Role of the Flexion Relaxation Phenomenon in the Analysis of Low Back Pain Risk in the Powerlifter: A Proof-of-Principle Study.

INTRODUCTION: Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. METHODS: Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. RESULTS: We included a group of 18 male (aged 24-39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 µV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. CONCLUSIONS: FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP.

Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study.

Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion-relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind-body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight-session yoga asanas program, with the first session conducted in-clinic and the rest delivered with tele-approach. Outcome measures included pain intensity, flexion-relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow-up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele-yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long-term effects of yoga for managing LBP.

Match Analysis, Physical Training, Risk of Injury and Rehabilitation in Padel: Overview of the Literature.

Padel is a racket sport that has been gaining great popularity and scientific interest in recent years. It could be considered to be a high-intensity intermittent sport with valuable cardiovascular and neuromuscular benefits; however, the risk of injury cannot be neglected. To date, there is still a gap of knowledge in the scientific literature on this emergent sport. Therefore, the present review aims to synthetize the current knowledge on padel game dynamics to better characterize the main risk factors, the injury rate and characteristics, and the most effective rehabilitative treatment strategies. PubMed, Scopus, Cochrane, and PEDro were screened up to January 2022 to identify eligible studies focusing on padel players as participants. Out of 160 records, we included 19 studies, which were focused on match analysis, anthropometric and physical training, the risk of injury, and rehabilitative interventions. The results showed that the high action velocity and the sudden changes in direction during a padel match could represent a risk factor for injuries, especially in untrained players. However, the high heterogeneity of the studies in the literature hinders our ability to draw any strong conclusions, and the results should be carefully considered. Future research should address the lack of knowledge on injury mechanisms and type to implement a tailored rehabilitation program.

Specialization and Injury Risk in Different Youth Sports: A Bio-Emotional Social Approach.

Aims: Sport specialization is an actual trend in youth athletes, but it can increase injury risk. The aim was to determine the eventual correlation between sports specialization and injury risk in various sports, using a biopsychosocial approach. Methods: 169 sport-specialized athletes completed [(38 female, 131 male); overall (11.2 ± 2.7 years), (56.28 ± 15.72 kg), (161.3 ± 15.52 cm)] a self-reported questionnaire regarding sociodemographic (age, gender, educational level), physical-attitudinal, injuries and psychological-attitudinal To analyze data univariate and correlate analyses were used. Results: Of 169 athletes enrolled, 53% were single-sport specialized (reported participation in one sport and trained > 8 months/year). In team sports (100%, OR = 0.75; p = 0.022) a high risk of having to remain at rest for up to 1 month because of overuse was observed. Males who suffered direct trauma (70%; OR = 1.03; p = 0.006) in the team group (95%, OR = 0.09; p = 0.008) were more exposed to that type of injury, and also the type of specialization figured significantly (p = 0.047). In addition, interoceptive awareness correlates with injury (95%, 1.04, p = 0.01). This study shows that, even though young athletes seem to be at a high risk of becoming injured, early team sport specialization and a high performance level cannot be considered to be the only risk factors.

Impact of COVID-19 lockdown on the epidemiology of soccer muscle injuries in Italian Serie A professional football players.

BACKGROUND: The aim of this study was to evaluate the influence that COVID-19 lockdown had on the epidemiology of soccer musculoskeletal injuries during 2019/2020 Italian First Football League Serie A in professional football players. METHODS: In this retrospective study we analyzed records from media-based platform (Trasfermarkt, https://www.transfermarkt.com), describing the epidemiology of muscle injuries before and after the first COVID-19 lockdown phases in Italian professional football players. We also classified the severity of the injury as the number of missing days from participation. RESULTS: We assessed a lower prevalence of post-lockdown injuries, albeit showing a similar injury rate at 1000 game-hours (prelockdown: 16.9 [13.0-20.7], post-lockdown: 15.5 [9.9-21.1]; RR=0.92 [0.46-1.8]). All risk ratios for injury rate were not significantly different (P>0.05) between pre- and post-lockdown. CONCLUSIONS: The incidence of muscle injuries has not significantly changed after the first COVID-19 lockdown in Italian professional soccer players. Recognizing injury rates might be crucial for physician to evaluate adequate preventive measures.

Body Representation Alterations in Patients with Unilateral Brain Damage.

OBJECTIVE: Systematic studies about the impact of unilateral brain damage on the different body representations (body schema, body structural representation, and body semantics) are still rare. Aim of this study was to evaluate body representation deficits in a relatively large sample of patients with unilateral brain damage and to investigate the impact of right or left brain damage on body representations (BRs), independently from deficits in other cognitive processes. METHOD: Sixty-four patients with unilateral stroke (22 with left brain damage, LBD; 31 with right brain damage without neglect, RBD-N; 11 with right brain damage with neglect, RBD+N) and 41 healthy individuals underwent a specific battery including BR as well as control tasks. RESULTS: In more than a third of the sample, selective (37.5%) and pure (31%) deficits of BR were presented and equally distributed among the different BRs (˜10% for each representation), with selective (27.2%) and pure (22.7%) body schema deficit mainly presented after left brain damage. As a group, patients with unilateral brain damage, independently of the side of lesion (LBD, RBD-N, RBD+N), had significantly worse performance on body structural representation with respect to healthy individuals, whereas LBD had numerically worse performance on body schema with respect to healthy individuals and RBD-N. No significant differences among groups were found on body semantics. CONCLUSION: BR deficits are not a rare consequence of unilateral brain damage and are independent of a more general cognitive dysfunction. Accordingly, the need for an accurate assessment and specific neuropsychological training in clinical settings is discussed.

Electromyographic Assessment of Anterior Cruciate Ligament Injury Risk in Male Tennis Players: Which Role for Visual Input? A Proof-of-Concept Study.

Anterior cruciate ligament (ACL) injury incidence is often underestimated in tennis players, who are considered as subjects conventionally less prone to knee injuries. However, evaluation of the preactivation of knee stabilizer muscles by surface electromyography (sEMG) showed to be a predictive value in the assessment of the risk of ACL injury. Therefore, this proof-of-concept study aimed at evaluating the role of visual input on the thigh muscle preactivation through sEMG to reduce ACL injury risk in tennis players. We recruited male, adult, semiprofessional tennis players from July to August 2020. They were asked to drop with the dominant lower limb from a step, to evaluate-based on dynamic valgus stress-the preactivation time of the rectus femoris (RF), vastus medialis, biceps femoris, and medial hamstrings (MH), through sEMG. To highlight the influence of visual inputs, the athletes performed the test blindfolded and not blindfolded on both clay and grass surfaces. We included 20 semiprofessional male players, with a mean age 20.3 ± 4.8 years; results showed significant early muscle activation when the subject lacked visual input, but also when faced with a less-safe surface such as clay over grass. Considering the posteromedial-anterolateral relationship (MH/RF ratio), tennis players showed a significant higher MH/RF ratio if blindfolded (22.0 vs. 17.0% not blindfolded; p < 0.01) and percentage of falling on clay (17.0% vs. 14.0% in grass; p < 0.01). This proof-of-principle study suggests that in case of absence of visual input or falling on a surface considered unsafe (clay), neuro-activation would tend to protect the anterior stress of the knee. Thus, the sEMG might play a crucial role in planning adequate athletic preparation for semiprofessional male athletes in terms of reduction of ACL injury risk.

The Body across the Lifespan: On the Relation between Interoceptive Sensibility and High-Order Body Representations.

BACKGROUND: Interoceptive information plays a pivotal role in building higher-order cognitive body representations (BR) that neuropsychological and neuroimaging evidence classifies as action-oriented (i.e., body schema) or non-action-oriented (i.e., visuo-spatial body map). This study aimed to explore the development of BR, considering the association with the interoceptive sensibility throughout the lifespan. METHODS: Two hundred thirty-nine healthy participants divided into five age groups (7 to 8 years; 9 to 10 years; 18 to 40 years; 41 to 60 years; over 60 years) completed a self-report measure of interoceptive sensibility (the Self-Awareness Questionnaire; SAQ) and were given tasks assessing the two BR (action-oriented: hand laterality task; non-action-oriented: frontal body evocation task). RESULTS: Both children (7-8 and 9-10 years) and older adults (over 60 years) performed worse than young (18-40 years) and middle-aged adults (41-60 years) in action- and non-action-oriented BR tasks. Moderation analyses showed that the SAQ score significantly moderated the relationship between age and action-oriented BR. CONCLUSIONS: The current results are consistent with inverted U-shaped developmental curves for action- and non-action-oriented BR. As an innovative aspect, the ability to mentally represent one's own body parts in diverse states could be negatively affected by higher interoceptive sensibility levels in childhood and late adulthood.

The development of body representations in school-aged children.

Following the triadic taxonomy, three different body representations do exist, namely the body semantics, the body structural representation and the body schema. The development of these body representations has been widely investigated in toddlers, but several issues remain to be addressed in school age. To assess age- and gender-related changes in different body representations and to investigate the presence of different patterns of interplay between these representations of the body, 90 children (age range: 7-10) and 37 young adults (age range: 18-35) were given tasks assessing the body semantics, the body structural representation and the body schema as well as control tasks. The present results suggested that the body schema, evaluated by means of hand laterality judgments, was still not completely developed in school-aged children, whereas the body structural representation reached an adult-like pattern by the age of 9-10 years. Finally, body semantics was fully developed in school-aged children. These findings were discussed in terms of their theoretical implications, for a better understanding of body representation development; also, implications for clinical assessment of body representation disorders were discussed.

Body Representations in Children with Cerebral Palsy.

We constantly process top-down and bottom-up inputs concerning our own body that interact to form body representations (BR). Even if some evidence showed BR deficits in children with cerebral palsy, a systematic study that evaluates different kinds of BR in these children, taking into account the possible presence of a general deficit affecting non-body mental representations, is currently lacking. Here we aimed at investigating BR (i.e., Body Semantics, Body Structural Representation and Body Schema) in children with cerebral palsy (CP) taking into account performance in tasks involving body stimuli and performance in tasks involving non-body stimuli. Thirty-three CP (age range: 5-12 years) were compared with a group of 103 typically-developing children (TDC), matched for age and sex. 63.64% of children with CP showed a very poor performance in body representation processing. Present data also show alterations in different body representations in CP in specific developmental stages. In particular, CP and TDC performances did not differ between 5 to 7 years old, whereas CP between 8 and 12 years old showed deficits in the Body Structural Representation and Body Schema but not in Body Semantics. These findings revealed the importance of taking into account the overall development of cognitive domains when investigating specific stimuli processing in children who do not present a typical development and were discussed in terms of their clinical implications.

Interoceptive awareness in focal brain-damaged patients.

BACKGROUND: Interoception is the basic process enabling evaluation of one's own internal state of body, but its alteration in brain-damaged patients has not been adequately investigated. Our study aimed to investigate awareness of visceral and somatosensorial sensations in brain-damaged patients with unilateral stroke. METHODS: Sixty patients (22 with left brain damage, LP; 25 with right brain damage without neglect, RPN-; and 13 with right brain-damage and extrapersonal and/or personal neglect, RPN+) and 45 healthy controls (HC) completed the Self-Awareness Questionnaire (SAQ), a self-report tool for assessing interoceptive awareness with two domains related to visceral (VD) and somatosensory feelings (SD), respectively. RESULTS: Comparing the SAQ subdomains scores between three groups of patients (LP, RPN-, and RPN+) and HC, we found that RPN+ had significantly lower scores on VD than HC and LP, whereas no significant difference was found on scores of SD between groups. CONCLUSION: Our results support the hypothesis of a right-hemispheric dominance for "interoceptive neural network" suggesting that processing of visceral sensations would be located mainly in the right hemisphere. Therefore, a careful assessment of interoceptive awareness in clinical practice would be useful to improve rehabilitation and to engage patients with deficit of interoceptive awareness in developing greater accuracy of body signals.

Late Activation of the Vastus Medialis in Determining the Risk of Anterior Cruciate Ligament Injury in Soccer Players.

CONTEXT: Activation time of the quadriceps is important in determining injury risk in professional soccer players. OBJECTIVE: To compare the activation time of the quadriceps and hamstrings muscles during a movement that puts stress on anterior cruciate ligament (ACL) to assess the risk of ACL injury. DESIGN: Case series. SETTING: University laboratory for movement analysis. PATIENTS OR OTHER PARTICIPANTS: Twenty (10 males and 10 females) professional soccer players. INTERVENTION(S): An inertial sensor and 4 electrodes positioned on the quadriceps and hamstrings muscles were used for the surface electromyography. The athlete resting on 1 leg dropped, from a 32-cm-high platform, on the suspended foot (testing leg), without jumping or lowering his center of gravity and maintaining single-leg landing for 5 seconds. Using a software, it is possible to calculate the activation time of the rectus femoris, vastus medialis (VM), biceps femoris, and semimembranosus muscles before ground contact. MAIN OUTCOME MEASURES: To evaluate the activation times of the rectus femoris, VM, biceps femoris, and semitendinosus muscles before ground contact in comparison with the range of normality calculated by the manufacturer. RESULTS: All male soccer players demonstrated a low risk related to the correct activation of all the examined muscles, while female soccer players demonstrated delayed activation of the VM. CONCLUSIONS: Delayed activation of the VM registered in females determines an increase in anterior shear force, which is an important risk factor for incurring an ACL injury. This testing protocol becomes adequate for the screening of high-risk athletes and for targeting interventions to specific imbalances that may increase injury risk.

["Enjoy the Sport - Schools against doping and drug dependence": a health education intervention in secondary schools]. / "Enjoy the Sport - la scuola contro il doping e le dipendenza 2.0". Intervento di educazione alla salute sul doping e droga: uno studio di campo nella scuola secondaria.

INTRODUCTION: The use of doping substances is growing not only in young athletes performing competitive and non-competitive sports, but also in amateur sports, thereby representing a social and public health problem. The aim of this study was to measure knowledge, attitudes and opinions on doping and drugs and their effects, among students of secondary schools, and to assess the effectiveness of a health education intervention. "Enjoy the Sport- the school against doping and addiction 2.0" is a program developed to discourage the use of drugs, in particular doping drugs, by introducing information on the origins, on the effects of drugs and examples of appropriate lifestyles. This project was conceived by C.I.S.C.O.D. (Comitato Italiano Sport Contro Droga), an association of the C.O.N.I. and carried out with its support. MATERIALS AND METHODS: The "Enjoy" project was a study with a one-arm experimental design and with a pre-post evaluation. A multiple-choice questionnaire was used to measure adolescents' knowledge, attitudes and opinions on doping and its effects. A descriptive analysis and post-pre intervention comparison was performed with the McNemar test. RESULTS: There was a significant increase in participants' knowledge of doping substances indicated by the WADA (World Anti-Doping Agency) (p<0.001) and a better understanding of the meaning of the term "doping". A decrease in the number of adolescents who would use doping substances (pre = 0.06%; post = 0.0%) was observed, as well as an increase in the number of adolescents who do not consider fair that athletes of any level should use substances that alter their performance (pre = 83.7%; post = 85%). A significant increase was observed in the proportion of participants who believe that athletes should not use doping substances because they are harmful to the human organism (pre = 38.6%; post = 51.7%) (p<0.001). CONCLUSIONS: The project "Enjoy the Sport" contributed to increasing the health literacy of secondary school students about doping (and consequent awareness of the negative aspects of drug use). Schools, therefore, are an appropriate setting for implementing educational interventions for the prevention of doping. However, it is fundamental to integrate knowledge and action, especially in the context of family, sport and sports associations.

Prevalence of Staphylococcus aureus carriage and pattern of antibiotic resistance, including methicillin resistance, among contact sport athletes in Italy.

Background and purpose: Athletes participating in contact or collision sports have a great chance of acquiring Staphylococcus aureus infections. The risk factors for colonization and infections include frequent antibiotic use, close contact situations, skin trauma, sharing of sports equipment, and poor hygiene. Therefore, our specific goals were to determine (1) prevalence of S. aureus among different types of contact sport athletes which were barely studied in the European region, (2) antimicrobial resistance of S. aureus isolates, and (3) association of carriage with particular risk factors of spor t practices. Patients and methods: A cross-sectional study was conducted among contact or collision sport athletes in Italy. A questionnaire was used to gather information about sociodemographic characteristics, specific sport activities, and participants' health conditions. Swabs were collected from the nares, oropharynx, and fingers and tested for S. aureus isolation and antimicrobial susceptibility. Results: S. aureus was carried by 42% of 238 enrolled athletes. Colonization was associated with number of weekly training days, sharing of sports equipment, not taking a shower immediately after training, and a previous history of pharyngitis or sinusitis and skin manifestations. Isolates were resistant to clindamycin (24.8%) and erythromycin (15.8%). Of all athletes, 1.3% carried methicillin-resistant S. aureus (MRSA); MRSA were 3% of all S. aureus isolates. No strains were resistant to sulfamethoxazole/trimethoprim. Conclusion: Our results have shown a high prevalence of S. aureus carriage and a relevant resistance to antimicrobials used for the treatment of S. aureus infections. Prevention efforts aimed at reducing S. aureus colonization, and thus potentially reducing infections, should be improved.

Salivary alpha-amylase, salivary cortisol, and anxiety during a youth taekwondo championship: An observational study.

The aim of this study was to assess the stress-related responses and the coach's capability to match perceived efforts of youth athletes during a taekwondo championship.Using a cross-sectional study design, salivary cortisol (sC) and alpha-amylase (sAA) were measured in 6 males and 3 females young (11.0 ±â€Š0.9 years) athletes at awakening, 5 minutes before, and 1 minute and 30 minutes after official combats. State anxiety was recorded 60 minutes before the first competition, whereas coach's and athletes' ratings of perceived exertion (RPE) were obtained at the end of the combats. Time-matched (awakening and pre-competition) salivary samples and trait anxiety were collected 7-day postcompetition during a resting day.No effect for match outcome emerged. No difference emerged between athletes and coach RPEs. Higher (P = .03) state anxiety (41.6 ±â€Š10.9 points) was shown than trait anxiety (34.8 ±â€Š7.1 points). Time-matched sAA were similar. Peak sAA observed at the end of the combat (114.2 ±â€Š108.1 U/mL) was higher (P < .01) than the other samples (range: 20.6-48.1 U/mL), whereas sC increased (P < .05) from awakening (8.0 ±â€Š1.5 nmol/L), with peak levels observed at 30 minutes into the recovery phase (19.3 ±â€Š4.3 nmol/L). Furthermore, pre-competition sC (16.5 ±â€Š4.5 nmol/L) values were higher (P < .01) with respect to time-matched samples during the resting day (4.6 ±â€Š1.0 nmol/L). The 3 athletes engaged in consecutive matches showed a tendency toward increasing sAA and sC.Taekwondo combats pose a high stress on young athletes, eliciting a fast reactivity of the sympathetic-adreno-medullary system relative to the hypothalamic-pituitary-adrenocortical system. Understanding the athlete's efforts during combats, coaches are recommended to apply effective recovery strategies between matches.

Effects of official Taekwondo competitions on all-out performances of elite athletes.

This study investigated physiological and performance aspects of 15 (4 women and 11 men) elite Taekwondo athletes (24.0 ± 5.7 years) during their National Championship. The load of the competition was evaluated by means of heart rate (HR) and blood lactate (La). Pre and postmatch countermovement jump (CMJ), and handgrip performances were compared (p < 0.05). The match imposed a high load (HR > 85% of individual HRmax = 92 ± 12%; La = 6.7 ± 2.5 mmol·L⁻¹) on athletes. After the match, better (p < 0.0001) CMJ (men: 43.9 ± 5.2 cm; women: 30.8 ± 2.3 cm) and worst (p = 0.006) handgrip performances (men: 459 ± 87 N; women: 337 ± 70 N) were found with respect to prematch ones (CMJ: men = 40.8 ± 4.9 cm, women = 28.2 ± 2.5 cm; handgrip: men = 486 ± 88 N, women: 337 ± 70 N). Results indicate that the intermittent activity of the Taekwondo competition elicits a high neuromuscular activation of the lower limbs. Instead, the decreases in grip strength could be because of the repeated concussions on the upper limbs used to protect from the opponent's kicks and punches directed toward the scoring area of the torso. Practically, these results urge coaches to structure training sessions that enable athletes to maintain their upper limb strength during their match.