Use of Ultrasound to Monitor Biceps Femoris Mechanical Adaptations after Injury in a Professional Soccer Player.

This study examined the use of ultrasound to monitor changes in the long head of the biceps femoris (BF) architecture of aprofessional soccer player with acute first-time hamstring strain. The player followed a 14 session physiotherapy treatment until return to sport. The pennation angle and aponeurosis strain of the long head of the biceps femoris (BF) were monitored at 6 occasions (up until 1 year) after injury. The size of the scar / hematoma was reduced by 63.56% (length) and 67.9% (width) after the intervention and it was almost non-traceable one year after injury. The pennation angle of the fascicles underneath the scar showed a decline of 51.4% at the end of the intervention while an increase of 109.2% of the fascicles which were closer to deep aponeurosis was observed. In contrast, pennation angle of fascicles located away from the injury site were relatively unaffected. The treatment intervention resulted in a 57.9% to 77.3% decline of maximum strain per unit of MVC moment and remained similar one year after the intervention. This study provided an example of the potential use of ultrasound-based parameters to link the mechanical adaptations of the injured muscle to specific therapeutic intervention. Key pointsChanges in fascicle orientation after biceps femoris mild tear were reduced after a 28 day intervention and remained similar one year after injury.Tendon/aponeurosis strain per unit of moment of force decreased during the course of the therapeutic intervention.Future studies could utilize ultrasonography to monitor mechanical responses after various types of hamstring injury and interventions in order to improve criteria for a safe return to sport.

Reliability of Single-leg and Double-leg Balance Tests in Subjects with Anterior Cruciate Ligament Reconstruction and Controls.

The purpose of this study was to assess the test-retest reliability of postural balance in patients with anterior cruciate ligament reconstruction (ACL) and controls. Ten healthy subjects and 15 individuals with ACL reconstruction performed single-leg and double-leg balance tests. The center of pressure (COP) was recorded using a pressure platform. For the total COP path, the intraclass correlation coefficient (ICC) ranged from 0.79 to 0.91. For the COP standard deviation, the ICCs ranged from 0.68 to 0.94. For the COP velocity, the ICCs ranged from 0.72 to 0.91. The sway area and ellipse scores displayed ICCs values of 0.67 to 0.95 and 0.53 to 0.92, respectively. The ICCs were higher for double leg tests compared with single-stance ones. These results indicate that 30 s balance tests in double and single-leg stance are reliable tools to assess static balance. The use of such tests to monitor rehabilitation programs following ACL reconstruction is recommended.

Epidemiology of Injuries in Amateur Male Soccer Players: A Prospective One-Year Study.

The purpose of this study was to prospectively monitor and analyze injuries in Greek amateur male soccer players over one competitive season. One hundred and thirty male soccer players in a regional amateur league participated in this study. Injury data and exposure were collected from six teams during training and competition match over one season (2018/19). Injuries were collected weekly and were classified by setting, mechanism, severity, type, calendar distribution, period of injury occurrence, and anatomical location. A total of 103 injuries were recorded during the season, with an incident rate (IR) of 5.5 injuries/1000 h with 95% confidence intervals (CI) values of 4.45 (lower limit) and 6.09 (upper limit). Furthermore, IR was greater for the posterior thigh (IR 1.83/1000 h, 95% CI 1.21-2.44) and hip/groin complex (IR 1.45/1000 h, 95% CI 0.90-1.99) compared to other anatomical locations. Similarly, muscle injuries had greater IR (IR 3.61/1000 h, 95% CI 2.74-4.47) than other tissues. Amateur soccer players had a seven-fold greater chance of getting injured during games (IR 20.76/1000 h, 95% CI 15.28-26.24) rather than during training (IR 3.077/1000 h, 95% CI 2.16-3.80), while injury rates were higher towards the end of a session and peaked in October and February of the season. Based on these results, amateur soccer may benefit from injury prevention strategies incorporated into their regular training practice and focus on muscle injuries, especially in the posterior thigh and the hip/groin complex.

Transversus Abdominis and Lumbar Multifidus Thickness Among Three Dance Positions in Argentine Tango Dancers.

Core muscle function is considered a risk factor for low back pain appearance in dancers. The purpose of this study was to examine the transversus abdominis and lumbar multifidus thickness among Argentine Tango dancers in different functional dance positions. A secondary purpose was to compare muscle thickness at rest and contraction between dancers and untrained participants. Ten trained dancers and ten untrained women aged 33.8 ± 6.09 years participated in this study. Using ultrasonography, the transversus abdominis and lumbar multifidus muscle thickness were measured at rest and during contraction in three different dance positions: Basic in Open embrace, Basic in Close embrace, and Volcada. The results showed a significant increase in muscle thickness during contraction compared to thickness at rest for both muscles (p < 0.05). The group of dancers showed a greater transversus abdominis thickness than the untrained group (p < 0.05). Further, transversus abdominal thickness progressively increased from Basic in Open embrace to Basic in Close embrace position, as well as from Basic in Close embrace to Volcada position in dancers (p < 0.05), while fewer changes between positions were found for the untrained group. Multifidus muscle thickness also differed between positions, but no group differences were observed (p > 0.05). Training exercises in these Argentine Tango positions may be beneficial for the performance and prevention of low back pain, especially in Argentine Tango dancers.

Muscle Thickness During Core Stability Exercises in Children and Adults.

Core stability exercises are regular part of exercise programs for asymptomatic individuals across ages. The purpose of this study was to examine deep abdominal and multifidus muscle thickness in children and adults and to determine reliability of the rehabilitative ultrasound (RUSI) imaging. Transversus abdominis and lumbar multifidus thickness at rest and during core stability exercise were examined in pre-pubertal children (N = 23), adolescents (N = 20), young adults (N = 21) and middle-aged adults (N = 22). Thirty-nine participants were re-tested one week after to establish reliability. Muscle thickness at rest was lower in children and adolescents compared with young and middle-aged adults (p < 0.008). Young adults displayed the highest relative transversus abdominis thickness upon contraction (p < 0.008). Lumbar multfidus contraction thickness was greater in young-adults than middle-aged adults and pre-pubertal children (p < 0.008), but it was similar between young-adults and adolescents (p > 0.008). Reliability was high for both muscles (ICC3,3 = 0.76 - 0.99). The age-related differences in muscle thickness indicate that core stability exercises may be beneficial for children and middle-aged adults.

Hamstring-to-Quadriceps Ratio in Female Athletes with a Previous Hamstring Injury, Anterior Cruciate Ligament Reconstruction, and Controls.

Muscle strength imbalances around the knee are often observed in athletes after anterior cruciate ligament (ACL) surgery and hamstring muscle injury. This study examined three hamstrings-to-quadriceps (H:Q) strength ratio types (conventional, functional, and mixed) in thirteen female athletes with a history of hamstring injury, fourteen basketball players following ACL reconstruction and 34 controls. The conventional (concentric H:Q) peak torque ratio was evaluated at 120°·s-1 and 240°·s-1. The functional (eccentric hamstring to concentric quadriceps) torque ratio was evaluated at 120°·s-1. Finally, the mixed (eccentric hamstrings at 30°·s-1 to concentric quadriceps at 240°·s-1) torque ratio was calculated. Both ACL and the hamstring-injured groups showed a lower quadriceps and hamstrings strength compared with controls (p < 0.05). However, non-significant group differences in the H:Q ratio were found (p > 0.05). Isokinetic assessment of muscle strength may be useful for setting appropriate targets of training programs for athletes with a history of ACL surgery or hamstring strain. However, isokinetic evaluation of the H:Q ratio is not injury-specific and it does not vary between different methods of calculating the H:Q ratio.

Effects of two proprioceptive training programs on ankle range of motion, pain, functional and balance performance in individuals with ankle sprain.

BACKGROUND: Following ankle sprain, residual symptoms are often apparent, and proprioceptive training is a treatment approach. Evidence, however, is limited and the optimal program has to be identified. OBJECTIVE: To investigate the effects of two post-acute supervised proprioceptive training programs in individuals with ankle sprain. METHODS: Participants were recruited from a physiotherapy center for ankle sprain rehabilitation. In a pre-post treatment, blinded-assessor design, 22 individuals were randomly allocated to a balance or a proprioceptive neuromuscular facilitation (PNF) group. Both groups received 10 rehabilitation sessions, within a six-week period. Dorsiflexion range of motion (ROM), pain, functional and balance performance were assessed at baseline, at the end of training and eight weeks after training. RESULTS: Follow-up data were provided for 20 individuals. Eight weeks after training, statistically significant (p< 0.017) improvements were found in dorsiflexion ROM and most functional performance measures for both balance and PNF groups. Eight weeks after training, significant (p< 0.017) improvements in the frontal plane balance test and pain were observed for the balance group. CONCLUSIONS: Balance and PNF programs are recommended in clinical practice for improving ankle ROM and functional performance in individuals with sprain. Balance programs are also recommended for pain relief.

Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period.

BACKGROUND: Although ankle sprains are common in soccer, the role of various risk factors in amateur soccer players is unclear. PURPOSE: To identify the incidence of ankle sprain injuries, associated time loss of participation, and risk factors during two consecutive seasons in amateur players. STUDY DESIGN: Descriptive epidemiology study. METHODS: Of 336 athletes enrolled in the study, 312 male amateur soccer players were observed during a 2-year period. Ankle sprain injury incidents, participation time loss, injury mechanisms, ankle region injured, and other risk factors were recorded in games and practice sessions using questionnaires. RESULTS: During the study 208 ankle injuries were recorded, of which 139 were ankle sprains. These led to 975 sessions lost (on average, 7 lost sessions per injury). Most incidents (80.6%) were contact injuries, occurring mostly in defenders. Injury rates were equal between games and practice, while 61.1% of injuries were observed toward the end of each half of the game (P < .05). The injury incidence rate was higher during the first 2 months of the season as opposed to the last month (P < .05). Multinomial logistic regression showed that previous ankle sprain (P < .05) is a significant predictor of ankle sprain injury. CONCLUSION: Ankle sprain injuries in amateur soccer players are primarily contact injuries, occurring mainly in defenders and during both games and practice. It appears that more injuries occur in players with previous ankle injury. Injury rates are higher toward the end of a game and chiefly occur during the first 2 months of the season.

Effects of hip flexion angle on surface electromyographic activity of the biceps femoris and semitendinosus during isokinetic knee flexion.

BACKGROUND: Identifying combinations of the hip and knee joint angles which can selectively recruit specific hamstring muscles may be beneficial for injury prevention or rehabilitation. The purpose of this study was to examine the joint torque and electromyographic (EMG) activity of the semitendinosus (ST) and biceps femoris long head (BFlh). METHODS: Twenty subjects performed maximum isokinetic concentric and eccentric knee flexor efforts at 60°·s-1, 120°·s-1 and 150°·s-1 from three different hip joint angles while surface EMG of ST and BFlh was recorded. RESULTS: Analysis of variance showed that there are no inter-muscular differences in EMG amplitude across testing conditions (p > .05). Peak EMG occurred near full knee extension for the BFLh and at a higher flexion angle for the ST while exercise from a prone position shifted the peak EMG towards higher knee flexion angle (p < 0.05). CONCLUSION: Maximal dynamic knee flexion exercises do not induce a higher EMG amplitude of BFlh or ST. Exercising from a higher hip flexion angle near full knee extension may selectively activate the BFlh. LEVEL OF EVIDENCE: IIb.

Effects of Pilates and trunk strengthening exercises on health-related quality of life in women with chronic low back pain.

BACKGROUND: Pilates programs are widely used as a form of regular exercise in a broad range of populations investigating their effectiveness for chronic low back pain (CLBP) treatment. OBJECTIVE: The aim of this study was to compare the effects of a Pilates program and a trunk strengthening exercise program on functional disability and health-related quality of life (HRQOL) in women with nonspecific CLBP. METHODS: A total of 101 volunteer women with CLBP provided data with a 3-month follow-up. They were randomized to either a Pilates (n= 37), trunk strengthening exercise (n= 36) or a control group (n= 28), exercising for a period of 8 weeks, three times a week. Data were collected on HRQOL using the Short-Form 36 Health Survey (SF-36v2), and functional disability using the Roland Morris Disability Questionnaire prior to program initiation, mid-intervention, immediately after program termination, and three months post-intervention. RESULTS: The Pilates participants reported greater improvements on self-reported functional disability and HRQOL compared with participants in the trunk strengthening exercise and control groups (p < 0.05). The effects were retained for a period of three months after program termination for the Pilates group and to a lesser extent for the trunk strengthening exercise group. CONCLUSIONS: An 8-week Pilates program improved HRQOL and reduced functional disability more than either a trunk strengthening exercise program or controls among women with CLBP.

Hamstring Elongation Quantified Using Ultrasonography During the Straight Leg Raise Test in Individuals With Low Back Pain.

BACKGROUND: Although the straight leg raise (SLR) test frequently is used to assess hamstring extensibility in individuals with low back pain (LBP), evidence relating LBP, SLR, and hamstring extensibility remains unclear. The SLR measures the angle between the lifted leg and the horizontal, however, and, as such, it is not a direct measure of the elongation capacity of the hamstrings. OBJECTIVE: To examine the differences in hamstring elongation (quantified via ultrasonography) and SLR score between individuals with LBP and asymptomatic controls and to determine the relationship between hamstring elongation, SLR, and functional disability scores. DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Forty men and women with chronic LBP (mean ± SD, age 43.51 ± 3.71 years and 40 control subjects (age 45.11 ± 4.01 years) participated in this study. ASSESSMENT: Passive SLR, elongation assessed via ultrasonography, and functional disability. ASSESSMENT AND OUTCOME MEASUREMENTS: SLR score, elongation of tendinous tissue within the semitendinosus muscle, and Oswestry Disability Index. RESULTS: Two-way analysis of variance tests indicated a significantly lower SLR score and a greater Oswestry score in LBP group compared with control subjects (P < .05). In contrast, there were no significant group differences in hamstring elongation (P > .05). Gender did not have an effect on all dependent measures (P > .05). Hamstring elongation showed a low correlation with SLR score and a minimal correlation with Oswestry score. CONCLUSIONS: These results indicate that the SLR score is not determined by hamstring elongation (quantified via ultrasonography).

Neuromuscular interactions around the knee in children, adults and elderly.

Although injury and neuromuscular activation patterns may be common for all individuals, there are certain factors which differentiate neuromuscular activity responses between children, adults and elderly. The purpose of this study is to review recent evidence on age differences in neural activation and muscle balances around the knee when performing single joint movements. Particularly, current evidence indicates that there are some interesting similarities in the neuromuscular mechanisms by which children or the elderly differ compared with adults. Both children and elderly display a lower absolute muscle strength capacity than adults which cannot fully be explained by differences in muscle mass. Quadriceps activation failure is a common symptom of all knee injuries, irrespective of age but it is likely that its effect is more evident in children or adults. While one might expect that antagonist co-activation would differ between age categories, it appears that this is not the case. Although hamstring: quadriceps ratio levels are altered after knee injury, it is not clear whether this is an age specific response. Finally, evidence suggests that both children and the elderly display less stiffness of the quadriceps muscle-tendon unit than adults which affects their knee joint function.

Synergetic and antagonist muscle strength and activity in women with knee osteoarthritis.

BACKGROUND AND PURPOSE: People with knee osteoarthritis (OA) display limitations in daily activities and a lower quality of life. The purpose of this study was to investigate the differences in strength balance and activation during maximum strength efforts between women with knee OA and asymptomatic women. METHODS: Twelve women with knee OA (age 60.33 ± 6.66 years) and 11 controls (age 56.54 ± 5.46 years) performed maximum isokinetic eccentric and concentric knee extension and flexion tests at 60°/s, 120°/s, and 150°/s. Surface electromyography (EMG) was recorded from the biceps femoris (BF), vastus lateralis (VL), and vastus medialis (VM). Hamstrings-to-quadriceps moment ratios (H/Q), the synergetic (VL/VM), and co-contraction (BF/[VM + VL]) EMG ratios were calculated. RESULTS: Analysis-of-variance designs showed that women experiencing knee OA had significantly higher H/Q moment ratios and VM/VL EMG ratios than controls (P < 0.05). The co-contraction index was significantly lower in the OA group only during knee flexion (P < 0.05). CONCLUSIONS: Women with knee OA showed a higher H/Q moment ratios probably because of the need for better joint stability or a lower quadriceps capacity. This deficiency was accompanied by a higher VM activation, which probably serves to stabilize the patella upon maximum contraction as well as a higher activation of antagonist muscles.

Effects of stabilization exercises on health-related quality of life in women with chronic low back pain.

BACKGROUND: The study examined the effects of a 4-week intensive isometric and isotonic stabilization exercise program on dimensions of health-related quality of life (HRQL) in women with chronic low back pain (CLBP). METHODS: A total of 39 women (27-72 years old) provided data in an experimental study with a 9-month follow-up. Random allocation was undertaken for the two treatment groups out of the 3 groups: isometric stabilization (n = 13), isotonic stabilization (n = 13), and a control group (n = 13) that did not participate in any form of exercise. Health-related quality of life measures using the Short-Form 36 Health Survey were assessed before program initiation, immediately after program termination, and 4 times postintervention for a period of 9 months. RESULTS: The isometric stabilization group displayed large improvements in bodily pain and vitality for women with CLBP attending a 4-week intensive isometric stabilization exercise program. The effects were retained for a period of 9 months after program termination. CONCLUSIONS: Isometric stabilization exercises reduce pain and enhance vitality as dimensions of HRQL among women with chronic low back pain with such effects lasting for at least 9 months.

Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain.

OBJECTIVE: To examine the effectiveness of rhythmic stabilization exercises and transcutaneous electrical nerve stimulation (TENS) and their combination in treating women with chronic low back pain. DESIGN: Sequentially allocated, single-blinded and controlled study, with a two-month follow-up. SETTING: The data were collected in a patient rehabilitation setting. SUBJECTS: A total of 92 women (34-46 years old) with chronic low back pain were studied. INTERVENTIONS: Sequential allocation was undertaken into four groups: ;rhythmic stabilization' (n=23), ;rhythmic stabilization - TENS' (n=23), TENS (n=23), and a placebo group (n = 23). Each programme lasted for four weeks. All outcome measures were assessed prior to, immediately after, four weeks and eight weeks post intervention. MAIN MEASURES: Data were obtained on functional disability, pain intensity, trunk extension range of motion, dynamic endurance of trunk flexion and static endurance of trunk extension. RESULTS: A total of 88 patients provided two-month follow-up data. The ;rhythmic stabilization' and the ;rhythmic stabilization - TENS' groups displayed statistically significant (P<0.05) improvements in functional disability and pain intensity (ranging from 21.2 to 42.8%), trunk extension range of motion (ranging from 6.5 to 25.5%), dynamic endurance of trunk flexion and static endurance of trunk extension (ranging from 13.5 to 74.3%) compared with the remaining groups. CONCLUSIONS: The rhythmic stabilization programmes resulted in more gains in women with chronic low back pain regarding the present outcome variables compared with the other groups; therefore, its application in female chronic low back pain patients aged 34-46 years is recommended.

Ankle sprain injuries: a 2-year prospective cohort study in female Greek professional basketball players.

CONTEXT: Ankle sprains are a common basketball injury. Therefore, examination of risk factors for injury in female professional basketball players is worthwhile. OBJECTIVE: To examine rates of ankle sprains, associated time missed from participation, and risk factors for injury during 2 consecutive seasons. DESIGN: Prospective cohort study. SETTING: Eighteen professional basketball facilities. PATIENTS OR OTHER PARTICIPANTS: We observed 204 players from 18 female professional basketball teams for 2 consecutive seasons during a 2-year period. MAIN OUTCOME MEASURE(S): Using questionnaires, we recorded the incidence of ankle sprains, participation time missed, and mechanisms of injury in games and practice sessions. Potential risk factors, such as age, body mass, height, training experience, and history of ankle sprain, were examined using multivariate logistic regression. RESULTS: Fifty of the 204 participants sustained ankle injuries; injuries included 32 ankle sprains, which translated to an ankle sprain rate of 1.12 per 1000 hours of exposure to injury. The 32 players missed 224.4 training and game sessions and an average of 7.01 sessions per injury. Most injuries occurred in the key area of the basketball court and were the result of contact. Injury rates during games were higher than injury rates during practice sessions. Centers, followed by guards and forwards, had the highest rate of injury. Players who did not wear an external ankle support had an odds ratio of 2.481 for sustaining an ankle sprain. CONCLUSIONS: Female professional basketball athletes who did not wear an external ankle support, who played in the key area, or who functioned as centers had a higher risk for ankle sprain than did other players.