Balance Control Deficits are Associated with Diminished Ankle Force Sense, Not Position Sense, in Athletes with Chronic Ankle Instability.

OBJECTIVES: To compare balance control and ankle proprioception between athletes with and without chronic ankle instability (CAI). A further objective was to explore the relationship between balance control performance and ankle proprioception in athletes with CAI. DESIGN: Cross-sectional study. SETTINGS: Sports Rehabilitation Laboratory. PARTICIPANTS: Eighty-eight recreational athletes (47 CAI and 41 healthy control) were recruited. INTERVENTIONS: No applicable. MAIN OUTCOME MEASURES: Balance control performance was assessed using the sway velocity of the centre of the pressure during the one-leg standing tasks. Ankle proprioception, including joint position sense and force sense, were tested using absolute error (AE) associated with joint position reproduction and force reproduction tasks in four directions, i.e., plantarflexion, dorsiflexion, inversion, and eversion. RESULTS: Athletes with CAI performed significantly worse than those without CAI in balance control tasks. In addition, CAI athletes showed significantly worse joint position sense and force sense in all three movement directions tested (plantarflexion, inversion, and eversion). Correlation analysis showed that the AE of the plantarflexion force sense was significantly moderately correlated with medial-lateral sway velocity in the one-leg standing with eyes open and closed conditions (r = 0.372-0.403, p = 0.006-0.012), and the AE of inversion force sense was significantly moderately correlated with medial-lateral sway velocity in the one-leg standing with eyes open (r = 0.345, p = 0.018) in athletes with CAI, but the joint position sense measures were not (all p > 0.05). CONCLUSIONS: Athletes with CAI showed significantly impaired balance control performance and diminished ankle proprioception. Deficit in force sense was deemed as a moderate predictor of one-leg standing balance control deficits in athletes with dominant-side injury CAI, while ankle position sense may be a small predictor.

Cerebral hemodynamics underlying ankle force sense modulated by high-definition transcranial direct current stimulation.

This study aimed to investigate the effects of high-definition transcranial direct current stimulation on ankle force sense and underlying cerebral hemodynamics. Sixteen healthy adults (8 males and 8 females) were recruited in the study. Each participant received either real or sham high-definition transcranial direct current stimulation interventions in a randomly assigned order on 2 visits. An isokinetic dynamometer was used to assess the force sense of the dominant ankle; while the functional near-infrared spectroscopy was employed to monitor the hemodynamics of the sensorimotor cortex. Two-way analyses of variance with repeated measures and Pearson correlation analyses were performed. The results showed that the absolute error and root mean square error of ankle force sense dropped more after real stimulation than after sham stimulation (dropped by 23.4% vs. 14.9% for absolute error, and 20.0% vs. 10.2% for root mean square error). The supplementary motor area activation significantly increased after real high-definition transcranial direct current stimulation. The decrease in interhemispheric functional connectivity within the Brodmann's areas 6 was significantly correlated with ankle force sense improvement after real high-definition transcranial direct current stimulation. In conclusion, high-definition transcranial direct current stimulation can be used as a potential intervention for improving ankle force sense. Changes in cerebral hemodynamics could be one of the explanations for the energetic effect of high-definition transcranial direct current stimulation.

Effects of gait retraining using minimalist shoes on the medial gastrocnemius muscle-tendon unit behavior and dynamics during running.

The effects of a 12-week gait retraining program on the adaptation of the medial gastrocnemius (MG) and muscle-tendon unit (MTU) were investigated. 26 runners with a rearfoot strike pattern (RFS) were randomly assigned to one of two groups: gait retraining (GR) or control group (CON). MG ultrasound images, marker positions, and ground reaction forces (GRF) were collected twice during 9 km/h of treadmill running before and after the intervention. Ankle kinetics and the MG and MTU behavior and dynamics were quantified. Runners in the GR performed gradual 12-week gait retraining transitioning to a forefoot strike pattern. After 12-week, (1) ten participants in each group completed the training; eight participants in GR transitioned to non-RFS with reduced foot strike angles; (2) MG fascicle contraction length and velocity significantly decreased after the intervention for both groups, whereas MG forces increased after intervention for both groups; (3) significant increases in MTU stretching length for GR and peak MTU recoiling velocity for both groups were observed after the intervention, respectively; (4) no significant difference was found for all parameters of the series elastic element. Gait retraining might potentially influence the MG to operate at lower fascicle contraction lengths and velocities and produce greater peak forces. The gait retraining had no effect on SEE behavior and dynamics but did impact MTU, suggesting that the training was insufficient to induce mechanical loading changes on SEE behavior and dynamics.

Acute effect of foot strike patterns on in vivo tibiotalar and subtalar joint kinematics during barefoot running.

BACKGROUND: Foot kinematics, such as excessive eversion and malalignment of the hindfoot, are believed to be associated with running-related injuries. The majority of studies to date show that different foot strike patterns influence these specific foot and ankle kinematics. However, technical deficiencies in traditional motion capture approaches limit knowledge of in vivo joint kinematics with respect to rearfoot and forefoot strike patterns (RFS and FFS, respectively). This study uses a high-speed dual fluoroscopic imaging system (DFIS) to determine the effects of different foot strike patterns on 3D in vivo tibiotalar and subtalar joints kinematics. METHODS: Fifteen healthy male recreational runners underwent foot computed tomography scanning for the construction of 3-dimensional models. A high-speed DFIS (100 Hz) was used to collect 6 degrees of freedom kinematics for participants' tibiotalar and subtalar joints when they adopted RFS and FFS in barefoot condition. RESULTS: Compared with RFS, FFS exhibited greater internal rotation at 0%-20% of the stance phase in the tibiotalar joint. The peak internal rotation angle of the tibiotalar joint under FFS was greater than under RFS (p < 0.001, Cohen's d = 0.92). RFS showed more dorsiflexion at 0%-20% of the stance phase in the tibiotalar joint than FFS. RFS also presented a larger anterior translation (p < 0.001, Cohen's d = 1.28) in the subtalar joint at initial contact than FFS. CONCLUSION: Running with acute barefoot FFS increases the internal rotation of the tibiotalar joint in the early stance. The use of high-speed DFIS to quantify the movement of the tibiotalar and subtalar joint was critical to revealing the effects of RFS and FFS during running.

Effects of a 12-week gait retraining program on the Achilles tendon adaptation of habitually shod runners.

PURPOSE: This study investigated the effects of a 12-week gait retraining program on the morphological and mechanical properties of the Achilles tendon (AT) during running on the basis of real-time dynamic ultrasound imaging. METHODS: A total of 30 male recreational runners who were used to wearing cushioned shoes with a rearfoot strike (RFS) pattern were recruited. They were randomized into a retraining group (RG, n = 15) and a control group (CG, n = 15). The RG group was asked to run in five-fingered minimalist shoes with a forefoot strike (FFS) pattern, and the CG group was asked to keep their strike pattern. Three training sessions were performed per week. All the participants in RG uploaded running tracks obtained through a mobile application (.jpg) after each session for training supervision. The ground reaction force, kinematics, and kinetics of the ankle joint at 10 km/h were collected using an instrumented split-belt treadmill and a motion capture system. The morphological (length and cross-sectional area) and mechanical characteristics (force, stress, strain, etc.) of AT in vivo were recorded and calculated with a synchronous ultrasonic imaging instrument before and after the intervention. Repeated two-way ANOVA was used to compare the aforementioned parameters. RESULTS: A total of 28 participants completed the training. The strike angle of RG after training was significantly smaller than that before training and significantly smaller than that of CG after training (F (1, 13) = 23.068, p < 0.001, partial η2 = 0.640). The length (F (1, 13) = 10.086, p = 0.007, partial η2 = 0.437) and CSA (F (1, 13) = 7.475, p = 0.017, partial η2 = 0.365) of AT in RG increased after training. A significant main effect for time was observed for the time-to-peak AT force (F (1, 13) = 5.225, p = 0.040, partial η2 = 0.287), average (F (1, 13) = 7.228, p = 0.019, partial η2 = 0.357), and peak AT loading rate (F (1, 13) = 11.687, p = 0.005, partial η2 = 0.473). CONCLUSION: Preliminary evidence indicated that a 12-week gait retraining program could exert a beneficial effect on AT. 57% (8/14) runners in RG shifted from RFS to FFS pattern. Although not all runners were categorized as FFS pattern after the intervention, their foot strike angle was reduced. Retraining primarily positively promoted AT morphological properties (i.e., CSA and length) to strengthen AT capability for mechanical loading.

Effects of high-definition transcranial direct current stimulation on the cortical-muscular functional coupling and muscular activities of ankle dorsi-plantarflexion under running-induced fatigue.

Transcranial direct current stimulation (tDCS) can improve motor control performance under fatigue. However, the influences of tDCS on factors contributing to motor control (e.g., cortical-muscular functional coupling, CMFC) are unclear. This double-blinded and randomized study examined the effects of high-definition tDCS (HD-tDCS) on muscular activities of dorsiflexors and plantarflexors and CMFC when performing ankle dorsi-plantarflexion under fatigue. Twenty-four male adults were randomly assigned to receive five sessions of 20-min HD-tDCS targeting primary motor cortex (M1) or sham stimulation. Three days before and 1 day after the intervention, participants completed ankle dorsi-plantarflexion under fatigue induced by prolonged running exercise. During the task, electroencephalography (EEG) of M1 (e.g., C1, Cz) and surface electromyography (sEMG) of several muscles (e.g., tibialis anterior [TA]) were recorded synchronously. The corticomuscular coherence (CMC), root mean square (RMS) of sEMG, blood lactate, and maximal voluntary isometric contraction (MVC) of ankle dorsiflexors and plantarflexors were obtained. Before stimulation, greater beta- and gamma-band CMC between M1 and TA were significantly associated with greater RMS of TA (r = 0.460-0.619, p = 0.001-0.024). The beta- and gamma-band CMC of C1-TA and Cz-TA, and RMS of TA and MVC torque of dorsiflexors were significantly higher after HD-tDCS than those at pre-intervention in the HD-tDCS group and post-intervention in the control group (p = 0.002-0.046). However, the HD-tDCS-induced changes in CMC and muscle activities were not significantly associated (r = 0.050-0.128, p = 0.693-0.878). HD-tDCS applied over M1 can enhance the muscular activities of ankle dorsiflexion under fatigue and related CMFC.

Mechanics of The Medial Gastrocnemius-Tendon Unit in Behaving more Efficiently in Habitual Non-Rearfoot Strikers than in Rearfoot Strikers during Running.

This study aims to quantify how habitual foot strike patterns would affect ankle kinetics and the behavior and mechanics of the medial gastrocnemius-tendon unit (MTU) during running. A total of 14 runners with non-rearfoot strike patterns (NRFS) and 15 runners with rearfoot strike patterns (RFS) ran on an instrumented treadmill at a speed of 9 km/h. An ultrasound system and a motion capture system were synchronously triggered to collect the ultrasound images of the medial gastrocnemius (MG) and marker positions along with ground reaction forces (GRF) during running. Ankle kinetics (moment and power) and MG/MTU behavior and mechanical properties (MG shortening length, velocity, force, power, MTU shortening/lengthening length, velocity, and power) were calculated. Independent t-tests were performed to compare the two groups of runners. Pearson correlation was conducted to detect the relationship between foot strike angle and the MTU behavior and mechanics. Compared with RFS runners, NRFS runners had 1) lower foot strike angles and greater peak ankle moments; 2) lower shortening/change length and contraction velocity and greater MG peak force; 3) greater MTU lengthening, MTU shortening length and MTU lengthening velocity and power; 4) the foot strike angle was positively related to the change of fascicle length, fascicle contraction length, and MTU shortening length during the stance phase. The foot strike angle was negatively related to the MG force and MTU lengthening power. The MG in NRFS runners appears to contract with greater force in relatively isometric behavior and at a slower shortening velocity. Moreover, the lengthening length, the lengthening velocity of MTU, and the MG force were greater in habitual NRFS runners, leading to a stronger stretch reflex response potentially.

Effects of tDCS on Foot Biomechanics: A Narrative Review and Clinical Applications.

In recent years, neuro-biomechanical enhancement techniques, such as transcranial direct current stimulation (tDCS), have been widely used to improve human physical performance, including foot biomechanical characteristics. This review aims to summarize research on the effects of tDCS on foot biomechanics and its clinical applications, and further analyze the underlying ergogenic mechanisms of tDCS. This review was performed for relevant papers until July 2023 in the following databases: Web of Science, PubMed, and EBSCO. The findings demonstrated that tDCS can improve foot biomechanical characteristics in healthy adults, including proprioception, muscle strength, reaction time, and joint range of motion. Additionally, tDCS can be effectively applied in the field of foot sports medicine; in particular, it can be combined with functional training to effectively improve foot biomechanical performance in individuals with chronic ankle instability (CAI). The possible mechanism is that tDCS may excite specific task-related neurons and regulate multiple neurons within the system, ultimately affecting foot biomechanical characteristics. However, the efficacy of tDCS applied to rehabilitate common musculoskeletal injuries (e.g., CAI and plantar fasciitis) still needs to be confirmed using a larger sample size. Future research should use multimodal neuroimaging technology to explore the intrinsic ergogenic mechanism of tDCS.

Morphological and viscoelastic properties of the Achilles tendon in the forefoot, rearfoot strike runners, and non-runners in vivo.

The purpose of this study was to investigate the differences in the morphological and viscoelastic properties of the Achilles tendon (AT) among different groups (rearfoot strikers vs. forefoot strikers vs. non-runners). Thirty healthy men were recruited, including habitual forefoot strike runners (n = 10), rearfoot strike runners (n = 10), and individuals with no running habits (n = 10). The AT morphological properties (cross-sectional area and length) were captured by using an ultrasound device. The real-time ultrasound video of displacement changes at the medial head of the gastrocnemius and the AT junction during maximal voluntary isometric contraction and the plantar flexion moment of the ankle was obtained simultaneously by connecting the ultrasound device and isokinetic dynamometer via an external synchronisation box. The results indicated that male runners who habitually forefoot strike exhibited significantly lower AT hysteresis than male non-runners (p < 0.05). Furthermore, a greater peak AT force during maximal voluntary contraction was observed in forefoot strike male runners compared to that in male individuals with no running habits (p < 0.05). However, foot strike patterns were not related to AT properties in recreational male runners (p > 0.05). The lower AT hysteresis in male FFS runners implied that long-term forefoot strike patterns could enhance male-specific AT's ability to store and release elastic energy efficiently during running, resulting in a more effective stretch-shortening cycle. The greater peak AT force in male FFS runners indicated a stronger Achilles tendon.

Anodal transcranial direct current stimulation enhances ankle force control and modulates the beta-band activity of the sensorimotor cortex.

This study aimed to investigate the cortical responses to the ankle force control and the mechanism underlying changes in ankle force control task induced by transcranial direct current stimulation (tDCS). Sixteen young adults were recruited, and they completed the electroencephalogram (EEG) assessment and high-definition tDCS (HD-tDCS) sessions. Root mean square (RMS) error was used to evaluate ankle force control task performance. Spectral power analysis was conducted to extract the average power spectral density (PSD) in the alpha (8-13 Hz) and beta (13-30 Hz) bands for resting state and tasking (i.e. task-PSD). The ankle force control task induced significant decreases in alpha and beta PSDs in the central, left, and right primary sensorimotor cortex (SM1) and beta PSD in the central frontal as compared with the resting state. HD-tDCS significantly decreased the RMS and beta task-PSD in the central frontal and SM1. A significant association between the percent change of RMS and the percent change of beta task-PSD in the central SM1 after HD-tDCS was observed. In conclusion, ankle force control task activated a distributed cortical network mainly including the SM1. HD-tDCS applied over SM1 could enhance ankle force control and modulate the beta-band activity of the sensorimotor cortex.

Effects of intervention combining transcranial direct current stimulation and foot core exercise on sensorimotor function in foot and static balance.

OBJECTIVE: This study aimed to examine the effects of combining transcranial direct current stimulation (tDCS) and foot core exercise (FCE) on the sensorimotor function of the foot (i.e., toe flexor strength and passive ankle kinesthesia) and static balance. METHODS: In this double-blinded and randomized study, 30 participants were randomly assigned into two groups: tDCS combined with FCE and sham combined with FCE (i.e., control group). The participants received 2 mA stimulation for 20 min concurrently with FCE over 4 weeks (i.e., three sessions per week). After the first two groups completed the intervention, a reference group (FCE-only group) was included to further explore the placebo effects of sham by comparing it with the control group. Foot muscle strength, passive ankle kinesthesia, and static balance were assessed at baseline and after the intervention. RESULTS: Compared with the control group and baseline, tDCS combined with FCE could increase toe flexor strength (p < 0.001) and decrease the passive kinesthesia threshold of ankle eversion (p = 0.002). No significant differences in static balance were observed between tDCS + FCE and control groups. The linear regression models showed an association towards significance between the percent changes in metatarsophalangeal joint flexor strength and the anteroposterior average sway velocity of the center of gravity in one-leg standing with eyes closed following tDCS + FCE (r2 = 0.286; p = 0.057). The exploratory analysis also showed that compared with FCE alone, the sham stimulation did not induce any placebo effects during FCE. CONCLUSION: Participating in 4 weeks of intervention using tDCS in combination with FCE effectively enhances toe flexor strength and foot-ankle sensory function.

Is Anodal Transcranial Direct Current Stimulation an Effective Ergogenic Technology in Lower Extremity Sensorimotor Control for Healthy Population? A Narrative Review.

Anodal transcranial direct current stimulation (a-tDCS) aims to hone motor skills and improve the quality of life. However, the non-repeatability of experimental results and the inconsistency of research conclusions have become a common phenomenon, which may be due to the imprecision of the experimental protocol, great variability of the participant characteristics within the group, and the irregularities of quantitative indicators. The aim of this study systematically summarised and analysed the effect of a-tDCS on lower extremity sensorimotor control under different experimental conditions. This narrative review was performed following the PRISMA guidelines until June 2022 in Web of Science, PubMed, Science Direct, Google Scholar, and Scopus. The findings of the present study demonstrated that a-tDCS can effectively improve the capabilities of lower extremity sensorimotor control, particularly in gait speed and time-on-task. Thus, a-tDCS can be used as an effective ergogenic technology to facilitate physical performance. In-depth and rigorous experimental protocol with larger sample sizes and combining brain imaging technology to explore the mechanism have a profound impact on the development of tDCS.

Effects of 4 Weeks of High-Definition Transcranial Direct Stimulation and Foot Core Exercise on Foot Sensorimotor Function and Postural Control.

Objective: This study aimed to examine the effects of 4 weeks of high-definition transcranial direct current stimulation (HD-tDCS) and foot core exercise (FCE) on foot sensorimotor function (i.e., toe flexor strength and passive ankle kinesthesia) and postural control. Methods: In total, 36 participants were randomly assigned into three groups as follows: HD-tDCS, FCE, and the control group. A total of 12 training sessions were performed over 4 weeks (i.e., three sessions per week) in the laboratory. The HD-tDCS group received 20-min HD-tDCS with a current density of 2 mA, and the FCE group completed short foot exercise, towel curls, toe spread and squeeze, and balance board training. Participants in the control group just maintained the activities what they usually did and did not receive any interventions. Foot muscle strength, passive ankle kinesthesia, and postural control were assessed at baseline and post-intervention. Results: HD-tDCS induced a greater decrease in the percentage changes in the passive kinesthesia thresholds of ankle inversion (p < 0.001) and eversion (p = 0.013) than the control group. Compared with the control group, a significant increase in the percentage change in the metatarsophalangeal joint flexor strength was found in the HD-tDCS group (p = 0.008) and the FCE group (p = 0.027), and a significant increase in the percentage change in toe flexor strength was observed in the FCE group (p = 0.015). Moreover, FCE induced a greater reduction in the percent changes in the medial-lateral average center of gravity sway velocity in one-leg standing with eyes open (p = 0.033) and the anteroposterior average center of gravity sway velocity in one-leg standing with eyes closed (p < 0.001) than control. Conclusion: This study demonstrated that 4 weeks of HD-tDCS and FCE induced distinct benefits on foot sensorimotor function and the standing postural control performance in healthy young adults. HD-tDCS could improve the metatarsophalangeal joint flexor strength and the passive kinesthesia thresholds of ankle inversion and eversion. Meanwhile, FCE could also enhance foot muscle strength and enhance postural control performance in one-leg standing.

Effects of 12-week transition training with minimalist shoes on Achilles tendon loading in habitual rearfoot strike runners.

Minimalist shod runners have reported greater material and mechanical properties of the Achilles tendon (AT) due to increased loading than runners who wear more cushioned running shoes. This study aimed to investigate the effects of 12-week transition training from conventional shoes to minimalist shoes on AT loading in habitual rearfoot strike runners. Seventeen healthy male habitual rearfoot strikers completed 12-week transition training. They were instructed either to run in minimalist shoes with a forefoot strike pattern (MIN + FFS, n = 9) or run in minimalist shoes but were free to develop their strike pattern (MIN, n = 8). Ultrasound images were captured to determine the cross-sectional area of the AT. Sagittal plane ankle kinematics and ground reaction forces were recorded simultaneously to quantify ankle joint mechanics and AT loading. The strike angle significantly decreased in MIN + FFS after the transition training, indicating a flatter foot at initial contact, whereas no changes were observed in MIN. After training, a significant increase in peak plantarflexion moment was observed for MIN + FFS (15.4%) and MIN (7.6%). Significantly increased peak AT force, peak loading rate and peak stress were observed after training in both groups. Specifically, MIN + FFS had a greater increase in peak AT force (20.3% versus 10.1%), peak loading rate (37.2% versus 25.4%) and peak AT stress (13.7% versus 8.1%) than MIN. Furthermore, for both groups, there were no significant differences in the moment arm and cross-sectional area of the AT observed before and after 12 weeks of training. The results of this study suggested that it was insufficient to promote the morphological adaptation of the AT, but the mechanical loading of the AT was adapted during running after 12-week transition training with minimalist shoes in MIN + FFS and MIN. Preliminary evidence showed that a gradual transition to minimalist shoes with a forefoot strike pattern may be beneficial to the mechanical loading of the AT.

Sex Differences in the Morphological and Mechanical Properties of the Achilles Tendon.

BACKGROUND: Patients with Achilles tendon (AT) injuries are often engaged in sedentary work because of decreasing tendon vascularisation. Furthermore, men are more likely to be exposed to AT tendinosis or ruptures. These conditions are related to the morphological and mechanical properties of AT, but the mechanism remains unclear. This study aimed to investigate the effects of sex on the morphological and mechanical properties of the AT in inactive individuals. METHODS: In total, 30 inactive healthy participants (15 male participants and 15 female participants) were recruited. The AT morphological properties (cross-sectional area, thickness, and length) were captured by using an ultrasound device. The AT force-elongation characteristics were determined during isometric plantarflexion with the ultrasonic videos. The AT stiffness was determined at 50%-100% maximum voluntary contraction force. The AT strain, stress, and hysteresis were calculated. RESULTS: Male participants had 15% longer AT length, 31% larger AT cross-sectional area and 21% thicker AT than female participants (p < 0.05). The plantarflexion torque, peak AT force, peak AT stress, and AT stiffness were significantly greater in male participants than in female participants (p < 0.05). However, no significant sex-specific differences were observed in peak AT strain and hysteresis (p > 0.05). CONCLUSIONS: In physically inactive adults, the morphological properties of AT were superior in men but were exposed to higher stress conditions. Moreover, no significant sex-specific differences were observed in peak AT strain and hysteresis, indicating that the AT of males did not store and return elastic energy more efficiently than that of females. Thus, the mechanical properties of the AT should be maintained and/or improved through physical exercise.

Gender Difference in Architectural and Mechanical Properties of Medial Gastrocnemius-Achilles Tendon Unit In Vivo.

This study aims to explore whether gender differences exist in the architectural and mechanical properties of the medial gastrocnemius-Achilles tendon unit (gMTU) in vivo. Thirty-six healthy male and female adults without training experience and regular exercise habits were recruited. The architectural and mechanical properties of the gMTU were measured via an ultrasonography system and MyotonPRO, respectively. Independent t-tests were utilized to quantify the gender difference in the architectural and mechanical properties of the gMTU. In terms of architectural properties, the medial gastrocnemius (MG)'s pennation angle and thickness were greater in males than in females, whereas no substantial gender difference was observed in the MG's fascicle length; the males possessed Achilles tendons (ATs) with a longer length and a greater cross-sectional area than females. In terms of mechanical properties, the MG's vertical stiffness was lower and the MG's logarithmic decrement was greater in females than in males. Both genders had no remarkable difference in the AT's vertical stiffness and logarithmic decrement. Gender differences of individuals without training experience and regular exercise habits exist in the architectural and mechanical properties of the gMTU in vivo. The MG's force-producing capacities, ankle torque, mechanical efficiency and peak power were higher in males than in females. The load-resisting capacities of AT were greater and the MG strain was lesser in males than in females. These findings suggest that males have better physical fitness, speed and performance in power-based sports events than females from the perspective of morphology and biomechanics.

Effects of Transcranial Direct Current Stimulation Combined With Physical Training on the Excitability of the Motor Cortex, Physical Performance, and Motor Learning: A Systematic Review.

Purpose: This systematic review aims to examine the efficacy of transcranial direct current stimulation (tDCS) combined with physical training on the excitability of the motor cortex, physical performance, and motor learning. Methods: A systematic search was performed on PubMed, Web of Science, and EBSCO databases for relevant research published from inception to August 2020. Eligible studies included those that used a randomized controlled design and reported the effects of tDCS combined with physical training to improve motor-evoked potential (MEP), dynamic posture stability index (DPSI), reaction time, and error rate on participants without nervous system diseases. The risk of bias was assessed by the Cochrane risk of bias assessment tool. Results: Twenty-four of an initial yield of 768 studies met the eligibility criteria. The risk of bias was considered low. Results showed that anodal tDCS combined with physical training can significantly increase MEP amplitude, decrease DPSI, increase muscle strength, and decrease reaction time and error rate in motor learning tasks. Moreover, the gain effect is significantly greater than sham tDCS combined with physical training. Conclusion: tDCS combined with physical training can effectively improve the excitability of the motor cortex, physical performance, and motor learning. The reported results encourage further research to understand further the synergistic effects of tDCS combined with physical training.

Systematic Review of the Impact of Transcranial Direct Current Stimulation on the Neuromechanical Management of Foot and Ankle Physical Performance in Healthy Adults.

Objective: This study aims to review existing literature regarding the effects of transcranial direct current stimulation (tDCS) on the physical performances of the foot and ankle of healthy adults and discuss the underlying neurophysiological mechanism through which cortical activities influence the neuromechanical management of the physical performances of the foot and ankle. Methods: This systematic review has followed the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses. A systematic search was performed on PubMed, EBSCO, and Web of Science. Studies were included according to the Participants, Intervention, Comparison, Outcomes, and Setting inclusion strategy. The risk of bias was assessed through the Cochrane Collaboration tool, and the quality of each study was evaluated through the Physiotherapy Evidence Database (PEDro) scale. Results: The electronic search resulted in 145 studies. Only eight studies were included after screening. The studies performed well in terms of allocation, blinding effectiveness, and selective reporting. Besides, the PEDro scores of all the studies were over six, which indicated that the included studies have high quality. Seven studies reported that tDCS induced remarkable improvements in the physical performances of the foot and ankle, including foot sole vibratory and tactile threshold, toe pinch force, ankle choice reaction time, accuracy index of ankle tracking, and ankle range of motion, compared with sham. Conclusion: The results in these studies demonstrate that tDCS is promising to help improve the physical performances of the foot and ankle. The possible underlying mechanisms are that tDCS can ultimately influence the neural circuitry responsible for the neuromechanical regulation of the foot and ankle and then improve their physical performances. However, the number of studies included was limited and their sample sizes were small; therefore, more researches are highly needed to confirm the findings of the current studies and explore the underlying neuromechanical effects of tDCS.

Effectiveness of Using Compression Garments in Winter Racing Sports: A Narrative Review.

Nowadays, compression garments (CGs) are widely used in winter racing sports, such as speed skating, short-track speed skating, alpine skiing, and cross-country skiing. However, the effect of wearing CGs on athletic performance in these specific sports is still not fully examined. Thus, the aim of this narrative review is to summarize the research and application of CGs in winter racing sports and to discuss how the CGs help athletes improve their performance in an integrative manner (i.e., physiology, aerodynamics, and biomechanics). A total of 18 experimental studies dedicated to CGs in winter racing sports were identified from the peer-review scientific literature. The main findings are as follows. (1) Currently, CG studies have mainly focused on drag reduction, metabolism, muscle function, strength performance, and fatigue recovery. (2) The results of most studies conducted in wind tunnels showed that, for cylindrical structures similar to the human body, clothing with rough surfaces can reduce air drag. Notably, the effect of CGs on drag reduction in real competition has not been fully explored in the literature. (3) Compression can reduce muscle vibrations at high impact and help athletes control the center of pressure movement, a function that is important for alpine skiing. Future studies are needed to improve current understanding of the effects of compression clothing microstructure on drag reduction and their stretching in different parts of the body. Furthermore, the design of experimental protocol must be consistent with those during the competition, thus providing a full discussion on energy metabolism, fatigue, and recovery affected by CGs.

Changes in the Plantar Flexion Torque of the Ankle and in the Morphological Characteristics and Mechanical Properties of the Achilles Tendon after 12-Week Gait Retraining.

PURPOSE: Although the Achilles tendon (AT) is the largest and strongest tendon, it remains one of the most vulnerable tendons among elite and recreational runners. The present study aims to explore the effects of 12-week gait retraining (GR) on the plantar flexion torque of the ankle and the morphological and mechanical properties of the AT. METHODS: Thirty-four healthy male recreational runners (habitual rearfoot strikers) who never tried to run in minimal shoes were recruited, and the intervention was completed (20 in the GR group vs. 14 in the control (CON) group). The participants in the GR group were asked to run in minimal shoes (INOV-8 BARE-XF 210) provided by the investigators with forefoot strike patterns during the progressive 12-week GR. Meanwhile, the participants in the CON group were instructed to run in their own running shoes, which they were familiar with, with original foot strike patterns and intensities. The morphological properties of the AT, namely, length and cross-sectional area (CSA), were obtained by using an ultrasound device. A dynamometer was utilized simultaneously to measure and calculate the plantar flexion torque of the ankle, the rate of torque development, the peak force of the AT, and the stress and strain of the AT. RESULTS: After 12-week GR, the following results were obtained: (1) A significant time effect in the peak ankle plantarflexion torque was observed (p = 0.005), showing a 27.5% increase in the GR group; (2) A significant group effect in the CSA was observed (p = 0.027), specifically, the increase in CSA was significantly larger in the GR group than the CON group; (3) A significant time effect in the peak AT force was observed (p = 0.005), showing a 27.5% increase in the GR group. CONCLUSION: The effect of 12 weeks of GR is an increase in AT CSA, plantar flexor muscle strength of the ankle, and peak AT force during a maximal voluntary isometric contraction test. These changes in AT morphology and function could be positive for tendon health and could prevent future AT injury.