Discrete Hamstring: Quadriceps Strength Ratios Do Not Represent Angle-Specific Ratios in Premier League Soccer Players.

ABSTRACT: Lunn, DE, Nicholson, G, Cooke, M, Crespo, R, Robinson, T, Price, RJ, and Walker, J. Discrete hamstring: quadriceps strength ratios do not represent angle-specific ratios in Premier League soccer players. J Strength Cond Res 37(12): 2417-2422, 2023-This study compared angle-specific hamstring:quadriceps (H:Q) ratios with their discrete counterparts during strength testing in professional male soccer players. Twenty-seven professional English Premier League soccer players were recruited for this study (age: 22 ± 4 years; stature: 1.81 ± 0.08 m; body mass: 74.7 ± 6.5 kg). Isokinetic testing of the knee flexors and extensors was conducted concentrically at two angular velocities (60° and 240°·s -1 ) and eccentrically (for the knee flexors only) at 30°·s -1 . Conventional H:Q ratio was calculated as the ratio between peak joint moment in the flexors and extensors at 60°·s -1 . Functional H:Q ratio was calculated as the peak joint moment in the flexors during the eccentric condition and the extensors at 240°·s -1 . Discrete conventional and functional H:Q ratios were 0.56 ± 0.06 and 1.28 ± 0.22, respectively. The residual differences between discrete values and angle-specific residual values were 13.60 ± 6.56% when normalized to the magnitude of the discrete value. For the functional ratios, the normalized residual was 21.72 ± 5.61%. Therefore, neither discrete ratio was representative of angle-specific ratios, although the conventional ratio had lower error overall. Therefore, practitioners should consider H:Q ratio throughout the full isokinetic range of motion, not just the discrete ratio calculated from peak joint moments, when designing and implementing training programs or monitoring injury risk, recovery from injury, and readiness to return to play.

Are rugby league players involved in more tackles than normal, prior to an injury sustained during a tackle event?

Rugby league has a relatively high injury risk, with the tackle having the greatest injury propensity. The number of tackles players engage in, prior to injurious tackles may influence injury risk, which has yet to be investigated. Therefore, this study investigated if rugby league players are involved in more tackles (as either tackler or ball carrier) (i) in the 10 minutes, or (ii) 1-min periods prior to an injurious tackle-event, (iii) differences for ball carriers vs. tacklers, and (iv) forwards vs. backs. Video analysis was utilised to quantify the number and rate of tackles in the 10-min periods prior to 61 tackle-related injuries. One thousand two hundred and eighty 10-min periods where players were not injured, were used as matched-controls. Generalized mixed linear models were used to analyse mean total and rate for tackles. Injured players were involved in significantly fewer tackles during the 10-min period, yet significantly more tackles during the final minute prior to the injurious tackle-event, compared to non-injured players. There were no differences between ball carriers vs. tacklers during the 10-min period. Both injured position groups were involved in significantly more tackles in the final minute. Additional match data sources are needed to further inform injury preventive strategies of tackle events.

Development and Maintenance of Sprint Training Adaptations: An Uphill-Downhill Study.

ABSTRACT: Bissas, A, Paradisis, GP, Nicholson, G, Walker, J, Hanley, B, Havenetidis, K, and Cooke, CB. Development and maintenance of sprint training adaptations: an uphill-downhill study. J Strength Cond Res 36(1): 90-98, 2022-We examined the development of performance adaptations resulting from an uphill-downhill training program and monitored the decline of adaptations during detraining. Twenty-eight men were randomly assigned to 1 of 2 sprint training groups who trained 3 times per week for 6 weeks and a control group (C). The uphill-downhill group (U+D) trained on an 80-m platform with 3° slopes, whereas the horizontal (H) group trained on flat track. Subjects were tested for maximal running speed (MRS), associated kinematics, and leg strength before and after training, with U+D subjects also tested after weeks 2 and 4 of training, and after a 3-week detraining period. The U+D group increased their MRS by 3.7% (from 8.75 ± 0.72 to 9.07 ± 0.64 m·s-1, p < 0.05), their stride rate by 3.1% (from 4.21 ± 0.21 to 4.34 ± 0.18 Hz, p < 0.05), and their knee extensors' maximum isometric force by 21% (from 2,242 ± 489 to 2,712 ± 498 N, p < 0.05) after training. The time course of changes showed declines for weeks 1-4 (1.4-5.1%), but an ascending trend of improvement compensated all losses by the end of week 6 (p < 0.05). During detraining, no decreases occurred. No changes were observed for the H and C groups. The minimum period to produce positive effects was 6 weeks, with a very good standard of performance maintained 3 weeks after training. U+D training will prove useful for all athletes requiring fast adaptations, and it can fit into training mesocycles because of its low time demands.

Muscle-tendon morphology and function following long-term exposure to repeated and strenuous mechanical loading.

We mapped structural and functional characteristics of muscle-tendon units in a population exposed to very long-term routine overloading. Twenty-eight military academy cadets (age = 21.00 ± 1.1 years; height = 176.1 ± 4.8 cm; mass = 73.8 ± 7.0 kg) exposed for over 24 months to repetitive overloading were profiled via ultrasonography with a senior subgroup of them (n = 11; age = 21.4 ± 1.0 years; height = 176.5 ± 4.8 cm; mass = 71.4 ± 6.6 kg) also tested while walking and marching on a treadmill. A group of eleven ethnicity- and age-matched civilians (age = 21.6 ± 0.7 years; height = 176.8 ± 4.3 cm; mass = 74.6 ± 5.6 kg) was also profiled and tested. Cadets and civilians exhibited similar morphology (muscle and tendon thickness and cross-sectional area, pennation angle, fascicle length) in 26 out of 29 sites including the Achilles tendon. However, patellar tendon thickness along the entire tendon was greater (P < .05) by a mean of 16% for the senior cadets compared with civilians. Dynamically, cadets showed significantly smaller ranges of fascicle length change and lower shortening velocity in medial gastrocnemius during walking (44.0% and 47.6%, P < .05-.01) and marching (27.5% and 34.3%, P < .05-.01) than civilians. Furthermore, cadets showed lower normalized soleus electrical activity during walking (22.7%, P < .05) and marching (27.0%, P < .05). Therefore, 24-36 months of continuous overloading, primarily occurring under aerobic conditions, leads to more efficient neural and mechanical behavior in the triceps surae complex, without any major macroscopic alterations in key anatomical structures.

Importance of Physical Qualities for Speed and Change of Direction Ability in Elite Female Soccer Players.

Emmonds, S, Nicholson, G, Beggs, C, Jones, B, and Bissas, A. Importance of physical qualities for speed and change of direction ability in elite female soccer players. J Strength Cond Res 33(6): 1670-1678, 2019-The purpose of this study was to determine the importance of physical qualities for speed and change of direction (CoD) ability in female soccer players. Data were collected on 10 female soccer players who were part of a professional English Women's Super League team. Player assessments included anthropometric (stature and body mass), body composition (dual-energy X-ray absorptiometry), speed (10-m and 20-m sprints), CoD ability (505 agility), aerobic (Yo-Yo Intermittent Recovery Test), lower-body strength (bilateral knee extensions), and power (countermovement jump [CMJ], squat jump [SJ], 30-cm drop jump [DJ]) measures. The relationships between the variables were evaluated using eigenvector analysis and Pearson correlation analysis. Multiple linear regression revealed that the performance variables (10 and 20 m speed, mean 505, and CoD deficit mean) can be predicted with almost 100% accuracy (i.e., adjusted R > 0.999) using various combinations of the predictor variables (DJ height, CMJ height, SJ height, and lean body mass). An increase of 1 SD in DJ height was associated with reductions of -5.636 and -9.082 SD in 10-m and 20-m sprint times. One SD increase in CMJ also results in a reduction of -3.317 and -0.922 SD, respectively, in mean 505 and CoD deficit mean values. This study provides comparative data for professional English female soccer players that can be used by strength and conditioning coaches when monitoring player development and assessing the effectiveness of training programs. Findings highlight the importance of developing reactive strength to improve speed and CoD ability in female soccer players.

Physical Qualities of International Female Rugby League Players by Playing Position.

The purpose of this study was to investigate the anthropometric, body composition, and fitness characteristics of female rugby league players by playing position. Data were collected on 27 players who were part of the English elite women's rugby league squad. Player assessments comprised anthropometric (stature and body mass), body composition (dual-energy X-ray absorptiometry) and fitness {lower-body power (countermovement jump [CMJ], 20 kg jump squat [JS], and 30 cm drop jump), 5, 10, 20, 30, and 40 m sprint, 505 agility, Yo-Yo intermittent recovery test level 1} measures. Players were classified into playing position (i.e., forwards and backs) before analysis. A multivariate analysis of variance demonstrated significant (p ≤ 0.05) differences for body mass, stature, total fat, lean mass, and percentage body fat between forwards and backs. Positional differences were also observed for speed, agility, and lower-body power. Significant relationships were observed between total body fat and all fitness variables, and total lean mass was related to CMJ and JS peak power. This study provides comparative data for female rugby league forwards and backs. Body fat was strongly associated with performance and should therefore be considered in developing fitness characteristics. The relationship to match performance and trainability of these characteristics warrants further investigation.

Do the acute biochemical and neuromuscular responses justify the classification of strength- and hypertrophy-type resistance exercise?

This study aimed to examine a wide profile of acute biochemical and neuromuscular responses to strength (STR) and hypertrophy (HYP) resistance exercise (RE). Seven trained men completed an STR workout (4 × 6 repetitions, 85% 1 repetition maximum [1RM], 5-minute rest periods), an HYP workout (4 × 10 repetitions, 70% 1RM, 90-second rest periods), and a control condition (CON) in a randomized crossover design. Peak force (PF), rate of force development (RFD), and muscle activity were quantified before and after exercise during an isometric squat protocol. Blood samples were taken 20, 10, and 0 minutes before and 0, 10, and 60 minutes after exercise to measure the concentration of blood lactate (BL), pH, and a number of electrolytes that were corrected for plasma volume changes. No differences were observed between the workouts for changes in PF, RFD, or muscle activity. Repeated contrasts revealed a greater (p ≤ 0.05) increase in BL concentration and reduction in pH after the HYP protocol than the STR or CON conditions. There were similar but significant (p ≤ 0.05) changes in the concentration of a number of electrolytes after both workouts, and a handful of these changes displayed significant correlations with the PF reductions observed after the HYP condition. Although the STR and HYP workouts were significantly different in terms of intensity, volume, and rest, these differences were only observable in the acid-base responses. The present findings reinforce the need for practitioners to look beyond the classification of RE workouts when aiming to elicit specific physiological responses.

Differences in run-up, take-off, and flight characteristics: successful vs. unsuccessful high jump attempts at the IAAF world championships.

Studies previously conducted on high jump have yielded important information regarding successful performance. However, analyses in competitive scenarios have often disregarded athletes' unsuccessful attempts. This study aimed to investigate the biomechanical differences between successful and unsuccessful jumps during competition. High-speed video footage (200 Hz) was obtained from 11 athletes during the 2018 Men's World Athletics Indoor Championship Final. From each athlete, one successful (SU) and one unsuccessful (UN) jump at the same bar height were included in the analysis, leaving seven athletes in total. Following whole-body 3D manual digitization, several temporal and kinematic variables were calculated for the run-up, take-off, and flight phases of each jump. During SU jumps, athletes raised the center of mass to a greater extent (p < 0.01) from take-off. Touchdown in SU jumps was characterized by a faster anteroposterior velocity (p < 0.05), lower backward lean (p < 0.05), and changes in joint angles for the stance and trail limbs (p < 0.05). Athletes also shortened the final contact time during SU jumps (p < 0.01) after producing a longer flight time in the final step of the run-up (p < 0.05). Elite-level high jumpers undertake a series of adjustments to successfully clear the bar after UN jumps. These adjustments reinforce the importance of the run-up in setting the foundations for take-off and bar clearance. Furthermore, the findings demonstrate the need for coaches to be mindful of the adjustments required in stance and trail limbs when looking to optimize feedback to athletes during training and competition.

A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women.

Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.

Feasibility of OpenPose markerless motion analysis in a real athletics competition.

This study tested the performance of OpenPose on footage collected by two cameras at 200 Hz from a real-life competitive setting by comparing it with manually analyzed data in SIMI motion. The same take-off recording from the men's Long Jump finals at the 2017 World Athletics Championships was used for both approaches (markerless and manual) to reconstruct the 3D coordinates from each of the camera's 2D coordinates. Joint angle and Centre of Mass (COM) variables during the final step and take-off phase of the jump were determined. Coefficients of Multiple Determinations (CMD) for joint angle waveforms showed large variation between athletes with the knee angle values typically being higher (take-off leg: 0.727 ± 0.242; swing leg: 0.729 ± 0.190) than those for hip (take-off leg: 0.388 ± 0.193; swing leg: 0.370 ± 0.227) and ankle angle (take-off leg: 0.247 ± 0.172; swing leg: 0.155 ± 0.228). COM data also showed considerable variation between athletes and parameters, with position (0.600 ± 0.322) and projection angle (0.658 ± 0.273) waveforms generally showing better agreement than COM velocity (0.217 ± 0.241). Agreement for discrete data was generally poor with high random error for joint kinematics and COM parameters at take-off and an average ICC across variables of 0.17. The poor agreement statistics and a range of unrealistic values returned by the pose estimation underline that OpenPose is not suitable for in-competition performance analysis in events such as the long jump, something that manual analysis still achieves with high levels of accuracy and reliability.

Anatomical reconstruction of the anterior inferior tibiofibular ligament in elite athletes using InternalBrace suture tape.

AIMS: The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. METHODS: Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)). RESULTS: All patients returned to their pre-injury level of sports activities. One patient developed a delayed union of the medial malleolus. The mean return to play was 62 days (49 to 84) for isolated injuries, while the patients with concomitant injuries returned to play in a mean of 104 days (56 to 196). The AOFAS score returned to 100 postoperatively in all patients. Knee-to-wall measurements were the same as the contralateral side in 18 patients, while one patient lacked 2 cm compared to the contralateral side. CONCLUSION: This study suggests the use of the InternalBrace in the management of unstable syndesmotic injuries offers an alternative method of stabilization, with good short-term results, including early return to sports in elite athletes. Cite this article: Bone Joint J 2022;104-B(1):68-75.

The Association Between Hip-Shoulder Separation Angles and Technique Characteristics in World-Class High Jumpers.

Hip-shoulder separation (H-Ssep) has been widely researched in many sporting activities (e.g., golf) to provide information on the contribution of torso rotation to performance and injury. Although it is necessary for high jumpers to generate significant long-axis rotation to successfully clear the bar, limited information exists on H-Ssep for high jump athletes. As such, this study aimed to (a) characterize the H-Ssep of world-class high jump athletes during competition, (b) determine if differences exist between male and female athletes and (c) to examine the relationship between H-Ssep and the biomechanical parameters used to describe high jump technique. Twenty-nine world-class high jumpers (17 males, 12 females) were video recorded (frame rate: 120-200 Hz) during the 2017 and 2018 World Athletics Championship finals. H-Ssep was quantified at touchdown (TD) and take-off (TO) following manual digitizing (SIMI motion) and a number of other common biomechanical parameters were computed. The observed levels of H-Ssep at TD (-46±12°) and TO (16 ±11°) were in line with those reported previously for other sports. The magnitude of H-Ssep varied between individuals and showed significant associations with other approach and take-off characteristics. Significant differences in H-Ssep were not evident between male and female athletes despite significant differences in other performance- and technique-related parameters. These findings highlight the divergent take-off characteristics of world-class performers and their reliance on hip-shoulder interactions when generating long axis rotation. Coaches should be mindful of the mechanical and physical consequences of H-Ssep when developing technical models, conditioning interventions and coaching strategies.

A video analysis framework for the rugby league tackle.

Rugby league tackle video analysis research typically uses technical criteria from coaching cues or tackle variables from rugby union. As such, content validity and relevance could be questioned. A video analysis framework that establishes appropriate variables for rugby league is therefore required. The study aimed to adopt a 5-stage process to establish a video analysis framework for the rugby league tackle, which was content valid, relevant and reliable.The 5-stage process included 1) creation of draft video analysis framework, using available rugby tackle research, 2) expert group recruitment and critique, 3) refinement of framework to establish content validity, 4) response process validity task and agreement within expert group, 5) intra- and inter-reliability testing using Kappa statistics.The agreed framework comprised six phases including; tackle event, defensive start point, pre-contact, initial contact, post-contact and play-the-ball. Within the identified phases, 63 variables were established. The intra- and inter-reliability testing resulted in strong agreement within all phases.The video analysis framework can be used in rugby league tackle research, categorising complex tackle events, such as injurious or optimal tackles, improving both player welfare and performance. The application of the framework to future rugby league research will increase coherence and usefulness of research findings.

Inter-limb asymmetries and kicking limb preference in English premier league soccer players.

The aims of this study were: (1) to quantify interlimb asymmetries in EPL soccer players in the context of kicking limb preference and (2) to establish the relationship between interlimb asymmetries and measures of physical performance. Twenty-two players (age: 21.8 ± 4.4 years) from an EPL club performed a running gait assessment (20 km/h) and unilateral countermovement jumps, a CoD assessment (modified 505 test), and an isokinetic knee extension/flexion protocol using each leg. Asymmetries were quantified using the percentage difference method and Pearson's correlations were used to quantify the association between variables. Players displayed the greatest level of asymmetry in isokinetic strength measures (5.9-12.7%) and lower levels of asymmetry in gait (1.6-7.7%), jump (0.9-7.0%) and CoD (1.9-3.5%) assessments. The influence of the preferred kicking limb was most evident in the isokinetic assessment with the players showing dominance in the preferred limb for knee flexor strength and in the non-preferred limb for knee extensor strength. These manifested in the asymmetry values calculated for the hamstring:quadricep (H:Q) ratios at 60°/s (8.80 ± 7.82%) and 240°/s (11.22 ± 7.04%) and in the functional H:Q ratio (12.67 ± 8.25%). The asymmetry values for peak extensor moment at 240°/s showed a significant correlation (ρ = -0.55, p = 0.034) with 10 m time in the CoD assessment. These findings provide benchmark asymmetry data for soccer practitioners and reveal that kicking limb preferences may bring about interlimb differences in the H:Q ratio which raises important considerations in the design of testing batteries and injury reduction interventions.

Morphological and mechanical properties of lower limbs in competitive racewalkers: Associations with performance.

Racewalking is an unconventional form of competitive gait that elicits a unique loading profile on lower limb muscles and tendons. This study mapped the structural and mechanical properties of lower limbs in competitive racewalkers and made associations with World Athletics competition performance points. Fourteen international racewalkers (seven men, seven women) were recruited for this study. Static ultrasonography was used to quantify muscle and tendon morphological characteristics. An isokinetic dynamometer was used to measure passive musculotendinous stiffness of the triceps surae, isometric (seven knee/ankle angle combinations) and isokinetic (four angular velocities) strength parameters in the plantarflexors and dorsiflexors, and isokinetic knee flexion and extension strength at five angular velocities. Correlations were found between performance and fascicle length of gastrocnemius medialis (r = -0.569, p = 0.034), dorsiflexor strength at 120°/s (r = 0.649, p = 0.016) and knee flexor strength at 30°/s (r = 0.632, p = 0.020). No associations were found for isometric plantarflexion or passive stiffness properties. Overall, the study showed various morphological and mechanical properties are associated with performance in competitive racewalkers. These associations seem to be related to the specific and unique biomechanical characteristics of racewalking.

Morphological and functional outcomes of operatively treated Achilles tendon ruptures.

Objectives: Achilles tendon rupture leads to functional impairments and these may be underpinned by morphological changes in the muscle-tendon unit. The functional performance of the injured limb will be impaired regardless of time since surgery and these impairments occur alongside changes in muscle-tendon morphology. Methods: Following operative treatment of Achilles tendon rupture and short-term immobilization, 12 patients completed a battery of tests during a single visit to the laboratory (performed an average of 4.4 ± 2.6 years post-surgery). Patients completed the Achilles' tendon rupture score (ATRS), tests of the ankle and hip range of motion (ROM) and ultrasound measurements of muscle-tendon architecture. Data on isokinetic (30°/s, 60°/s) plantar flexion strength, jumping performance and walking-running were also collected on the same visit. Percentage deficits were expressed relative to the non-injured limb and determined for statistical significance (p < 0.05). Relationships between outcome measures and time since surgery were tested using Pearson's correlation coefficients (p < 0.05). Results: The repaired limb showed a shorter muscle fascicle length (12.1-19.6%), increased fascicle pennation (18.0 ± 22.14%) and reduced muscle thickness (9.1-20.1%) in the gastrocnemius and/or soleus along with greater tendon cross-sectional area (46.7 ± 34.47%). Functionally, the repaired limb displayed lower countermovement jump height (-12.6 ± 15.68%) and longer drop jump contact times (5.5 ± 5.7%). Also, the repaired limb showed reduced hip internal-external ROM (6.3 ± 8.2%) but no differences existed between limbs for plantar flexion ROM and strength or gait characteristics. Good ATRS outcomes were reported (mean: 87.9 ± 16.2, range: 43-100) which related to time since surgery (r = 0.79) but individual ATRS items did not correlate with corresponding objective measures. Conclusion: Plantar flexor atrophy following surgically treated Achilles tendon rupture is partially compensated for by remodeling of the fascicles; however, impairments may still persist many years into the postoperative period although these may be more pronounced in high-velocity activities.

Commonly reported isokinetic parameters do not reveal long-term strength deficits of the Triceps surae complex following operative treatment of Achilles tendon rupture.

Isokinetic strength assessments are common outcome measures following operatively treated Achilles tendon (AT) ruptures. However, there is a lack of clarity on whether commonly reported outcome measures (such as peak joint moment) are sufficient to describe the extent of long-term functional deficits following AT rupture and repair. The present study conducted a comprehensive isokinetic evaluation of the Triceps surae complex in 12 participants who previously underwent AT rupture and repair. Testing occurred 4.4 (±2.6) years following surgery, and consisted of maximal isokinetic strength assessments of the plantarflexors at two angular velocities (30 and 60°âˆ™s-1) with the knee in flexed and straight positions. Differences between injured and non-injured limbs were tested through discrete and statistical parametric mapping analysis. Average joint moment showed significant main effects between injured and non-injured limbs, but common isokinetic parameters such as peak moment and angle of peak moment did not. The normalised moment curves showed a significant main effect of limb, angular velocity and knee joint position on joint moment throughout different portions of the range of motion. Temporal analysis revealed a significantly greater ability of the non-injured limb to sustain plantarflexor moments across a range of testing conditions. Participants who had undergone operative treatment of AT ruptures did not display inter-limb differences in discrete isokinetic strength outcomes that are often used in the literature. Instead, temporal analyses were required to highlight the reduced capacity of the injured limb to generate end-range joint moments and to sustain higher levels of joint moment for longer periods.

Changes in balance and joint position sense during a 12-day high altitude trek: The British Services Dhaulagiri medical research expedition.

Postural control and joint position sense are essential for safely undertaking leisure and professional activities, particularly at high altitude. We tested whether exposure to a 12-day trek with a gradual ascent to high altitude impairs postural control and joint position sense. This was a repeated measures observational study of 12 military service personnel (28±4 years). Postural control (sway velocity measured by a portable force platform) during standing balance, a Sharpened Romberg Test and knee joint position sense were measured, in England (113m elevation) and at 3 research camps (3619m, 4600m and 5140m) on a 12-day high altitude trek in the Dhaulagiri region of Nepal. Pulse oximetry, and Lake Louise scores were also recorded on the morning and evening of each trek day. Data were compared between altitudes and relationships between pulse oximetry, Lake Louise score, and sway velocity were explored. Total sway velocity during standing balance with eyes open (p = 0.003, d = 1.9) and during Sharpened Romberg test with eyes open (p = 0.007, d = 1.6) was significantly greater at altitudes of 3619m and 5140m when compared with sea level. Anterior-posterior sway velocity during standing balance with eyes open was also significantly greater at altitudes of 3619m and 5140m when compared with sea level (p = 0.001, d = 1.9). Knee joint position sense was not altered at higher altitudes. There were no significant correlations between Lake Louise scores, pulse oximetry and postural sway. Despite a gradual ascent profile, exposure to 3619 m was associated with impairments in postural control without impairment in knee joint position sense. Importantly, these impairments did not worsen at higher altitudes of 4600 m or 5140 m. The present findings should be considered during future trekking expeditions when developing training strategies targeted to manage impairments in postural control that occur with increasing altitude.