BACKGROUND: Increases in maximal strength and muscle volume represent central aims of training interventions. Recent research suggested that the chronic application of stretch may be effective in inducing hypertrophy. The present systematic review therefore aimed to syntheisize the evidence on changes of strength and muscle volume following chronic static stretching. METHODS: Three data bases were sceened to conduct a systematic review with meta-analysis. Studies using randomized, controlled trials with longitudinal (≥ 2 weeks) design, investigating strength and muscle volume following static stretching in humans, were included. Study quality was rated by two examiners using the PEDro scale. RESULTS: A total of 42 studies with 1318 cumulative participants were identified. Meta-analyses using robust variance estimation showed small stretch-mediated maximal strength increases (d = 0.30 p < 0.001) with stretching duration and intervention time as significant moderators. Including all studies, stretching induced small magnitude, but significant hypertrophy effects (d = 0.20). Longer stretching durations and intervention periods as well as higher training frequencies revealed small (d = 0.26-0.28), but significant effects (p < 0.001-0.005), while lower dosage did not reach the level of significance (p = 0.13-0.39). CONCLUSIONS: While of minor effectiveness, chronic static stretching represents a possible alternative to resistance training when aiming to improve strength and increase muscle size. As a dose-response relationship may exist, higher stretch durations and frequencies as well as long program durations should be further elaborated.
Soccer is a complex sports discipline that requires players to engage in diverse high-intensity and multidirectional activities. The optimization of strength and conditioning programs requires a comprehensive understanding of the physical attributes influencing player performance. While previous research has demonstrated the influence of knee and hip extensor muscles on the performance in sprints and other explosive movements, this study aimed to establish the relationship between plantar flexor muscle strength and high-intensity actions. Back squat (BS) and calf raise (CR) one-repetition maxima as well as linear sprint (5-, 10-, 30 m) and drop jump performance from different heights (15, 30, 45 and 60 cm) were measured in 45 elite youth players (age: 16.62 ± 1.1 years). Results showed significant negative correlations between BS strength and sprint times (r = -0.60 to -0.61), confirming the importance of lower limb extensor muscle strength in short-distance sprints. While no significant correlations were found with sprint performances, CR strength was significantly associated with drop jump test results from 45 and 60 cm drop height (r = 0.36 to 0.46). These findings demonstrate that isolated CR strength positively influences the performance in actions involving rapid stretch-shortening cycles, which suggests that current strength and conditioning programs for youth soccer players should be extended to also include exercises specifically targeting the plantar flexor muscles. While this cross-sectional study provides novel insights into the complex interplay between muscle strength and soccer-specific performance, its findings need to be corroborated in longitudinal studies directly testing the impact of plantar flexor strength training.
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a frequent, debilitating and still enigmatic disease. There is a broad overlap in the symptomatology of ME/CFS and the Post-COVID-19 Syndrome (PCS). A fraction of the PCS patients develop the full clinical picture of ME/CFS. New observations in microvessels and blood from patients suffering from PCS have appeared and include microclots and malformed pathological blood cells. Capillary blood flow is impaired not only by pathological blood components but also by prothrombotic changes in the vascular wall, endothelial dysfunction, and the expression of adhesion molecules in the capillaries. These disturbances can finally cause a low capillary flow and even capillary stasis. A low cardiac stroke volume due to hypovolemia and the inability of the capacitance vessels to adequately constrict to deliver the necessary cardiac preload generate an unfavorable low precapillary perfusion pressure. Furthermore, a predominance of vasoconstrictor over vasodilator influences exists, in which sympathetic hyperactivity and endothelial dysfunction play a strong role, causing the constriction of resistance vessels and of precapillary sphincters, which leads to a fall in capillary pressure behind the sphincters. The interaction of these two precapillary cardiovascular mechanisms causing a low capillary perfusion pressure is hemodynamically highly unfavorable in the presence of a primary capillary stasis, which is already caused by the pathological blood components and their interaction with the capillary wall, to severely impair organ perfusion. The detrimental coincidence of microcirculatory and precapillary cardiovascular disturbances may constitute the key disturbance of the Post-COVID-19 syndrome and finally lead to ME/CFS in predisposed patients because the interaction causes a particular kind of perfusion disturbance-capillary ischemia/reperfusion-which has a high potential of causing mitochondrial dysfunction by inducing sodium- and calcium-overload in skeletal muscles. The latter, in turn, worsens the vascular situation through the generation of reactive oxygen species to close a vicious cycle from which the patient can hardly escape.
COVID-19 , Fatigue Syndrome, Chronic , Humans , Fatigue Syndrome, Chronic/etiology , Post-Acute COVID-19 Syndrome , Capillaries , Microcirculation , COVID-19/complications , COVID-19/metabolism , Mitochondria/metabolism , Perfusion
The purpose of this study was to investigate the concordance of isokinetic bilateral strength differences of the knee extensors in single- and multi-joint movement tasks. One hundred and nineteen male athletes performed isokinetic legpresses at 0.1 m/s and 0.7 m/s as well as isokinetic knee extensions at 60°/s and 180°/s. Bilateral differences and directed bilateral differences (sign indicating the direction of the difference) were calculated for all measurements. Bland-Altman-Plots were plotted to investigate if the different conditions detect bilateral differences of the same magnitude. Additionally, concordance correlations for the directed bilateral differences of the different tests were calculated to investigate magnitude and direction. The results indicate poor to fair concordance between the bilateral differences in the legpress conditions as well as between single- and multi-joint tasks. The single-joint knee extensions displayed a moderate level of agreement. Bilateral strength differences in isokinetic movement tasks are dependent on movement velocity and the nature of the task (single- or multi-joint movement) in the lower extremities. Both the value and the direction of the strength differences show no clear pattern across the investigated measurements and cannot be used interchangeably. Therefore, to assess interlimb strength balance, multiple different tests should be performed.
Introduction: Based on the assumption of maximal strength as a basic ability, several studies show a high influence of maximum strength on jumping performance in several sport athletes. However, there is a wide range of correlations from r = 0.17-0.9 between squat 1RM and jumping performance in different sports. Additionally, there are only a few studies investigating the influence of deadlift one repetition maximum (1RM) on jumping performance. Thus, this study aimed to investigate the correlations between 1RM in the deadlift on jumping performance using the countermovement jump height (CMJ) and squat jump height (SJ) considering different sports. Methods: 103 athletes with experience in the deadlift from soccer, basketball, American football, powerlifting as well as participants from different sports without any deadlift experience (control group) were included to this study. Results: Overall statistics showed a significant moderate influence of deadlift 1RM (r = 0.301-0.472) on jumping performance. However, subgroup analysis showed no significant correlation between deadlift 1RM and jumping performance in control participants, while moderate correlations could be detected in powerlifters (r = 0.34-0.39), soccer players (r = 0.437-0.46), American football players (0.584-0.62) and high correlations in basketball players (r = 0.809-0.848) showing significant influence of type of sport on correlations between deadlift maximum strength and jumping performance. Discussion: Presented results underline movement velocity- and task specificity of strength training routines which is discussed in the light of the respective sports.
In ice hockey, speed strength is one of the major physical key performance indicators, which is significantly influenced by maximum strength. The objective of this study was to evaluate the age-dependent relationship of off-ice maximum strength and vertical jump performance with on-ice linear sprint performance, considering age and performance level. Ninety-one male youth and adult professional ice hockey players (age: 19.3 ± 5.49 years) were recruited and divided into four age groups: under 16, 18, 21 years old and professional elite players (Pro) (i.e., > 21 years). They were tested in maximal isometric strength, squat jump (loaded and unloaded), countermovement jump and on-ice sprint performance (15 m and 30 m linear sprint; 15 m flying linear sprint). Statistical analysis revealed that on-ice sprint performance correlated with isometric strength performance (r = |0.34|-|0.63|) and with off-ice jump performance (r = |0.61|-|0.77|) without an influence of age group or performance level. However, performance differed between age groups and performance level, the largest differences being found between the youngest age group (U16) and the Pro group (g = 0.966-3.281). The present study shows that maximum strength influences on-ice sprint performances in ice hockey players, as well as performance differences between age groups and professional players. Strength and jumping performance should therefore be included in regular performance testing in ice hockey. Since performance differences are observed for almost all strength and speed-strength performances of the youth teams to the Pros, training of these variables is strongly recommended to improve in the transition phase from junior to elite level.
BACKGROUND: Accurate measurements of muscular performance are important for diagnostics, for example during rehabilitation after traumatic injuries but also in competitive sports. For these purposes, dynamometric devices are widely used and considered the gold standard for muscle strength testing. However, few previous studies have tested the reproducibility of peak moment (PM) at velocities close to the maximum device capability, and in general, reproducibility results cannot be transferred to other devices or test protocols. The purpose of this study was to evaluate the reproducibility of PM for different isometric and isokinetic knee extension exercises using the IsoMed 2000. METHODS: Thirty subjects volunteered in three repeated test sessions, including isometric knee extension (100° and 140° knee angle) and isokinetic knee extension (30°/s and 400°/s). Statistical analysis for comparison of sessions two and three included paired sample t-test, calculation of intraclass correlation coefficient (ICC) and standard error of measurement (SEM). Additionally, Bland Altman statistics and corresponding plots were created. RESULTS: A significant difference between sessions in PM was found for isometric knee extension in one leg (140° left). Reproducibility was high for all conditions with ICC ranging from 0.964 to 0.988 and SEM in the range of 7.6 to 10.5 Nm. Bland Altman statistics revealed a bias between - 7.3 and 0.7 Nm. CONCLUSIONS: Reproducibility of PM using the IsoMed 2000 was good after an initial familiarization trial with high values of relative reproducibility. Absolute reproducibility can be interpreted as appropriate for most common practical applications.
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a devastating disease affecting millions of people worldwide. Due to the 2019 pandemic of coronavirus disease (COVID-19), we are facing a significant increase of ME/CFS prevalence. On May 11th to 12th, 2023, the second international ME/CFS conference of the Charité Fatigue Center was held in Berlin, Germany, focusing on pathomechanisms, diagnosis, and treatment. During the two-day conference, more than 100 researchers from various research fields met on-site and over 700 attendees participated online to discuss the state of the art and novel findings in this field. Key topics from the conference included: the role of the immune system, dysfunction of endothelial and autonomic nervous system, and viral reactivation. Furthermore, there were presentations on innovative diagnostic measures and assessments for this complex disease, cutting-edge treatment approaches, and clinical studies. Despite the increased public attention due to the COVID-19 pandemic, the subsequent rise of Long COVID-19 cases, and the rise of funding opportunities to unravel the pathomechanisms underlying ME/CFS, this severe disease remains highly underresearched. Future adequately funded research efforts are needed to further explore the disease etiology and to identify diagnostic markers and targeted therapies.
Fatigue Syndrome, Chronic , Humans , Fatigue Syndrome, Chronic/diagnosis , Fatigue Syndrome, Chronic/epidemiology , Fatigue Syndrome, Chronic/therapy , Pandemics , Post-Acute COVID-19 Syndrome , Prevalence
Increasing muscle strength and cross-sectional area is of crucial importance to improve or maintain physical function in musculoskeletal rehabilitation and sports performance. Decreases in muscular performance are experienced in phases of reduced physical activity or immobilization. These decrements highlight the need for alternative, easily accessible training regimens for a sedentary population to improve rehabilitation and injury prevention routines. Commonly, muscle hypertrophy and strength increases are associated with resistance training, typically performed in a training facility. Mechanical tension, which is usually induced with resistance machines and devices, is known to be an important factor that stimulates the underlying signaling pathways to enhance protein synthesis. Findings from animal studies suggest an alternative means to induce mechanical tension to enhance protein synthesis, and therefore muscle hypertrophy by inducing high-volume stretching. Thus, this narrative review discusses mechanical tension-induced physiological adaptations and their impact on muscle hypertrophy and strength gains. Furthermore, research addressing stretch-induced hypertrophy is critically analyzed. Derived from animal research, the stretching literature exploring the impact of static stretching on morphological and functional adaptations was reviewed and critically discussed. No studies have investigated the underlying physiological mechanisms in humans yet, and thus the underlying mechanisms remain speculative and must be discussed in the light of animal research. However, studies that reported functional and morphological increases in humans commonly used stretching durations of > 30 min per session of the plantar flexors, indicating the importance of high stretching volume, if the aim is to increase muscle mass and maximum strength. Therefore, the practical applicability seems limited to settings without access to resistance training (e.g., in an immobilized state at the start of rehabilitation), as resistance training seems to be more time efficient. Nevertheless, further research is needed to generate evidence in different human populations (athletes, sedentary individuals, and rehabilitation patients) and to quantify stretching intensity.
ABSTRACT: Warneke, K, Keiner, M, Wohlann, T, Lohmann, LH, Schmitt, T, Hillebrecht, M, Brinkmann, A, Hein, A, Wirth, K, and Schiemann, S. Influence of long-lasting static stretching intervention on functional and morphological parameters in the plantar flexors: a randomised controlled trial. J Strength Cond Res 37(10): 1993-2001, 2023-Animal studies show that long-lasting stretching training can lead to significant hypertrophy and increases in maximal strength. Accordingly, previous human studies found significant improvements in maximal voluntary contraction (MVC), flexibility, and muscle thickness (MTh) using constant angle long-lasting stretching. It was hypothesized that long-lasting stretching with high intensity will lead to sufficient mechanical tension to induce muscle hypertrophy and maximal strength gains. This study examined muscle cross-sectional area (MCSA) using magnetic resonance imaging (MRI). Therefore, 45 well-trained subjects (f: 17, m: 28, age: 27.7 ± 3.0 years, height: 180.8 ± 4.9 cm, mass: 80.4 ± 7.2 kg) were assigned to an intervention group (IG) that stretched the plantar flexors 6 × 10 minutes per day for 6 weeks or a control group (CG). Data analysis was performed using 2-way ANOVA. There was a significant Time × Group interaction in MVC ( p < 0.001-0.019, Æ 2 = 0.158-0.223), flexibility ( p < 0.001, Æ 2 = 0.338-0.446), MTh ( p = 0.002-0.013, Æ 2 = 0.125-0.172), and MCSA ( p = 0.003-0.014, Æ 2 = 0.143-0.197). Post hoc analysis showed significant increases in MVC ( d = 0.64-0.76), flexibility ( d = 0.85-1.12), MTh ( d = 0.53-0.6), and MCSA ( d = 0.16-0.3) in IG compared with CG, thus confirming previous results in well-trained subjects. Furthermore, this study improved the quality for the morphological examination by investigating both heads of the gastrocnemius with MRI and sonography. Because stretching can be used passively, an application in rehabilitation settings seems plausible, especially if no commonly used alternatives such as strength training are applicable.
Muscle Stretching Exercises , Humans , Young Adult , Adult , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/physiology , Range of Motion, Articular , Muscle Strength/physiology
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is often associated with various other syndromes or conditions including mast cell activation (MCA), dysmenorrhea and endometriosis, postural tachycardia (POTS) and small fiber neuropathy (SFN). The causes of these syndromes and the reason for their frequent association are not yet fully understood. We previously published a comprehensive hypothesis of the ME/CFS pathophysiology that explains the majority of symptoms, findings and chronicity of the disease. We wondered whether some of the identified key pathomechanisms in ME/CFS are also operative in MCA, endometriosis and dysmenorrhea, POTS, decreased cerebral blood flow and SFN, and possibly may provide clues on their causes and frequent co-occurrence. Our analysis indeed provides strong arguments in favor of this assumption, and we conclude that the main pathomechanisms responsible for this association are excessive generation and spillover into the systemic circulation of inflammatory and vasoactive tissue mediators, dysfunctional ß2AdR, and the mutual triggering of symptomatology and disease initiation. Overall, vascular dysfunction appears to be a strong common denominator in these linkages.
Endometriosis , Fatigue Syndrome, Chronic , Female , Humans , Fatigue Syndrome, Chronic/complications , Fatigue Syndrome, Chronic/epidemiology , Dysmenorrhea/complications , Endometriosis/complications , Comorbidity
To improve flexibility, stretching is most commonly used and in training interventions duration-dependent effects are hypothesized. However, there are strong limitations in used stretching protocols in most studies, particularly regarding documentation of intensity and performed procedure. Thus, aim of this study was to compare different stretching durations on flexibility in the plantar flexors and to exclude potential biases. Eighty subjects were divided into four groups performing daily stretching training of 10min (IG10), 30min (IG30) and 1h (IG60) and one control group (CG). Flexibility was measured in bended and extended knee joint. Stretching was performed with a calf muscle stretching orthosis to ensure long-lasting stretching training. Data were analysed with a two-way ANOVA for repeated measures on two variables. Two-way ANOVA showed significant effects for time (η2 = 0.557-0.72, p < 0.001) and significant interaction effects for time × group (η2 = 0.39-0.47, p < 0.001). Flexibility in the knee to wall stretch improved with 9.89-14.46% d = 0.97-1.49 and 6.07-16.39% with d = 0.38-1.27 when measured via the goniometer of the orthosis. All stretching times led to significant increases in flexibility in both tests. While there were no significant differences measured via the knee to wall stretch between the groups, the range of motion measurement via the goniometer of the orthosis showed significantly higher improvements in flexibility depending on stretching duration with the highest increase in both tests with 60 minutes of stretch per day.
Maximal strength measured via maximal voluntary contraction is known as a key factor in competitive sports performance as well as injury risk reduction and rehabilitation. Maximal strength and hypertrophy are commonly trained by performing resistance training programs. However, literature shows that long-term, long-lasting static stretching interventions can also produce significant improvements in maximal voluntary contraction. The aim of this study is to compare increases in maximal voluntary contraction, muscle thickness and flexibility after 6 weeks of stretch training and conventional hypertrophy training. Sixty-nine (69) active participants (f = 30, m = 39; age 27.4 ± 4.4 years, height 175.8 ± 2.1 cm, and weight 79.5 ± 5.9 kg) were divided into three groups: IG1 stretched the plantar flexors continuously for one hour per day, IG2 performed hypertrophy training for the plantar flexors (5 × 10-12 reps, three days per week), while CG did not undergo any intervention. Maximal voluntary contraction, muscle thickness, pennation angle and flexibility were the dependent variables. The results of a series of two-way ANOVAs show significant interaction effects (p < 0.05) for maximal voluntary contraction (Æ2 = 0.143-0.32, p < 0.006), muscle thickness (Æ2 = 0.11-0.14, p < 0.021), pennation angle (Æ2 = 0.002-0.08, p = 0.077-0.625) and flexibility (Æ2 = 0.089-0.21, p < 0.046) for both the stretch and hypertrophy training group without significant differences (p = 0.37-0.99, d = 0.03-0.4) between both intervention groups. Thus, it can be hypothesized that mechanical tension plays a crucial role in improving maximal voluntary contraction and muscle thickness irrespective whether long-lasting stretching or hypertrophy training is used. Results show that for the calf muscle, the use of long-lasting stretching interventions can be deemed an alternative to conventional resistance training if the aim is to increase maximal voluntary contraction, muscle thickness and flexibility. However, the practical application seems to be strongly limited as a weekly stretching duration of up to 7 h a week is opposed by 3 × 15 min of common resistance training.
Muscle Stretching Exercises , Humans , Young Adult , Adult , Muscle, Skeletal/physiology , Leg , Hypertrophy , Muscle Strength/physiology
Measuring maximal strength (MSt) is a very common performance diagnoses, especially in elite and competitive sports. The most popular procedure in test batteries is to test the one repetition maximum (1RM). Since testing maximum dynamic strength is very time consuming, it often suggested to use isometric testing conditions instead. This suggestion is based on the assumption that the high Pearson correlation coefficients of r ≥ 0.7 between isometric and dynamic conditions indicate that both tests would provide similar measures of MSt. However, calculating r provides information about the relationship between two parameters, but does not provide any statement about the agreement or concordance of two testing procedures. Hence, to assess replaceability, the concordance correlation coefficient (ρ c) and the Bland-Altman analysis including the mean absolute error (MAE) and the mean absolute percentage error (MAPE) seem to be more appropriate. Therefore, an exemplary model based on r = 0.55 showed ρ c = 0.53, A MAE of 413.58â N and a MAPE = 23.6% with a range of -1,000-800â N within 95% Confidence interval (95%CI), while r = 0.7 and 0.92 showed ρ c = 0.68 with a MAE = 304.51N/MAPE = 17.4% with a range of -750â N-600â N within a 95% CI and ρ c = 0.9 with a MAE = 139.99/MAPE = 7.1% with a range of -200-450â N within a 95% CI, respectively. This model illustrates the limited validity of correlation coefficients to evaluate the replaceability of two testing procedures. Interpretation and classification of ρ c, MAE and MAPE seem to depend on expected changes of the measured parameter. A MAPE of about 17% between two testing procedures can be assumed to be intolerably high.
Introduction: Speed-strength performance is important during human movements such as jumping, sprinting, and change of direction (COD) tasks, which are a substantial part of sports practice. Sex and age seem to influence performance output in young persons; however, few studies have focused on the influence of sex and age measured via standard protocols of performance diagnostics. Method: Therefore, the aim of this study was to investigate the influence of age and sex on linear sprint (LS), COD sprint, countermovement jump (CMJ) height, squat-jump (SJ) height, and drop-jump (DJ) height performance in untrained children and adolescents via a cross-sectional analysis. This study comprised 141 untrained male and female participants 10-14 years of age. Results: The results showed the influence of age in male participants on speed-strength performance, while in female participants, age did not significantly influence performance parameters. Moderate to high correlations between sprint and jump performance (r = 0.69-0.72), sprint and COD sprint performance (r = 0.58-0.72), and jump and COD sprint performance (r = 0.56-0.58) were found. Discussion: Based on the data from this study, it appears that the growth phase of age 10-14 does not necessarily lead to improvements in athletic performance. To ensure holistic motor development, female subjects in particular should be provided with specific training interventions with a focus on strength and power.
Contact injuries are difficult to prevent in sports because of the influence of many uncontrollable factors. Non-contact injuries, on the other hand, appear to be controllable and therefore predictable due to their exclusively internal nature. Nevertheless, the scientific community is still searching in vain for indicators to reliably predict the likelihood of injuries to athletes in order to prevent them. Therefore, a critical review of published data was conducted to discuss the current evaluation of strength imbalances as risk factors for contactless knee and thigh injuries. Different approaches to measure muscle strength, detect asymmetries, and methodological issues with the final goal of evaluating their relationship with injury rates was considered as well. All common strength tests on the basis of which an injury risk assessment is calculated had high to excellent ICC values. However, we found that all these tests have their respective limitations and problems. The HQ Ratio can be determined using different contraction forms or calculation methods. This variance in procedures in use makes uniform interpretation enormously difficult. Regardless, we found moderate or strong evidence of no association with future hamstring injury for half of all variables. For lateral differences, we were unable to find any relevant data directly indicating an influence on injury probability. Thus, to date, no significant relationship between asymmetries and non-contact injuries has been detected for either inter- or intra-limb differences. Therefore, the assessment of strength imbalances can only be considered as one component in a multifactorial approach to assess potential injury risks.
Athletic Injuries , Leg Injuries , Sports , Humans , Thigh , Lower Extremity/injuries , Knee Joint/physiology , Risk Factors , Muscle Strength , Athletic Injuries/complications
Following COVID-19 infection, a substantial proportion of patients suffer from persistent symptoms known as Long COVID. Among the main symptoms are fatigue, cognitive dysfunction, muscle weakness and orthostatic intolerance (OI). These symptoms also occur in myalgic encephalomyelitis/chronic fatigue (ME/CFS). OI is highly prevalent in ME/CFS and develops early during or after acute COVID-19 infection. The causes for OI are unknown and autonomic dysfunction is hypothetically assumed to be the primary cause, presumably as a consequence of neuroinflammation. Here, we propose an alternative, primary vascular mechanism as the underlying cause of OI in Long COVID. We assume that the capacitance vessel system, which plays a key role in physiologic orthostatic regulation, becomes dysfunctional due to a disturbance of the microvessels and the vasa vasorum, which supply large parts of the wall of those large vessels. We assume that the known microcirculatory disturbance found after COVID-19 infection, resulting from endothelial dysfunction, microthrombus formation and rheological disturbances of blood cells (altered deformability), also affects the vasa vasorum to impair the function of the capacitance vessels. In an attempt to compensate for the vascular deficit, sympathetic activity overshoots to further worsen OI, resulting in a vicious circle that maintains OI. The resulting orthostatic stress, in turn, plays a key role in autonomic dysfunction and the pathophysiology of ME/CFS.
Autonomic Nervous System Diseases , COVID-19 , Fatigue Syndrome, Chronic , Orthostatic Intolerance , Humans , Orthostatic Intolerance/complications , Orthostatic Intolerance/diagnosis , Vasa Vasorum , Microcirculation , Post-Acute COVID-19 Syndrome , COVID-19/complications
BACKGROUND: Muscle fatigue and pain are key symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Although the pathophysiology is not yet fully understood, there is ample evidence for hypoperfusion which may result in electrolyte imbalance and sodium overload in muscles. Therefore, the aim of this study was to assess levels of sodium content in muscles of patients with ME/CFS and to compare these to healthy controls. METHODS: Six female patients with ME/CFS and six age, BMI and sex matched controls underwent 23Na-MRI of the left lower leg using a clinical 3T MR scanner before and after 3 min of plantar flexion exercise. Sodium reference phantoms with solutions of 10, 20, 30 and 40 mmol/L NaCl were used for quantification. Muscle sodium content over 40 min was measured using a dedicated plugin in the open-source DICOM viewer Horos. Handgrip strength was measured and correlated with sodium content. RESULTS: Baseline tissue sodium content was higher in all 5 lower leg muscle compartments in ME/CFS compared to controls. Within the anterior extensor muscle compartment, the highest difference in baseline muscle sodium content between ME/CFS and controls was found (mean ± SD; 12.20 ± 1.66 mM in ME/CFS versus 9.38 ± 0.71 mM in controls, p = 0.0034). Directly after exercise, tissue sodium content increased in gastrocnemius and triceps surae muscles with + 30% in ME/CFS (p = 0.0005) and + 24% in controls (p = 0.0007) in the medial gastrocnemius muscle but not in the extensor muscles which were not exercised. Compared to baseline, the increase of sodium content in medial gastrocnemius muscle was stronger in ME/CFS than in controls with + 30% versus + 17% to baseline at 12 min (p = 0.0326) and + 29% versus + 16% to baseline at 15 min (p = 0.0265). Patients had reduced average handgrip strength which was associated with increased average muscle tissue sodium content (p = 0.0319, R2 = 0.3832). CONCLUSION: Muscle sodium content before and after exercise was higher in ME/CFS than in healthy controls. Furthermore, our findings indicate an inverse correlation between muscle sodium content and handgrip strength. These findings provide evidence that sodium overload may play a role in the pathophysiology of ME/CFS and may allow for potential therapeutic targeting.
Fatigue Syndrome, Chronic , Humans , Female , Hand Strength , Sodium , Muscle, Skeletal , Magnetic Resonance Imaging
Speed strength performances are substantially dependent on maximum strength. Due to their importance, various methods have been utilized to measure maximum strength (e.g., isometric or dynamic) with discussed differences regarding transferability to sport-specific movements dependent upon the testing procedure. The aim of this study was to analyze whether maximum isometric force (MIF) during isometric back squats correlates with maximum strength measurements of the one repetition maximum (1RM) in the squat, with countermovement jump (CMJ) performance, and with drop jump (DJ) performances in elite youth soccer players (n = 16, 18.4 ± 1.5 [range: 17-23] years old). Additionally, concordance correlation coefficients (CCC, [ρc]) between isometric and dynamic measurements were calculated to verify whether one measurement can actually reproduce the results of the other. To improve comprehension, differences between isometric and dynamic testing values were illustrated by providing differences between both testing conditions. For this, the mean absolute error (MAE) and the mean absolute percentage error (MAPE) were calculated. To reach equality in scale, the 1RM measures were multiplicated by 9.81 to obtain a value of N. The 1RM demonstrated correlations of τ = |0.38| to |0.52| with SJ and CMJ performances, while MIF demonstrated correlations of τ = |0.21| to |0.32|. However, the correlations of both 1RM and MIF with the DJ reactive strength index (RSI = jump height /contact time) from different falling heights were of no statistical significance. The data showed significant correlations between both the absolute (τ = |0.54|) and the relative (τ = |0.40|) performances of 1RM and MIF, which were confirmed by CCC of ρc= |0.56| to |0.66|, respectively. Furthermore, the MAE and MAPE showed values of 2080.87 N and 67.4%, respectively. The data in this study show that, despite good correlations, there is no exact coincidence between isometric and dynamic strength measurements. Accordingly, both measurements may only represent an estimation of maximal strength capacity and cannot be substituted for each other. Therefore, maximal strength should be tested by using high similarity in the contraction condition, as it is used in the training process to counteract underestimation in strength because of unfamiliarity with the testing condition.
