Relationship between Workload, Psychological State and Recovery in Female Soccer Athletes.

This study assessed the multifaceted relations between measures of workload, psychological state, and recovery throughout an entire soccer season in female collegiate soccer athletes (19.8±1.2 yrs, 132±12.3 lbs, 63±3.2 in). A prospective longitudinal study was utilized to measure workload (GPS training load, Rate of Perceived Exertion (RPE), psychological state (mental stress, mental fatigue, and mood), and recovery (sleep duration, sleep quality, and soreness), during 90 observations (59 training sessions and 21 games). Separate linear-mixed effect models were used to assess outcomes of RPE, soreness, and sleep duration. A linear mixed-effects model explained 59% of the variance in RPE following each session. Specifically, each standard deviation increase in GPS load and mental stress in the morning prior to training increased RPE by 1.46 (SE=0.08) and 0.29 (SE=0.07), respectively, following that day's training. Furthermore, a significant interaction was found between several predictor variables and chronological day in the season while predicting RPE. Specifically, for each standard deviation increase in GPS load, RPE went up by 0.0055 per day during the season suggesting that load had a higher impact on RPE as the season progressed. In contrast, the interaction of day by mental stress, sleep duration, and soreness continued to be stronger as the season progressed. Each linear mixed-effect model predicted a larger amount of variance when accounting for individual variations in the random effects.

Images depicting human pain increase exercise-induced pain and impair endurance cycling performance.

The current study investigated whether viewing images of others in pain influences exercise-induced pain (EIP) and cycling performance. Twenty-one recreational cyclists attended five laboratory visits. The first two visits involved measuring participants' maximal aerobic capacity and familiarized participants to the fixed power (FP) and 16.1 km cycling time trial (TT) tasks. The FP task required participants to cycle at 70% of their maximal aerobic power for 10-minutes. In the subsequent three visits, participants performed the FP and TT tasks after viewing pleasant, painful or neutral images. Participants rated the subset of painful images as more painful than the pleasant and neutral images; with no difference in the pain ratings of the pleasant and neutral images. In the FP task, EIP ratings were higher following painful compared to pleasant images, while no differences in EIP were observed between any other condition . In the TT, performance did not differ between the pleasant and neutral conditions. However, TT performance was reduced after viewing painful images compared to neutral or pleasant images. HR, B[La], perceived exertion and EIP did not differ between the three conditions. These results suggest that viewing painful images decreases TT performance and increases pain during fixed intensity cycling. Abbreviations: EIP: Exercise Induced Pain; FP: Fixed Power; TT: Time Trial; HR:Heart Rate; B[La]: Blood Lactate; RPE: Rating of Perceived Exertion; IAPS: International Affective Picture System; PO: Power Output.

Music Modulates Awake Bruxism in Chronic Painful Temporomandibular Disorders.

OBJECTIVE: In this experimental study, we aimed to determine whether guided music listening (GML) - a music intervention based on models of mood mediation and attention modulation - modulates masticatory muscle activity and awake bruxism in subjects with chronic painful muscular temporomandibular disorders (TMD myalgia, mTMD), a condition causing a significant burden to patients, their families, and healthcare systems. BACKGROUND: Awake bruxism - a stress behavior characterized by clenching of the teeth - is a strong contributor to chronic mTMD. GML modulates psychological stress and motor responses and could thus reduce muscle activity in chronic musculoskeletal conditions, including mTMD. METHODS: We recorded the electromyographic (EMG) activity in the right masseter of 14 women with chronic (>6 months) mTMD (median [IQR] = 39.5.3 [24.3] years) and 15 pain-free women (median [IQR] = 30.0 [3.5] years) during a GML session, including 3 music (stressful, relaxing, and participants' favorite music) and a no-music (pink noise) control blocks, each lasting 15 minutes. We measured the motor effort of the right masseter relative to the participants' maximum voluntary contraction (MVC), the muscular effort to maintain mandibular posture (EMGposture ), and to produce spontaneous awake bruxism episodes (EMGbruxism ), and the duration and frequency of spontaneous awake bruxism episodes. We tested between-group and within-group (between blocks) differences, as well as the effect of the interaction group by experimental block on these outcome measures. RESULTS: In both groups, EMGposture was significantly affected by the interaction group by experimental block (P < .001). Compared to pink noise [mean (95% CI); mTMD: 2.2 (1.6-2.8) %MVC; Controls: 1.1 (0.5-1.7) %MVC], EMGposture increased during the stressful music block [contrast estimate (95% CI); mTMD: +0.8 (0.7-0.8) %MVC; Controls: +0.3 (0.3-0.4) %MVC; both P < .001], and decreased during the relaxing [mTMD: -0.4 (-0.5 to -0.4) %MVC; Controls: -0.3 (-0.4 to -0.3) %MVC; both P < .001] and favorite [mTMD: -0.5 (-0.6 to -0.5) %MVC; Controls: -0.5 (-0.5 to -0.4) %MVC; both P < .001] music blocks. EMGposture was greater in mTMD individuals than controls during the favorite music [contrast estimate (95% CI): +1.1 (0.2-1.9) %MVC; P = .019] and the pink noise [+1.1 (0.2-2.0) %MVC; P = .014] blocks. EMGbruxism was significantly affected by the interaction group by experimental block (P < .001). In mTMD participants, compared to the pink noise block [mean (95% CI); 23.8 (16.0-31.6) %MVC], EMGbruxism increased during the stressful music block [contrast estimate (95% CI); +10.2 (8.6-11.8) %MVC], and decreased during the relaxing [-6.2 (-8.1 to -4.3) %MVC; P < .001] and favorite [-10.2 (-12.2 to -9.1) %MVC; P < .001] music blocks. These effects were not observed in the control group [mean (95% CI); pink noise: 19.3 (10.9-27.6); stressful: 21.2 (12.9-29.4) %MVC; relaxing: 21.6 (13.3-29.9) %MVC; favorite: 24.2 (15.8-32.7) %MVC; all P > .05]. EMGbruxism was significantly greater in mTMD participants than controls during the stressful music block [contrast estimate (95% CI): +12.9 (1.6-24.2) %MVC; P = .026). GML did not affect the duration or the frequency of awake bruxism in either group (median [IQR], mTMD: 23.5 [96.7] s, range 1-1300 seconds; Controls: 5.5 [22.5], range 0-246 seconds; P = .108). The frequency of awake bruxism episodes was greater in the mTMD group compared to controls only during the pink noise block (median [IQR], mTMD: 5 [15.3] episodes, range 0-62 episodes; Controls: 1 [3] episode, range 0-27 episodes; P = .046). No significant between-group differences were found in either the overall time spent engaging in awake bruxism (median [IQR], mTMD: 23.5 [96.7] s, range 1-1300 seconds; Controls: 5.5 [22.5], range 0-246 seconds; P = .108), or during each block (all P > .05). CONCLUSIONS: In subjects with chronic mTMD, relaxing music and the individual's favorite music decreased the muscular effort during spontaneous awake bruxism episodes by 26% and 44% (relative changes), respectively. In contrast, stressful music increases it by about 43%. Because of its positive effects on awake bruxism, GML with selected music could be a promising and non-invasive component of a multimodal approach for the management of chronic mTMD.

The effectiveness of a practical half-time re-warm-up strategy on performance and the physical response to soccer-specific activity.

The aim of this study was to assess the influence of a half-time (HT) re-warm up (RWU) strategy on measures of performance and the physical and perceptual response to soccer-specific activity. Ten male soccer players completed a control (CON) and RWU trial, in which participants completed 60 min (4 x 15-min periods with a 15-min HT interspersing the third and fourth periods) of a soccer-specific exercise protocol. The CON trial comprised a passive 15-min HT, whilst the RWU trial comprised a passive 12-min period, followed by a 3-min RWU. The RWU elicited an improvement in 20 m sprint times (d= 0.6; CON: 3.42 ± 0.20 s; RWU: 3.32 ± 0.12 s), and both squat (d= 0.6; CON: 26.96 ± 5.00 cm; RWU: 30.17 ± 5.13 cm) and countermovement jump height (d= 0.7; CON: 28.15 ± 4.72 cm; RWU: 31.53 ± 5.43 cm) following the RWU and during the initial stages of the second half. No significant changes were identified for 5 m or 10 m sprint performance, perceived muscle soreness, or PlayerLoadTM. Ratings of perceived exertion were however higher (~2 a.u) following the RWU. These data support the use of a HT RWU intervention to elicit acute changes in performance.

Acute Effects of Battle Rope Exercise on Performance, Blood Lactate Levels, Perceived Exertion, and Muscle Soreness in Collegiate Basketball Players.

Chen, WH, Yang, WW, Lee, YH, Wu, HJ, Huang, CF, and Liu, C. Acute effects of battle rope exercise on performance, blood lactate levels, perceived exertion, and muscle soreness in collegiate basketball players. J Strength Cond Res 34(10): 2857-2866, 2020-This study investigated the acute effects of battle rope (BR) exercise on basketball players' performance, blood lactate levels, rating of perceived exertion (RPE), and perceived muscle soreness. Fifteen well-trained Division-I male basketball players underwent the same test procedure at baseline, before BR exercise (30 minutes of rest after the baseline test), and after BR exercise. The 30-minute experimental protocol comprised 6 BR exercises at a work-to-rest ratio of 1:2 (20-second exercise and 40-second rest). Shooting accuracy, basketball chest pass speed, countermovement jump (CMJ) height, blood lactate levels, RPE (Borg Category-Ratio-10 scale), and perceived muscle soreness (visual analog scale, 0-100 mm) were measured in each test. The results indicated no change for any variables between baseline and before BR exercise. After BR exercise, performance decrements (p < 0.05) were recorded in shooting accuracy (16.9%) and basketball chest pass speed (9.1%), but no significant changes were observed for CMJ height. Battle rope exercise caused increases in blood lactate levels (13.6 mmol·L), RPE (9.9), and perceived muscle soreness (upper-limb: 63-67 mm; trunk: 43-68 mm; and lower-limb: 45-52 mm). In conclusion, BR exercise is physically demanding on the upper body, resulting in decreased performance in shooting accuracy and basketball chest pass speed. Battle rope exercise may not be beneficial before a practice or game because it triggers acute exercise-induced performance decrements and fatigue. However, BR exercise may be suitable for basketball training sessions in which the objective is to strengthen technical skills under fatiguing conditions.

The Effectiveness of Kinesio Taping in Recovering From Delayed Onset Muscle Soreness: A Crossover Study.

CONTEXT: Kinesio taping (KT) is a popular taping technique used in the recovery process; however, in the relevant literature, there is no real consensus on its efficacy. OBJECTIVE: To investigate whether rectus femoris KT application after delayed onset muscle soreness enhances recovery of muscle soreness, edema, and physical performance. PARTICIPANTS: A total of 22 healthy amateur male athletes participated in this study. DESIGN: Randomized, crossover study. SETTING: Human performance laboratory of the university. INTERVENTIONS: Participants performed an exercise protocol inducing delayed onset muscle soreness. They accomplished 2 distinct trials, with or without KT. The washout period between trials was 6 weeks. For the KT condition, KT inhibition technique was used and applied immediately after exercise bilaterally on rectus femoris. MAIN OUTCOME MEASURES: Range of motion, muscle soreness, and edema were measured at baseline, 30 minutes, 24, 48, and 72 hours postexercise. Dynamic balance, sprint, and horizontal jump were evaluated at similar time frame except for 30-minute postexercise. RESULTS: The findings showed that there were no significant differences between the KT group (KTG) and control group for all outcome variables (P > .05). Muscle soreness returned to baseline values 72 hours postexercise only within the KTG (P > .05). Although the horizontal jump performance decreased substantially from baseline to 24 and 48 hours postexercise only within the control group (P < .05), the performance increased significantly from 24 to 72 hours postexercise within the KTG (P < .05). Balance increased significantly from baseline to 48 hours postexercise (P < .05) in both groups. Balance also increased significantly from baseline to 72 hours postexercise only within the KTG (P < .05). The effect size of soreness which is our primary outcome was large in both groups (r > .5). CONCLUSIONS: KT is favorable in the recovery of muscle soreness after delayed onset muscle soreness. KT has beneficial effects on horizontal jump performance and dynamic balance.

Athletes Play Through Pain-What Does That Mean for Rehabilitation Specialists?

CONTEXT: Pain in sport has been normalized to the point where athletes are expected to ignore pain and remain in the game despite the possible detrimental consequences associated with playing through pain. While rehabilitation specialists may not have an influence on an athlete's competitive nature or the culture of risk they operate in, understanding the consequences of those factors on an athlete's physical well-being is definitely in their area of responsibility. OBJECTIVE: To explore the factors associated with the experiences of subelite athletes who play through pain in gymnastics, rowing, and speed skating. DESIGN: The authors conducted semistructured interviews with subelite athletes, coaches, and rehabilitation specialists. They recruited coach participants through their provincial sport organization. Athletes of the recruited coaches who were recovering from a musculoskeletal injury and training for a major competition were then recruited. They also recruited rehabilitation specialists who were known to treat subelite athletes independently by e-mail. SETTING: An observation session was conducted at the athlete's training facility. Interviews were then conducted either in a room at the university or at a preferred sound-attenuated location suggested by the participant. PARTICIPANTS: The authors studied 5 coaches, 4 subelite athletes, and 3 rehabilitation specialists. INTERVENTIONS: The authors photographed athletes during a practice shortly before an important competition, and we interviewed all the participants after that competition. Our photographs were used during the interview to stimulate discussion. RESULTS: The participant interviews revealed 3 main themes related to playing through pain. They are: Listening to your body, Decision making, and Who decides. CONCLUSION: When subelite athletes, striving to be the best in their sport continue to train with the pain of an injury, performance is affected in the short-term and long-term consequences are also possible. Our study provides some insight into the contrasting forces that athletes balance as they decide to continue or to stop.

Changes in perceptions of mental fatigue during a season in professional under-23 English Premier League soccer players.

The present study assessed changes in academy soccer players' perception of mental fatigue (MF) across a competitive season, investigating the relationship between MF and other subjective measures of wellness. Ten players completed a modified Brief Assessment of Mood (BAM+) questionnaire that included the question: "How mentally fatigued do you feel"? on match-day (MD) and one (MD+1), two (MD+2) and three (MD+3) days post-match (35 matches). Players reported their MF, along with other subjective measures (sleep, muscle soreness, fatigue and motivation). Results found MF was elevated on MD+1 (43±1 mm) compared to all other days (all P≤0.001). Players reported lower MF on MD+1 in the late-season phase (34±2 mm) compared to both early- (50±2 mm, P≤0.001) and mid-season (46±2 mm, P≤0.001). This coincided with an 80%-win rate in the late-season phase versus the early- (33%) and mid-season (50%). There were very strong repeated-measures correlations between changes in MF and sleep (r=-0.77), muscle soreness (r=0.94), fatigue (r=0.92) and motivation (r=-0.89; all P ≤ 0.0005). In conclusion, MF was closely aligned to match success and other wellness variables. This data suggests a potential lack of sensitivity for identifying MF using a subjective questionnaire. Therefore, researchers and practitioners could work together to identify other ways of practically assessing MF.

Thermal Infrared Imaging Can Differentiate Skin Temperature Changes Associated With Intense Single Leg Exercise, But Not With Delayed Onset of Muscle Soreness.

Muscle damage and soreness associated with increased exercise training loads or unaccustomed activity can be debilitating and impact the quality of subsequent activity/performance. Current techniques to assess muscle soreness are either time consuming, invasive or subjective. Infrared thermography has been identified as a quick, non-invasive, portable and athlete friendly method of assessing skin temperature. This study assessed the capability of thermal infrared imaging to detect skin temperature changes that may accompany the inflammatory response associated with delayed onset muscular soreness (DOMS). Eight recreationally trained participants (age 25 ± 3 years, mass 74.9 ± 13.6 kg, training minutes 296 ± 175 min·wk-1) completed 6 sets of 25 maximal concentric/eccentric contractions of the right knee flexors/extensors on a dynamometer to induce muscle damage and DOMS. The left knee extensors acted as a non-exercise control. Neuromuscular performance, subjective pain assessment and infrared thermography were undertaken at baseline, 24 and 48 hr post the DOMS-inducing exercise protocol. Data were analysed using Bayesian hierarchical regression and Cohen's d was also calculated. Maximal voluntary contraction torque was statistically lower at 24 hr (d = -0.70) and 48 hr (d = -0.52) compared to baseline, after the DOMS-inducing exercise protocol. These neuromuscular impairments coincided with statistically higher ratings of muscle soreness at 24 hr (d = 0.96) and 48 hr (d = 0.48). After adjusting for ambient temperature, anterior thigh skin temperature was statistically elevated at 24 hr, but not 48 hr, compared with baseline, in both the exercised and non-exercised leg. Thigh temperature was not different statistically between legs at these time points. Infrared imaging was able to detect elevations in skin temperature, at 24 hrs after the DOMS inducing exercise protocol, in both the exercised and non-exercised thigh. Elevations in the skin temperature of both thighs, potentially identifies a systemic inflammatory response occurring at 24 hr after the DOMS-inducing exercise protocol.

Effects of Water Immersion Methods on Postexercise Recovery of Physical and Mental Performance.

Ahokas, EK, Ihalainen, JK, Kyröläinen, H, and Mero, AA. Effects of water immersion methods on postexercise recovery of physical and mental performance. J Strength Cond Res 33(6): 1488-1495, 2019-The aim of this study was to compare the effectiveness of 3 water immersion interventions performed after active recovery compared with active recovery only on physical and mental performance measures and physiological responses. The subjects were physically active men (age 20-35 years, mean ± SD 26 ± 3.7 years). All subjects performed a short-term exercise protocol, including maximal jumps and sprinting. Four different recovery methods (10 minutes) were used in random order: cold water immersion (CWI, 10° C), thermoneutral water immersion (TWI, 24° C), and contrast water therapy (CWT, alternately 10° C and 38° C). All these methods were performed after an active recovery (10-minute bicycle ergometer; heart rate [HR] 120-140 b·min, 60-73% from age-calculated maximum HR), and the fourth method was active recovery (ACT) only. Within 96 hours after exercise bouts, recovery was assessed through a 30-m maximal sprint test, maximal countermovement jump (CMJ), self-perceived muscle soreness and relaxation questionnaires, and blood lactate, creatine kinase, testosterone, cortisol, and catecholamine levels. The self-perceived feeling of relaxation after 60-minute recovery was better (p < 0.05) after CWI and CWT than ACT and TWI. Statistically significant differences were not observed between the recovery methods in any other marker. In the 30-m sprint test, however, slower running time was found in ACT (p < 0.001) and CWT (p = 0.005), and reduced CMJ results (p < 0.05) were found in ACT when the results were compared with baseline values. Based on these findings, it can be concluded that CWI and CWT improve the acute feeling of relaxation that can play a positive role in athletes' performance and well-being.

The effects of audiovisual distraction on the muscle sympathetic responses to experimental muscle pain.

Pain elicited by intramuscular infusion of hypertonic saline solution causes muscle sympathetic nerve activity (MSNA) to increase in some subjects, yet decrease in others. Although the direction of the response is not predictable based on baseline physiological and psychological parameters, we know that it results from sustained functional changes in specific brain regions that are responsible for the behavioral and cardiovascular responses to psychological stressors, as well as those involved in attention. The aim of this study was to investigate whether MSNA responses to experimental muscle pain in humans could be altered with an audiovisual stimulus that served to distract them from the pain. MSNA was recorded from the left common peroneal nerve of 20 young healthy individuals during a 45-min intramuscular infusion of hypertonic saline solution into the ipsilateral tibialis anterior muscle. The distracting stimulus commenced 15 min after the start of the infusion and lasted for 15 min. Fifteen subjects showed an increase in mean burst amplitude of MSNA (to 176.4 ± 7.9% of baseline), while five showed a decrease (to 73.1 ± 5.2% of baseline); distraction had no effect on these profiles. These results indicate that even though the subjects were attending to the audiovisual stimulus, and were presumably distracted from the pain, it failed to alter the MSNA responses to muscle pain.

Reorganization of motor unit activity at different sites within the human masseter muscle during experimental masseter pain.

The aims were to test the hypotheses that experimental masseter muscle pain leads to recruitment and/or derecruitment of motor units at different sites within the masseter and that the patterns of change in motor unit activity differ between sites. Single motor unit (SMU) activity was recorded at two sites within the right masseter [superior/anterior, inferior/posterior (IP)] during isometric biting tasks (ramp, step level) on an intraoral force transducer in 17 participants during three experimental blocks comprising no infusion (baseline), 5% hypertonic saline infusion (pain), or isotonic saline infusion (control). A visual analog scale (VAS) was used to score pain intensity. The VAS scores were statistically significantly greater during infusion of hypertonic saline than during infusion of isotonic saline. No significant differences in force levels and rates of force change were found between experimental blocks. In comparison with isotonic saline infusion, SMUs could be recruited and derecruited at both sites during hypertonic saline infusion. The frequency of recruitment or derecruitment, in comparison with no change, was statistically significantly greater at the IP site than at the superior/anterior site. Experimental noxious masseter stimulation results in a reorganization of motor unit activity throughout the muscle, and the pattern of reorganization may be different in different regions of the muscle.

Influence of Baseline Psychological Health on Muscle Pain During Atorvastatin Treatment.

BACKGROUND: 3-hydroxy-3-methylglutaryl coenzyme A reductase reductase inhibitors (statins) are generally well tolerated, with statin-associated muscle symptoms (SAMS) the most common side effect (~10%) seen in statin users. However, studies and clinical observations indicate that many of the self-reported SAMS appear to be nonspecific (ie, potentially not attributable to statins). OBJECTIVE: Mental health and well-being influence self-perception of pain, so we sought to assess the effect of baseline well-being and depression on the development of muscle pain with 6 months of atorvastatin 80 mg/d (ATORVA) or placebo in healthy, statin-naive adults. METHODS: The Psychological General Well-being Index (n = 83) and Beck Depression Inventory (n = 55) questionnaires were administered at baseline in participants (aged 59.5 ± 1.2 years) from the effect of Statins on Skeletal Muscle Function and Performance (STOMP) trial (NCT00609063). Muscle pain (Short-Form McGill Pain Questionnaire [SF-MPQ]), pain that interferes with daily life (Brief Pain Inventory [BPI]), and pain severity (BPI) were then measured before, throughout, and after treatment. RESULTS: At baseline, there were no differences in well-being (Psychological General Well-being Index), depression (Beck Depression Inventory), or pain measures (SF-MPQ and BPI) (P values ≥ .05) between the placebo and ATORVA groups. Baseline well-being correlated negatively with baseline BPI pain severity (r = -0.290, P = .008). Baseline depression correlated with baseline pain (SF-MPQ; r = 0.314, P = .020). Baseline well-being and depression did not predict the change in pain severity or interference after 6 months among the total sample or between groups (P values ≥ .05). CONCLUSION: Baseline well-being and depression were not significant predictors of pain after 6 months of ATORVA (P values ≥ .05). Thus, they do not appear to increase the risk of SAMS in otherwise healthy adults.

Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis.

This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

[Chronic pain : Perception, reward and neural processing]. / Chronischer Schmerz : Wahrnehmung, Belohnung und neurale Verarbeitung.

Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.

Headache: an important factor associated with muscle soreness/pain at the two-year follow-up point among patients with major depressive disorder.

BACKGROUND: No study has compared the associations of headache, anxiety, and depression at baseline with muscle soreness or pain (MS/P) at baseline and at the two-year follow-up point among outpatients with major depressive disorder (MDD). This study aimed to investigate the above issue. METHODS: This study enrolled 155 outpatients with MDD at baseline, and 131 attended a two-year follow-up appointment. At baseline, migraine was diagnosed based on the International Classification of Headache Disorders, 2(nd) edition. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale was used to evaluate the intensities of headache and MS/P in the neck, shoulder, back, upper limbs, and lower limbs. Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale. Multiple linear regressions were used to compare the associations of these factors with MS/P. RESULTS: Compared with anxiety disorders, migraine was more strongly associated with MS/P in all areas at baseline and in the upper and lower limbs at follow-up. Headache intensity at baseline was the factor most strongly associated with MS/P in all areas at baseline and follow-up after controlling for depression and anxiety. Headache intensity at baseline predicted MS/P at baseline and follow-up. CONCLUSIONS: Migraine and headache intensity are important factors related to MS/P at baseline and follow-up among patients with MDD. Integrating depression and headache treatment might be indicated to improve MS/P.

Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement.

BACKGROUND: The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). METHODS: A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). RESULTS: A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability (p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache (p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache (p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (ß = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (ß = 0.40; p < 0.001) and kinesiophobia (ß = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability. CONCLUSION: Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.

Changes of the psychophysical state and feeling of wellness of professional soccer players during pre-season and in-season periods.

Perceived changes due to training monotony, strain, sleep, stress, fatigue, muscle soreness and the influence of specific training sessions on the affective valence were explored in professional soccer players. Seventeen players completed the Hooper questionnaire, the ratings of perceived exertion and feeling scale (FS) every training/match day before and during the soccer season. Higher players' training loads were recorded during pre-season when compared with in-season period (2558.1 ± 262.4 vs. 1642.8 ± 169.3 a.u., p < 0.01; respectively). The ratings of sleep, stress, fatigue and muscle soreness in pre-season were higher than those observed during in-season (p < 0.01) whereas the feeling score was lower (p < 0.01). Furthermore, training sessions, including technical/tactical work, induced an improved feeling score but linked with a lower training load when compared with sessions focus on physical emphasis (p < 0.01). Pre-season period of training induces a significantly more strenuous and exhausting demands on professional soccer players compared with the in-season period at the elite level.

Perceptions of well-being and physical performance in English elite youth footballers across a season.

The 2011 English Elite Player Performance Plan (EPPP) stipulates training volumes that could put elite youth players at high risk of non-functional overreaching. The aim of the study was to assess player perceptions of well-being and physical performance to these high training loads. Fourteen academy football players (mean ± SD: age 17 ± 1 years; stature 179 ± 6 cm; body mass 70.8 ± 8.6 kg, at pre-season) completed a perception of well-being questionnaire 1-4 times per week throughout each training block (pre-season, in-season 1, 2, 3). Physical performance tests were carried out at the end of each training block. Increases in training exposure (P < 0.05; [Formula: see text] = 0.52) and moderate to large deteriorations in perceptions of well-being (motivation, sleep quality, recovery, appetite, fatigue, stress, muscle soreness P < 0.05; [Formula: see text] = 0.30-0.53) were evident as the season progressed. A moderate decrease in 30 m sprint performance (P < 0.05; [Formula: see text] = 0.48), a large improvement in Yo-Yo intermittent recovery test performance (P < 0.05; [Formula: see text] = 0.93) and small decreases in countermovement jump (P > 0.05; [Formula: see text] = 0.18) and arrowhead agility (P < 0.05; [Formula: see text] = 0.24) performance were evident as the season progressed. The present findings show an imbalance between stress and recovery in English elite youth players even when players experience lower training exposure than stipulated by the EPPP.

[Psychotherapeutic procedures for fibromyalgia syndrome]. / Psychotherapeutische Verfahren beim Fibromyalgiesyndrom.

BACKGROUND: Psychosocial factors play an important role in the predisposition, triggering and course of fibromyalgia syndrome (FMS). Cognitive behavioral therapies are strongly recommended in the current guidelines on the management of FMS in Canada, Germany and Israel. AIMS: Review of techniques, aims and efficacy of psychotherapeutic procedures in FMS. MATERIAL AND METHODS: Narrative review based on a selective search for systematic reviews on the efficacy of psychotherapeutic procedures in FMS. RESULTS: There is robust evidence for the short and long-term efficacy of cognitive behavioral therapies on some key symptoms of FMS, e.g. pain, depression and disability. The quality and quantity of the evidence for the efficacy of other psychotherapeutic procedures (e.g. biofeedback, relaxation therapies, hypnosis/guided imagery and psychodynamic therapy) are insufficient. CONCLUSION: Cognitive behavioral therapies (e.g. acceptance and commitment therapy, cognitive behavioral therapy and operant therapy) should play an important role in a graduated and individually tailored therapy of FMS patients.