Mechanical diagnosis and therapy in musculoskeletal pain of individuals with spinal cord injury.

CONTEXT/OBJECTIVE: Musculoskeletal pain (MSKP) has high prevalence in individuals with spinal cord injury (SCI). Mechanical Diagnosis and Therapy (MDT) is a method focused on identifying the pain source in the musculoskeletal system and presents good results in pain relief in people without neurological impairment. However, no studies have investigated the use of MDT in SCI population. The objective was to evaluate the applicability and outcomes of MDT treatment in pain relief and independence improvement in daily activities of individuals with SCI presenting MSKP. DESIGN: Single-arm trial. SETTING: Rehabilitation Hospital. PARTICIPANTS: Twenty-four individuals with SCI who presented MSKP. INTERVENTION: MDT-certified physical therapist conducted assessments and treatments of pain according to the MDT approach. OUTCOMES MEASURES: Numeric rating scale (NRS) was used to measure pain and Pain Disability Index (PDI) and Patient-Specific Functional Scale (PSFS) to evaluate daily activities. RESULTS: Significant median decreases were found for NRS (from 7 to 2) and PDI (from 27 to 8) after MDT, whereas PSFS score presented a significant mean increase (from 3.2-7.7). The average decrease in pain after MDT treatment was 70.9% (5.36 on the NRS). CONCLUSION: MDT can reduce pain and enhance independence in daily activities in individuals with SCI and MSKP.

Neuromuscular disorders in women and men with spinal cord injury are associated with changes in muscle and tendon architecture.

OBJECTIVE: The present study aimed to determine the association between neuromuscular function, motor function impairment, and muscle and tendon structures in individuals with spinal cord injury (SCI) compared to a control (non-disabled) population. DESIGN: A cross-sectional study with a control group. SETTING: Center of Adapted Sports Training and Special Physical Education. PARTICIPANTS: Fifteen individuals with SCI and motor function impairments participated in the study. A paired non-disabled group was recruited for comparison. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Muscle (biceps brachii, rectus femoris, vastus lateralis, vastus medialis, and tibialis anterior) and tendon (quadriceps and patellar tendons) structures were assessed by ultrasound imaging (thickness, pennation angle, fascicle length, and echogenicity). Neuromuscular electrophysiological disorders were also assessed using electrodiagnosis techniques (stimulus non-responsivity and chronaxie) in the same muscles. RESULTS: Except for the biceps brachii muscle, muscle thickness, pennation angle, and fascicle length were lower (p < 0.01) while echogenicity and chronaxie were greater (p < 0.01) in SCI participants. The SCI participants had a higher prevalence of neuromuscular electrophysiological disorders for all muscles, except the biceps brachii. CONCLUSION: Neuromuscular disorders occur in association with muscle and tendon maladaptation in individuals with chronic SCI. A higher prevalence of electrophysiological disorders suggests an acquired polyneuromyopathy for muscles with motor function impairment even though the muscle was innerved, in addition to widespread muscle atrophy.

Synchronous and asynchronous tele-exercise during the coronavirus disease 2019 pandemic: Comparisons of implementation and training load in individuals with spinal cord injury.

INTRODUCTION: Tele-exercise could represent an alternative for remote care in individuals with spinal cord injury at this time of the pandemic of coronavirus disease 2019. However, the differences regarding the training loads and implementation between synchronous and asynchronous types are not yet known. The purpose of this study was to compare the implementation and training load between synchronous and asynchronous tele-exercise programs in individuals with spinal cord injury. METHODS: Forty individuals with spinal cord injury were recruited and stratified into tetraplegia and paraplegia groups. All subjects performed 3 weeks of both the synchronous and asynchronous tele-exercise programs, after two weeks of familiarization with the exercises, remote connection tools and methods to record information. The primary outcomes were training load (average daily workload and average and total weekly training load) and implementation (adherence and successful exercise recording). Demographic characteristics were obtained from participants' electronic medical records. RESULTS: Weekly mean workload, total workload, adherence and successful exercise recording presented significantly higher values in the synchronous compared to asynchronous tele-exercises. Average daily workload did not present significant differences between the tele-exercises. DISCUSSION: The training load for each training session presented no differences between synchronous and asynchronous tele-exercises. Both adherence and successful data recording showed more favourable implementation values for synchronous training, thus allowing greater weekly training loads (total and average).

Feasibility and validity of the push-up test for synchronous and asynchronous strength tele-assessment in spinal cord injury individuals with paraplegia.

OBJECTIVES: This study aimed to determine whether the synchronous and asynchronous push-up tele-assessment in individuals with spinal cord injury (SCI) is feasible and valid and to identify the relationship between the participants' self-reported asynchronous strength tele-assessment and asynchronous push-up tele-assessment. STUDY DESIGN: Cross-sectional study. METHODS: Thirty-three men and women with SCI were included in this study. The participants were assessed using the one-maximum repetition test (1RM), the maximum repetitions with 60% of 1RM (MRT) of the bench press exercise, and synchronous and asynchronous push-up tele-assessment. The videos and the total repetitions performed were recorded. The primary outcomes were 1RM, MRT, synchronous push-up tele-assessment and asynchronous volume loads, and the participants' self-reported asynchronous strength tele-assessment volume load. RESULTS: The synchronous push-up tele-assessment and asynchronous volume loads presented significant correlations with 1RM (0.73 and 0.45, p < 0.001, respectively) and MRT volume loads (0.87 and 0.66, p < 0.001, respectively). The asynchronous push-up tele-assessment presented significant correlations with the synchronous version (intraclass correlation coefficient, ICC = 0.86; 95% CI: 0.72-0.93, p < 0.001) and participants' self-reported asynchronous strength tele-assessment volume loads (ICC = 0.88; 95% CI: 0.75-0.94, p < 0.001). The difference between the synchronous push-up tele-assessment and asynchronous volume load means was 254.9 kg, and the interval around the differences was 1856.1 kg. The difference between asynchronous push-up tele-assessment and participants' self-reported asynchronous strength tele-assessment means was -239.4 kg, and the interval around these was 1884.1 kg. CONCLUSION: The synchronous push-up tele-assessment is a feasible and valid way to assess the maximum resistance strength of individuals with SCI. Although the asynchronous push-up tele-assessment demonstrated excellent and significant correlations with the synchronous push-up tele-assessment and participants' self-reported asynchronous strength tele-assessment, the test repetitions and the volume loads were underestimated by 15.5% (synchronous push-up tele-assessment vs. asynchronous) and overestimated by 17.3% (asynchronous push-up tele-assessment vs. participants' self-reported asynchronous strength tele-assessment), and the effect sizes ranged from 0.19-0.38. The authors suggest emphasizing the criteria of repetition validity to reduce test error.

Time Course of Recovery Following CrossFit® Karen Benchmark Workout in Trained Men.

The establishment of fatigue following the acute exercise stimulus is a complex and multi-factorial process, that might arise due to a range of distinct physiological mechanisms. However, a practical method of assessing CrossFit® athletes' recovery status has been neglected entirely in real-world sporting practice. The study describes the acute and delayed time course of recovery following the CrossFit® Benchmark Workout Karen. Eight trained men (28.4 ± 6.4 years; 1RM back squat 139.1 ± 26.0 kg) undertook the Karen protocol. The protocol consists of 150 Wall Balls (9 kg), aiming to hit a target 3 m high. Countermovement jump height (CMJ), creatine kinase (CK), and perceived recovery status scale (PRS) (general, lower and upper limbs) were assessed pre, post-0h, 24, 48 and 72 h after the session. The creatine kinase concentration 24 h after was higher than pre-exercise (338.4 U/L vs. 143.3 U/L; p = 0.040). At 48h and 72 h following exercise, CK concentration had returned to baseline levels (p > 0.05). The general, lower and upper limbs PRS scores were lower in the 24-h post-exercise compared to pre-exercise (general PRS: 4.7 ± 1.5 and 7.7 ± 1.7; p = 0.013; upper limbs PRS: 6.6 ± 1.3 and 7.5 ± 1.3; p = 0.037; lower limbs PRS: 3.9 ± 2.5 and 7.3 ± 0.1; p = 0.046). Our findings provide insights into the fatigue profile and recovery in acute CrossFit® and can be useful to coaches and practitioners when planning training programs. Moreover, recovery status can be useful to optimize training monitoring and to minimize the potential detrimental effects associated with the performance of repeated high-intensity sessions of CrossFit®.

Force-velocity relationship in Paralympic powerlifting: two or multiple-point methods to determine a maximum repetition.

BACKGROUND: Due to the absence of evidence in the literature on Paralympic Powerlifting the present study investigated various methods to assess bench press maximum repetition and the way each method influences the measurement of minimum velocity limit (MVT), load at zero velocity (LD0), and force-velocity (FV). OBJECTIVE: To evaluate the precision of the multi-point method using proximal loads (40, 50, 60, 70, 80, and 90% of one repetition maximum; 1RM) compared to the four-point method (50, 60, 70, and 80% of 1RM) and the two-point method using distant loads (40 and 80% and 50 and 80% of 1RM) in in the MVT, LD0, and FV, in bench press performed by Paralympic Powerlifters (PP). METHODS: To accomplish this, 15 male elite PP athletes participated in the study (age: 27.7 ± 5.7 years; BM: 74.0 ± 19.5 kg). All participants performed an adapted bench press test (free weight) with 6 loads (40, 50, 60, 70, 80, and 90% 1RM), 4 loads (50, 60, 70, and 80% 1RM), and 2 loads (40-80% and 50-80% 1RM). The 1RM predictions were made by MVT, LD0, and FV. RESULTS: The main results indicated that the multiple (4 and 6) pointsmethod provides good results in the MVT (R2 = 0.482), the LD0 (R2 = 0.614), and the FV (R2 = 0.508). The two-point method (50-80%) showed a higher mean in MVT [1268.2 ± 502.0 N; ICC95% 0.76 (0.31-0.92)], in LD0 [1504.1 ± 597.3 N; 0.63 (0.17-0.86)], and in FV [1479.2 ± 636.0 N; 0.60 (0.10-0.86)]. CONCLUSION: The multiple-point method (4 and 6 points) and the two-point method (40-80%) using the MVT, LD0, and FV all showed a good ability to predict bench press 1RM in PP.

Validation of the Repetitions in Reserve Rating Scale in Paralympic Powerlifting Athletes.

The present study aimed to validate the perceived exertion scale based on the repetitions in reserve (RIR) of Paralympic Powerlifting (PP) athletes. Twenty-one PP athletes were assessed in the one-maximum repetition test (1RM) of the bench press exercise, maximum repetition strength tests with loads corresponding to 90, 85, 80, and 75% of 1RM, and 4-repetitions strength tests (4-repST) with 100, 90, 85, 80, and 75% of the 1RM. The RIR scale was assessed after each set of the 4-repST and compared to the 1RM and maximum strength tests. For criterion validity, the total estimated repetition was significantly lower compared to the maximum strength test repetitions in the lower scores of the RIR scale (median=7.0 vs. 9.0 for 75% of 1RM). The total estimated repetition correlation with maximum strength was very high and significant (ICC=0.91). Using the Bland and Altman method, the difference between means was 0.9 reps, and the interval around differences was 6.4 reps. For construct validity, and the RIR scale presented high correlation with 1RM intensities (rho=0.86, p≤0.05). The RIR scale was validated and coaches and sports trainers can use this monitoring tool to ensure submaximal loads when improving lift technique, which is extremely rigorous in PP.

Peak Torque Prediction Using Handgrip and Strength Predictors in Men and Women With Motor Complete Spinal Cord Injury.

OBJECTIVES: To establish predictive equations for peak torque of muscle groups with totally and partially preserved innervation in individuals with motor complete spinal cord injury (SCI), based on hand dynamometry and strength predictor variables. METHODS: The cross-sectional study conducted at a rehabilitation hospital consecutively recruited 108 men and women with SCI. All participants performed maximum peak torque tests for shoulder abduction/adduction (isokinetic), trunk flexion/extension (isometric), and handgrip strength testing (hand dynamometer) to establish predictive peak torque equations. The primary outcomes were peak torque variables. Handgrip strength, age, injury level, time since injury, age at injury, body mass, height, body mass index, and physical activity level were the secondary outcomes used as strength predictor variables. RESULTS: Handgrip strength was a predictor variable for shoulder abduction/adduction peak torque. The best predictive models for shoulder abduction/adduction peak torque exhibited R 2 = 0.57 and R 2 = 0.60, respectively (p ≤ .05). Injury level showed the highest significant predictive capacity for trunk flexion/extension peak torque models (R 2 = 0.38 and R 2 = 0.29; p ≤ .05). CONCLUSION: Shoulder abduction/adduction peak torque predictive equations may be an alternative for use in an accessible strength tool (hand dynamometry) to evaluate training and rehabilitation programs. Trunk flexion/extension peak torque equations exhibited moderate correlations and high standard error of the estimates and should be used with caution.

Handgrip Strength Cutoff Points for Functional Independence and Wheelchair Ability in Men With Spinal Cord Injury.

OBJECTIVES: To determine optimal handgrip strength (HGS) cutoff points for greater functional independence and wheelchair skills in men with spinal cord injury (SCI), and to establish predictive equations for functional independence and wheelchair ability in men with SCI, based on demographic characteristics, HGS, and functionality. METHODS: In this cross-sectional study conducted at a rehabilitation hospital, 54 men with SCI were recruited and stratified into high and low paraplegia groups. All participants performed a maximum HGS test to determine cutoff points for the Spinal Cord Independence Measure (SCIM-III) and Adapted Manual Wheelchair Circuit (AMWC). The primary outcomes were the SCIM-III, AMWC, and HGS. Demographic characteristics obtained from participants' electronic medical records were the secondary outcomes, used as predictor variables of functional independence. RESULTS: The SCIM-III scale, performance score, and 3-minute overground wheeling test presented significant regression equations (R = 0.45, R = 0.69, and R = 0.72). The HGS showed a cutoff point of 102.5 kilogram force (kgf) to achieve a score of 70 on the SCIM-III and a 3-minute overground wheeling distance of 270 m. The HGS cutoff point to obtain a performance score of 23.7 seconds was 93.0 kgf. CONCLUSION: The HGS was a significant predictor for the SCIM-III score, AMWC performance score, and 3-minute overground wheeling test. Three significant predictive equations were established based on HGS. The cutoff points could be adopted as parameters for optimal functional independence and wheelchair skills.

Evaluation of Strength and Muscle Activation Indicators in Sticking Point Region of National-Level Paralympic Powerlifting Athletes.

BACKGROUND: The sticking region is considered an intervening factor in the performance of the bench press with high loads. OBJECTIVE: To evaluate the strength indicators in the sticking point region in Powerlifting Paralympic athletes. METHODS: Twelve Brazilian Powerlifting Paralympic athletes performed maximum isometric force (MIF), rate of force development (RFD), time at MIF, velocity, dynamic time in sticking, and surface electromyography in several distances from the bar to the chest. RESULTS: For velocity, there was a difference between the pre-sticking and sticking region (1.98 ± 0.32 and 1.30 ± 0.43, p = 0.039) and dynamic time between the pre-sticking and the sticking region (0.40 ± 0.16 and 0.97 ± 0.37, p = 00.021). In static test for the MIF, differences were found between 5.0 cm and 15.0 cm (CI 95% 784; 1088; p = 0.010) and between 10.0 cm and 5.0 cm (CI 95% 527; 768; p < 0.001). Regarding the RFD, differences were found (CI 95% 938; 1240; p = 0.004) between 5.0 cm and 25.0 cm and between 10.0 cm and 25.0 cm (CI 95% 513; 732; p < 0.001). In relation to time, there were differences between 5.0 cm and 15.0 cm (CI 95% 0.330; 0.515; p < 0.001), 5.0 cm, and 25.0 cm (CI 95% 0.928; 1.345; p = 0.001), 10.0 cm and 15.0 cm (p < 0.05) and 15.0 cm and 25.0 cm (p < 0.05). No significant differences were observed between the muscles in electromyography, although the triceps showed the highest muscle activation values. CONCLUSIONS: The maximum isometric force, rate of force development, time, velocity, and dynamic time had lower values, especially in the initial and intermediate phases in the sticking region.

Does prolonged walking cause greater muscle fatigability in individuals with incomplete spinal cord injury compared with matched-controls?

BACKGROUND: Individuals with incomplete spinal cord injury (iSCI) might show muscle fatigability during walking, primarily over long distances. The cause can be related to the motor impairment and walking compensations identified in this population. However, evidence on the occurrence of muscle fatigability after prolonged walking in individuals with iSCI is conflicting. RESEARCH QUESTION: Does prolonged walking cause higher muscle fatigability in individuals with iSCI compared with matched-controls? METHODS: We adopted a repeated measures design, in which maximal voluntary isometric contractions were performed before and after a walking test to induce the fatigability, in 24 individuals with iSCI and 24 matched-controls. Body weight-normalized peak torque (PT/BW), rate of force development (RFD), root mean square (RMS) and neuromuscular efficiency were used to assess the muscle fatigability. A mixed model ANOVA (2 × 2) was used for between-group and within-group comparisons. The significance was set in 5%. RESULTS: Individuals with iSCI showed a greater decline in the PT/BW and RMS after the walking test. However, the RFD presented a greater decrease in the control group. SIGNIFICANCE: Our results showed that prolonged walking caused higher muscle fatigability in individuals with iSCI compared to healthy individuals. Therefore, muscle fatigability should be considered during the rehabilitation planning and in activities of daily living of individuals with iSCI. Moreover, the identification of muscle fatigability in individuals with iSCI might be useful to prevent high levels of physical exertion and, possibly, the risk of fall.

The Torque Referenced to a Perceived Exertion Level Is Affected by the Type of Movement in Men With Spinal Cord Injury.

OBJECTIVES: To compare a standardized submaximal intensity (based on the rate of perceived exertion [RPE]) with the percentage of the average and peak torque during a familiarization session in individuals with different spinal cord injury (SCI) levels in gravity-resisted and gravity-assisted movements. METHODS: This was a cross-sectional study at a rehabilitation hospital. Thirty-six individuals stratified in tetraplegia (TP), high paraplegia (HP), and low paraplegia (LP) groups and 12 matched control participants (CG) were enrolled in the study. Participants performed a maximum strength test using isokinetic dynamometry. The familiarization consisted of 10 submaximal repetitions with a level 2 (i.e., 20% of the maximum score) in the Resistance Exercise Scale (OMNI-RES). Fisher's exact test compared the percentages of the average torque (%ATFam) and peak torque (%PTFam) of the familiarization (based on the peak torque during the maximum strength tests) to the %ATFam and %PTFam attained with 20% of RPE. The coefficient of variation (CV) was calculated to assess the torque dispersion during each familiarization set. RESULTS: The %ATFam was lower for gravity-assisted compared to gravity-resisted movements for HP, LP, and CG (p ≤ .05). The CV was significantly lower in gravity-resisted movements during familiarization for TP, LP, and CG. CONCLUSION: Different RPE levels should be adopted for gravity-resisted or gravity-assisted upper limb exercises to maintain the same relative intensity during a familiarization session.

Kinesiotaping enhances the rate of force development but not the neuromuscular efficiency of physically active young men.

INTRODUCTION: Investigations on the effects of KT on human performance have been increasing in the last few years. However, there is a paucity of studies investigating its effects on neuromuscular efficiency (NME) and rate of force development (RFD). OBJECTIVE: To evaluate the NME and RFD of the soleus and gastrocnemius muscles in physically active individuals under KT application. METHOD: Twenty young males (79.7±8.2kg; 1.78±0.05m; 24.7±4.4years) performed three conditions in a randomized order: (1) Baseline (BL, no tape); (2) Activation (ACTIKT, tape for muscle activation); and (3) Inhibition (INHIKT, tape for muscle inhibition). The tape was applied along the lateral and medial border of gastrocnemius with 30% tension for 48h. Peak torque (PT), RFD and NME were measured at BL and 48h after ACTIKT and INHIKT by performing a maximum isometric contraction. RESULTS: The RFD was significantly higher in ACTIKT compared to BL at 0-30 (P=0.010), 0-50 (P=0.008) and 0-100ms (P=0.007). The PT and NME did not differ among conditions (P>0.05). CONCLUSION: KT applied for muscle activation yielded a higher RFD during the initial phase of the muscle contraction. However, KT has no enhancement effect on NME and peak torque.

The interactions between hemostasis and resistance training: a review.

Physical inactivity is considered a risk factor for cardiovascular disease and is strongly associated with changes in arterial structure. Regular physical activity and exercise contributes to the prevention of coronary artery disease. Therefore, cardiovascular and resistance training improve hemostatic parameters and promote a less thrombotic blood profile. This review highlights the studies, mechanisms, and outcomes relating to the effectiveness of resistance training on the process of hemostasis. The Pubmed, Scopus, Medline, Scielo, Lilacs, Ibecs, and Cochrane databases were used to locate the original articles. Seventeen studies were found during the research process. Of these, ten articles were excluded. Those protocols using a high volume of training for young adults showed a greater fibrinolytic response, and training protocols with intensities above 80% of 1 maximum repetition showed an increased platelet activity. In subjects with coronary artery disease, just one session of resistance training resulted in improvement in the fibrinolytic system (tissue plasminogen activator) without raising potential thrombotic markers.

Body composition modifications in people with chronic spinal cord injury after supervised physical activity.

BACKGROUND: Quantification of body composition variables is important for planning of better activities in relation to individuals with spinal cord injury (SCI). OBJECTIVES: (1) To evaluate changes in body composition in patients with SCI after a supervised physical activity process; (2) To correlate total body fat with time since injury. DESIGN: Pre-post intervention. SETTING: Sarah Rehabilitation Hospital Network, Brazil. PARTICIPANTS: Fifty-three men with SCI aged 18-52 years with duration of injury >3 years. INTERVENTIONS: The subjects were divided into three groups: tetraplegia (TT) (C5-C8), high paraplegia (HP) (T1-T6), and low paraplegia (LP) (T7-L2). Body composition was estimated in the first and last weeks of hospitalization. OUTCOME MEASURES: Body weight (kg), skinfolds sum (mm), absolute (kg), and relative (%) fat and lean body mass. RESULTS: Body weight increased in TT and decreased in HP (0.8 kg, 95%CI 0.1-1.5; and -1.0 kg, 95%CI -2.0 to 0.0, respectively; P < 0.05). Skinfolds sum decreased only in HP (-13.1 mm, 95%CI -20.7 to -5.5; P < 0.05). Absolute and relative body fat decreased significantly in the paraplegia groups. Lean body mass (LBM) percentage increased significantly in the paraplegia groups. Absolute LBM increased in TT and LP (0.8 kg, 95%CI 0.3-1.3; and 1.3 kg, 95%CI 0.8 to 1.8, respectively; P < 0.05). There was no correlation between time since injury and skinfolds sum for the three groups (P < 0.05). CONCLUSION: TT, HP, and LP demonstrated favorable changes in body composition after 29 days of supervised physical activity. However, these changes were different in direction and magnitude.