Point Prevalence of the Biomechanical Dimension of Dysfunctional Breathing Patterns Among Competitive Athletes.

ABSTRACT: Shimozawa, Y, Kurihara, T, Kusagawa, Y, Hori, M, Numasawa, S, Sugiyama, T, Tanaka, T, Suga, T, Terada, RS, Isaka, T, and Terada, M. Point prevalence of the biomechanical dimension of dysfunctional breathing patterns among competitive athletes. J Strength Cond Res 37(2): 270-276, 2023-There is growing evidence of associations between altered biomechanical breathing patterns and numerous musculoskeletal and psychological conditions. The prevalence of dysfunctional and diaphragmatic breathing patterns is unknown among athletic populations. The purpose of this study was to examine the prevalence of dysfunctional and diaphragmatic breathing patterns among athletic populations with a clinical measure to assess the biomechanical dimension of breathing patterns. Using a cross-sectional design, 1,933 athletes across multiple sports and ages were screened from 2017 to 2020. Breathing patterns were assessed using the Hi-Lo test in the standing position. Scores of the Hi-Lo test were determined based on the presence or absence of abdominal excursion, anterior-posterior chest expansion, superior rib cage migration, and shoulder elevation. The Hi-Lo test scores were used to categorize observational breathing mechanics as dysfunctional and diaphragmatic breathing patterns. The prevalence of athletes with dysfunctional breathing patterns was 90.6% (1,751 of 1,933). Athletes with diaphragmatic breathing patterns accounted for 9.4% of all athletes in our sample (182 of 1,933). There were no differences in the proportion of breathing patterns between male and female athletes ( p = 0.424). Breathing patterns observations were associated with sport-setting categories ( p = 0.002). The highest percentages of dysfunctional breathers were in middle school student athletes (93.7%), followed by elementary school student athletes (91.2%), high school student athletes (90.6%), professional/semiprofessional athletes (87.5%), and collegiate athletes (84.8%). The current study observed that dysfunctional breathing patterns (90.6%) in the biomechanical dimension were more prevalent than diaphragmatic breathing pattern (9.4%) among competitive athletes. These results suggest that clinicians may need to consider screening breathing patterns and implementing intervention programs aimed to improve the efficiency of biomechanical dimensions of breathing patterns in athletic populations. This study may help raise awareness of impacts of dysfunctional breathing patterns on athletes' health and performance.

Associations of muscle volume of individual human plantar intrinsic foot muscles with morphological profiles of the foot.

Human plantar intrinsic foot muscles consist of 10 muscles that originate and insert within the sole of the foot. It is known that the anatomical cross-sectional area (ACSA) and muscle thickness of two plantar intrinsic foot muscles, the flexor hallucis brevis (FHB) and abductor hallucis (ABH), associate with morphological parameters of the foot, such as total and truncated foot length and navicular height. However, it is unclear how the size for each of the plantar intrinsic foot muscles associates with various morphological profiles of the foot. This study aimed to elucidate this subject. By using magnetic resonance imaging (MRI), serial images of the right foot were obtained in 13 young adult men without foot deformities. From the obtained MR images, ACSA for each of the individual plantar intrinsic foot muscles was analyzed along the foot length, and then its muscle volume (MV) was calculated. The analyzed muscles were the abductor digiti minimi (ABDM), ABH, adductor hallucis oblique head (ADDH-OH), adductor hallucis transverse head (ADDH-TH), flexor digitorum brevis (FDB), FHB, and quadratus plantae (QP). Furthermore, MV of the whole plantar intrinsic foot muscle (WHOLE) was defined as the total MVs of all the analyzed muscles. As morphological parameters, total foot length, truncated foot length, forefoot width, ball circumference, instep circumference, navicular height, great toe eversion angle, and little toe inversion angle were measured using a laser three-dimensional foot scanner in standing and sitting conditions. In addition, navicular drop (ND) and normalized truncated navicular height (NTNH) were also calculated as medial longitudinal arch (MLA) height indices. The MV of WHOLE was significantly associated with the forefoot width, ball circumference, and instep circumference (r = 0.647-0.711, p = 0.006-0.013). Positive correlations were found between the forefoot width and MV of FHB, FDB, and QP (r = 0.564-0.653, p = 0.015-0.045), between the ball circumference and MV of QP (r = 0.559, p = 0.047), between the instep circumference and MV of FHB (r = 0.609, p = 0.027), and between the little toe inversion angle and MV of QP (r = 0.570, p = 0.042). The MVs of ABH, ABDM, and ADDH-OH were not significantly correlated with any morphological parameters of the foot. Similarly, no significant correlations were found between MV of each muscle and either of the MLA height indices (ND and NTNH). Thus, the current results indicate that forefoot width and circumferential parameters (instep and ball circumference), not MLA height, associate with the size of the whole plantar intrinsic foot muscles, especially those specialized in toe flexion (FHB, FDB, and QP).

Plantar intrinsic foot muscle activity and its relationship with postural sway during tiptoe standing in ballet dancers and non-dancers.

BACKGROUND: Minimizing postural sway during tiptoe standing is essential for ballet dancers. Investigation of the activity of the plantar intrinsic foot muscles (PIFMs) may provide insight into postural sway in dancers. Herein, we compared PIFM activity during tiptoe standing between dancers and non-dancers and examined its relationship with postural sway. METHODS: We enrolled 14 female ballet dancers and 13 female non-dancers. Electromyography (EMG) amplitudes of 64 channels of PIFMs and center of pressure (COP) data were recorded during bipedal tiptoe standing tasks performed with ankle plantarflexion angles of 20°, 40°, and 60° (dancers only). The EMG amplitudes were normalized to those during the maximum voluntary contraction, and the muscle activity level and its coefficient of variation over time (EMG-CVtime) during the task were assessed. Standard deviations in the anteroposterior and mediolateral directions, velocity, and area were calculated from the COP data. RESULTS: Most COP and EMG variables were significantly lower in dancers than in non-dancers in both the 20° and 40° tasks (p < 0.05). Significant correlations were found between most combinations of the COP and EMG variables in both the 20° and 40° tasks in the whole cohort (r = 0.468-0.807, p ≤ 0.014). In the 60° task in dancers, COP velocity was strongly correlated with EMG-CVtime (r = 0.700, p = 0.005). CONCLUSION: These results provide novel evidence that the PIFMs do not require high activity, but rather that its low, steady activity is the key, to achieve less postural sway during bipedal tiptoe standing in dancers.

Differences in the Size of Individual Plantar Intrinsic Foot Muscles Between Ballet Dancers and Non-Dancers.

INTRODUCTION: In classic ballet, choreography often involves tiptoe standing. Tiptoe standing requires a high and stable foot arch structure, which is achieved by contraction of the plantar intrinsic foot muscles (PIFMs). Long-term repetitive loading with a specific movement can induce hypertrophic adaptation of the associated muscles. For dancers, however, limited information on the size of individual PIFMs is available from previous studies. The purpose of this study was to determine the differences in the sizes of 10 individual PIFMs between dancers and non-dancers. METHODS: Muscle volumes (MVs) of 10 individual PIFMs were measured using magnetic resonance imaging in 15 female dancers and 15 female non-dancers. Muscles analyzed included abductor hallucis, flexor digitorum brevis, abductor digiti minimi, quadratus plantae, lumbricals, flexor hallucis brevis, adductor hallucis oblique head, adductor hallucis transverse head, flexor digiti minimi, plantar/dorsal interossei. In addition to absolute MVs, relative MVs normalized to body mass (rMVBM) and the percentage of individual MVs relative to the sum of 10 individual PIFM MVs (%MVWHOLE) were calculated. RESULTS: The absolute MVs of 6 individual PIFMs, including the flexor digitorum brevis and lumbricals, were +16% to 59% larger in dancers than in non-dancers (P ≤ .048). The rMVBM of all individual PIFMs were +35% to 95% larger in dancers than in non-dancers (P ≤ .019). The %MVWHOLE of the flexor digitorum brevis and lumbricals were +10% to 36% higher (P ≤ .014) and those of the abductor digiti minimi and adductor hallucis oblique head were +8% to 11% lower (P ≤ .037) in dancers than in non-dancers. CONCLUSIONS: For all 3 MV measures, only the flexor digitorum brevis and lumbricals, which are functionally specialized for flexion of the second to fifth metatarsophalangeal joints, were consistently larger in dancers than in non-dancers. This may be due to long-term repetitive loading on these PIFMs during ballet training involving tiptoe standing.

A classification of the plantar intrinsic foot muscles based on the physiological cross-sectional area and muscle fiber length in healthy young adult males.

BACKGROUND: Plantar intrinsic foot muscles (PIFMs) are composed of 10 muscles and play an essential role in achieving functional diversity in the foot. Previous studies have identified that the morphological profiles of PIFMs vary between individuals. The morphological profiles of a muscle theoretically reflect its output potentials: the physiological cross-sectional area (PCSA) of a muscle is proportional to its maximum force generation, and the muscle fiber length (FL) is its shortening velocity. This implies that the PCSA and FL may be useful variables for characterizing the functional diversity of the individual PIFM. The purpose of this study was to examine how individual PIFMs can be classified based on their PCSA and FL. METHODS: In 26 healthy young adult males, the muscle volume and muscle length of seven PIFMs (abductor hallucis, ABDH; abductor digiti minimi, ABDM; adductor hallucis oblique head, ADDH-OH; ADDH transverse head, ADDH-TH; flexor digitorum brevis, FDB; flexor hallucis brevis, FHB; quadratus plantae, QP) were measured using magnetic resonance imaging. The PCSA and FL of each of the seven PIFMs were then estimated by combining the data measured from the participants and those of muscle architectural parameters documented from cadavers in previous studies. A total of 182 data samples (26 participants × 7 muscles) were classified into clusters using k-means cluster analysis. The optimal number of clusters was evaluated using the elbow method. RESULTS: The data samples of PIFMs were assigned to four clusters with different morphological profiles: ADDH-OH and FHB, characterised by large PCSA and short FL (high force generation and slow shortening velocity potentials); ABDM and FDB, moderate PCSA and moderate FL (moderate force generation and moderate shortening velocity potentials); QP, moderate PCSA and long FL (moderate force generation and rapid shortening velocity potentials); ADDH-TH, small PCSA and moderate FL (low force generation and moderate shortening velocity potentials). ABDH components were assigned equivalently to the first and second clusters. CONCLUSIONS: The approach adopted in this study may provide a novel perspective for interpreting the PIFMs' function based on their maximal force generation and shortening velocity potentials.

Triceps brachii hypertrophy is substantially greater after elbow extension training performed in the overhead versus neutral arm position.

The biarticular triceps brachii long head (TBLong) is lengthened more in the overhead than neutral arm position. We compared triceps brachii hypertrophy after elbow extension training performed in the overhead vs. neutral arm position. Using a cable machine, 21 adults conducted elbow extensions (90-0°) with one arm in the overhead (Overhead-Arm) and the other arm in the neutral (Neutral-Arm) position at 70% one-repetition maximum (1RM), 10 reps/set, 5 sets/session, 2 sessions/week for 12 weeks. Training load was gradually increased (+5% 1RM/session) when the preceding session was completed without repetition failure. 1RM of the assigned condition and MRI-measured muscle volume of the TBLong, monoarticular lateral and medial heads (TBLat+Med), and whole triceps brachii (Whole-TB) were assessed pre- and post-training. Training load and 1RM increased in both arms similarly (+62-71% at post, P = 0.285), while their absolute values/weights were always lower in Overhead-Arm (-34-39%, P < 0.001). Changes in muscle volume in Overhead-Arm compared to Neutral-Arm were 1.5-fold greater for the TBLong (+28.5% vs. +19.6%, Cohen's d = 0.61, P < 0.001), 1.4-fold greater for the TBLat+Med (+14.6% vs. +10.5%, d = 0.39, P = 0.002), and 1.4-fold greater for the Whole-TB (+19.9% vs. +13.9%, d = 0.54, P < 0.001). In conclusion, triceps brachii hypertrophy was substantially greater after elbow extension training performed in the overhead versus neutral arm position, even with lower absolute loads used during the training.HighlightsGrowing evidence suggests that resistance training at long muscle lengths promotes muscle hypertrophy, but its practical applications are yet to be explored.Triceps brachii muscle hypertrophy was substantially greater after cable elbow extension training performed in the overhead than neutral arm position, particularly in the biarticular triceps brachii long head, even with lower absolute loads lifted (i.e. lower mechanical stress to muscles/joints).Cable elbow extension training should be performed in the overhead rather than neutral arm position if one aims to maximise muscle hypertrophy of the triceps brachii or to prevent atrophy of this muscle.

Associations between the size of individual plantar intrinsic and extrinsic foot muscles and toe flexor strength.

BACKGROUND: The size of the plantar intrinsic and extrinsic foot muscles has been shown to be associated with toe flexor strength (TFS). Previous studies adopted the size of limited plantar intrinsic foot muscles or a compartment containing several muscles as an independent variable for TFS. Among the plantar intrinsic and extrinsic foot muscles, therefore, it is unclear which muscle(s) primarily contributes to TFS production. The present study aimed to clarify this subject. METHODS: In 17 young adult men, a series of anatomical cross-sectional area of individual plantar intrinsic and extrinsic foot muscles was obtained along the foot length and the lower leg length, respectively, using magnetic resonance imaging. Maximal anatomical cross-sectional area (ACSAmax) and muscle volume (MV) for each constituent muscle of the plantar intrinsic foot muscles (flexor hallucis brevis; flexor digitorum brevis, FDB; abductor hallucis; adductor hallucis oblique head, ADDH-OH; adductor hallucis transverse head, ADDH-TH; abductor digiti minimi; quadratus plantae) and extrinsic foot muscles (flexor hallucis longus; flexor digitorum longus) were measured. TFS was measured with a toe grip dynamometry. RESULTS: TFS was significantly associated with the ACSAmax for each of the ADDH-OH (r = 0.674, p = 0.003), ADDH-TH (r = 0.523, p = 0.031), and FDB (r = 0.492, p = 0.045), and the MV of the ADDH-OH (r = 0.582, p = 0.014). As for the ADDH-OH, the correlation coefficient with TFS was not statistically different between ACSAmax and MV (p = 0.189). Stepwise multiple linear regression analysis indicated that ACSAmax and MV of the ADDH-OH alone explained 42 and 29%, respectively, of the variance in TFS. CONCLUSION: The ADDH-OH is the primary contributor to TFS production among the plantar intrinsic and extrinsic foot muscles as the result of the stepwise multiple linear regression analysis.

Effects of age and sex on association between toe muscular strength and vertical jump performance in adolescent populations.

Toe muscular strength plays an important role in enhancing athletic performance because the forefoot is the only part of the body touching the ground. In general, muscular strength increases with age throughout adolescence, and sex-related difference in muscular strength becomes evident during childhood and adolescence. However, toe muscular strength is known to be levelled off after late adolescence in both sexes. For adolescent populations, therefore, the association of toe muscular strength with physical performance might differ with age and/or sex. This study aimed to investigate differences in relationships between toe muscular strength and vertical jump performance across sex and age in adolescent populations. The maximum isometric strength of the toe muscles and vertical jump height (VJ) were assessed in 479 junior high school students (JH) aged 12-14 years (243 boys and 236 girls) and 465 high school students (HS) aged 15-18 years (265 boys and 200 girls). Two types of measurements were performed to evaluate the toe muscular strength: toe gripping strength (TGS) with the metatarsophalangeal joint in the plantar flexed position and toe push strength (TPS) with the metatarsophalangeal joint in the dorsiflexed position. TGS and TPS were normalized to body weight. Two-way ANOVA showed that TGS had significant main effects of sex (boys > girls) and age (HS > JH) while TPS only had a significant main effect of sex (boys > girls). When the effects of sex and age were separately analyzed, VJ was significantly correlated with TGS in JH girls, HS girls, and JH boys (r = 0.253-0.269, p < 0.05), but not in HS boys (r = 0.062, p = 0.3351). These results suggest that toe muscular strength is relatively weakly associated with vertical jump performance in adolescent boys and girls, but the association would not be established in high school boys.

Association between patellar tendon moment arm and running performance in endurance runners.

A shorter joint moment arm (MA) may help maintain the necessary muscle force when muscle contractions are repeated. This beneficial effect may contribute to reducing the energy cost during running. In this study, we examined the correlation between patellar tendon MA and running performance in endurance runners. The patellar tendon MA and quadriceps femoris muscle volume (MV) in 42 male endurance runners and 14 body size-matched male untrained participants were measured using a 1.5-T magnetic resonance system. The patellar tendon MA was significantly shorter in endurance runners than in untrained participants (p = 0.034, d = 0.65). In endurance runners, shorter patellar tendon MA correlated significantly with better personal best 5000-m race rime (r = 0.322, p = 0.034). A trend toward such a significant correlation was obtained between quadriceps femoris MV and personal best 5000-m race time (r = 0.303, p = 0.051). Although the correlation between patellar tendon MA and personal best 5000-m race time did not remain significant after adjusting for the quadriceps femoris MV (partial r = 0.247, p = 0.120), a stepwise multiple regression analysis (conducted with body height, body mass, patellar tendon MA, and quadriceps femoris MV) selected the patellar tendon MA (ß = 0.322) as only a predictive variable for the personal best 5000-m race time (adjusted R2  = 0.081, p = 0.038). These findings suggest that the shorter patellar tendon MA, partially accorded with the smaller quadriceps femoris size, may be a favorable morphological variable for better running performance in endurance runners.

Relationship of the knee extensor strength but not the quadriceps femoris muscularity with sprint performance in sprinters: a reexamination and extension.

PURPOSE: This study examined the relationships of knee extensor strength and quadriceps femoris size with sprint performance in sprinters. METHODS: Fifty-eight male sprinters and 40 body size-matched male non-sprinters participated in this study. The knee extensor isometric and isokinetic strengths were measured using a dynamometer. The isokinetic strength measurements were performed with slow and fast velocities at 60°/s and 180°/s, respectively. The quadriceps femoris muscle volume (MV) was measured using magnetic resonance imaging. The relative knee extensor strengths and quadriceps femoris MV were calculated by normalizing to body mass. RESULTS: Absolute and relative knee extensor strengths during two velocity isokinetic contractions, but not during isometric contraction, were significantly higher in sprinters than in non-sprinters (P = 0.047 to < 0.001 for all). Such a significant difference was also observed for relative quadriceps femoris MV (P = 0.018). In sprinters, there were positive correlations between all three knee extensor strengths and quadriceps femoris MV (r = 0.421 to 0.531, P = 0.001 to < 0.001 for all). The absolute and relative strengths of the fast-velocity isokinetic knee extension correlated negatively with personal best 100-m sprint time (r = -0.477 and -0.409, P = 0.001 and < 0.001, respectively). In contrast, no such significant correlations were observed between absolute and relative quadriceps femoris MVs and personal best 100-m sprint time. CONCLUSIONS: These findings suggest that despite the presence of the relationship between muscle strength and size, the knee extensor strength may be related to superior sprint performance in sprinters independently of the quadriceps femoris muscularity.

No Correlation Between Plantar Flexor Muscle Volume and Sprint Performance in Sprinters.

The plantar flexor torque plays an important role in achieving superior sprint performance in sprinters. Because of the close relationship between joint torque and muscle size, a simple assumption can be made that greater plantar flexor muscles (i.e., triceps surae muscles) are related to better sprint performance. However, previous studies have reported the absence of these relationships. Furthermore, to examine these relationships, only a few studies have calculated the muscle volume (MV) of the plantar flexors. In this study, we hypothesized that the plantar flexor MVs may not be important morphological factors for sprint performance. To test our hypothesis, we examined the relationships between plantar flexor MVs and sprint performance in sprinters. Fifty-two male sprinters and 26 body size-matched male non-sprinters participated in this study. On the basis of the personal best 100 m sprint times [range, 10.21-11.90 (mean ± SD, 11.13 ± 0.42) s] in sprinters, a K-means cluster analysis was applied to divide them into four sprint performance level groups (n = 8, 8, 19, and 17 for each group), which was the optimal number of clusters determined by the silhouette coefficient. The MVs of the gastrocnemius lateralis (GL), gastrocnemius medialis (GM), and soleus (SOL) in participants were measured using magnetic resonance imaging. In addition to absolute MVs, the relative MVs normalized to body mass were used for the analyses. The absolute and relative MVs of the total and individual plantar flexors were significantly greater in sprinters than in non-sprinters (all p < 0.01, d = 0.64-1.39). In contrast, all the plantar flexor MV variables did not differ significantly among the four groups of sprinters (all p > 0.05, η2 = 0.02-0.07). Furthermore, all plantar flexor MV variables did not correlate significantly with personal best 100 m sprint time in sprinters (r = -0.253-0.002, all p > 0.05). These findings suggest that although the plantar flexor muscles are specifically developed in sprinters compared to untrained non-sprinters, the greater plantar flexor MVs in the sprinters may not be important morphological factors for their sprint performance.

Greater Hamstrings Muscle Hypertrophy but Similar Damage Protection after Training at Long versus Short Muscle Lengths.

PURPOSE: We investigated the effects of seated versus prone leg curl training on hamstrings muscle hypertrophy and susceptibility to eccentric exercise-induced muscle damage. METHODS: Part 1: Twenty healthy adults conducted seated leg curl training with one leg (Seated-Leg) and prone with the other (Prone-Leg), at 70% one-repetition maximum (1RM), 10 repetitions per set, 5 sets per session, 2 sessions per week for 12 wk. Magnetic resonance imaging (MRI)-measured muscle volume of the individual and whole hamstrings was assessed pre- and posttraining. Part 2: Nineteen participants from part 1 and another 12 untrained controls (Control-Leg) performed eccentric phase-only leg curl exercise at 90% 1RM, 10 repetitions per set, 3 sets for each of the seated/prone conditions with each leg. MRI-measured transverse relaxation time (T2) and 1RM of seated/prone leg curl were assessed before, 24, 48, and 72 h after exercise. RESULTS: Part 1: Training-induced increases in muscle volume were greater in Seated-Leg versus Prone-Leg for the whole hamstrings (+14% vs +9%) and each biarticular (+8%-24% vs +4%-19%), but not monoarticular (+10% vs +9%), hamstring muscle. Part 2: After eccentric exercise, Control-Leg had greater increases in T2 in each hamstring muscle (e.g., semitendinosus at 72 h: +52%) than Seated-Leg (+4%) and Prone-Leg (+6%). Decreases in 1RM were also greater in Control-Leg (e.g., seated/prone 1RM at 24 h: -12%/-24%) than Seated-Leg (0%/-3%) and Prone-Leg (+2%/-5%). None of the changes significantly differed between Seated-Leg and Prone-Leg at any time points. CONCLUSION: Hamstrings muscle size can be more effectively increased by seated than prone leg curl training, suggesting that training at long muscle lengths promotes muscle hypertrophy, but both are similarly effective in reducing susceptibility to muscle damage.

Toe flexor strength is associated with mobility in older adults with pronated and supinated feet but not with neutral feet.

BACKGROUND: Older adults are known to have more pronated foot posture and decreased toe flexor strength (TFS), as well as decreased mobility in daily life compared to young adults. Although foot posture is reported to be an influential factor for walking biomechanics in young adults, there is less information on this subject in older adults. Age-related reduction in TFS is shown to be associated with impairments of functional performance, but it is poorly understood whether foot posture influences the relationships between TFS and functional performances. Therefore, the present study aimed to elucidate this concern by examining older women. METHODS: Seventy community-dwelling older women (76.8 ± 4.4 years) voluntarily participated in this study. Foot posture was evaluated by the 6-item foot posture index (FPI). Based on the FPI score, participants were allocated to pronated, neutral, or supinated group (n = 33, 26, and 11, respectively). TFS was assessed using a toe grip dynamometer in a seated position. Scores of 30-s chair stand, timed up-and-go, 5-m comfortable-speed walking, and static balance tests were determined to evaluate functional performances. Pearson's correlation coefficients were computed to examine the relationships between TFS and functional performances in each group. RESULTS: TFS positively correlated with comfortable walking speed in the pronated (r = 0.37, p = 0.03) and supinated (r = 0.76, p < 0.001) groups, but not in the neutral group (r = 0.17, p = 0.42). For the two significant relationships, an analysis of covariance showed that there was no significant difference between the pronated and supinated groups in the slopes of the regression lines, suggesting a similar relative contribution of TFS to comfortable walking speed between the two groups. In addition, TFS tended to negatively correlate with timed up-and-go time in the pronated (r = - 0.32, p = 0.07) and supinated (r = - 0.56, p = 0.08) groups, and positively correlate with 30-s chair stand score in the pronated group (r = 0.31, p = 0.08). CONCLUSIONS: The present study indicates that TFS would be associated with mobility, walking performance in particular, in older women with pronated and supinated feet but not with neutral feet.