptomatic physically active adults. Flexibility gains may be improved by a longer duration of treatment and administration by a trained therapist. Gains appear to decline rapidly postrolling. Neither device has been shown to confer a therapeutic benefit superior to static stretching, and the effectiveness of these devices for preventing injury is unknown. Strength of Recommendation: Grade B evidence supports the use of roller massagers to increase hamstrings flexibility in asymptomatic physically active adults.

Effects of Sling Exercise on Flexibility, Balance Ability, Body Form, and Pain in Patients With Chronic Low Back Pain.

PURPOSE: The aim of this study was to investigate the effects of sling exercise on pain, balance, flexibility, and body form in patients with chronic low back pain (LBP). DESIGN: The pretest-posttest control group design. METHODS: Thirty participants with chronic lumbar pain were divided into three groups (Sling only, Sling + Swing stick flexible bar, and Sling + Ball cushion) and exercised for 12 weeks. FINDINGS: All types of sling exercises provided significant positive effects on pain scale, body balance, flexibility, and body form. In particular, the sling exercise with swing stick flexible bar or ball cushion was more effective on body form, flexibility, and balance than a sling alone. CONCLUSIONS: In conclusion, sling exercises over a period of 12 weeks had positive effects on flexibility, balance, pain, and body form in patients with chronic lumbar pain. CLINICAL RELEVANCE: This study has generated effects of sling exercise, which will assist nursing practitioners in prescribing the beneficial physical rehabilitation for patients with chronic LBP.