Muscle and intensity based hamstring exercise classification in elite female track and field athletes: implications for exercise selection during rehabilitation.

BACKGROUND: Hamstring injuries are common in many sports, including track and field. Strains occur in different parts of the hamstring muscle but very little is known about whether common hamstring loading exercises specifically load different hamstring components. The purpose of this study was to investigate muscle activation of different components of the hamstring muscle during common hamstring loading exercises. METHODS: Twenty elite female track and field athletes were recruited into this study, which had a single-sample, repeated-measures design. Each athlete performed ten hamstring loading exercises, and an electromyogram (EMG) was recorded from the biceps femoris and semitendinosus components of the hamstring. Hamstring EMG during maximal voluntary isometric contraction (MVIC) was used to normalize the mean data across ten repetitions of each exercise. An electrogoniometer synchronized to the EMG was used to determine whether peak EMG activity occurred during muscle-tendon unit lengthening, shortening, or no change in length. Mean EMG values were compared between the two recording sites for each exercise using the Student's t-test. RESULTS: The lunge, dead lift, and kettle swings were low intensity (<50% MVIC) and all showed higher EMG activity for semitendinosus than for biceps femoris. Bridge was low but approaching medium intensity, and the TRX, hamstring bridge, and hamstring curl were all medium intensity exercises (≥50% or <80% MVIC). The Nordic, fitball, and slide leg exercises were all high intensity exercises. Only the fitball exercise showed higher EMG activity in the biceps femoris compared with the semitendinosus. Only lunge and kettle swings showed peak EMG in the muscle-tendon unit lengthening phase and both these exercises involved faster speed. CONCLUSION: Some exercises selectively activated the lateral and medial distal hamstrings. Low, medium, and high intensity exercises were demonstrated. This information enables the clinician, strength and conditioning coach and physiotherapist to better understand intensity- and muscle-specific activation during hamstring muscle rehabilitation. Therefore, these results may help in designing progressive strengthening and rehabilitation and prevention programs.

Arthroscopic meniscus allograft transplantation in male professional soccer players: a 36-month follow-up study.

BACKGROUND: Meniscus allograft transplantation (MAT) is an option for symptomatic patients who have undergone subtotal meniscectomy and can potentially result in pain relief and increased function. HYPOTHESIS: Professional soccer players would benefit from arthroscopic MAT in terms of pain, knee function, and return to play at 36-month follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve male patients who had undergone MAT (6 medial, 6 lateral) were prospectively evaluated at 12- and 36-month follow-up. The mean age at the time of surgery was 24.5 ± 3.6 years (range, 19-29 years), and the mean time from meniscectomy to surgery was 37 ± 31 months (range, 2-82 months). The transplantation was performed in patients who had undergone subtotal meniscectomy using an arthroscopic bone plug-free technique with a single tibial tunnel plus "all-inside" meniscus sutures. The anterior horn of the transplanted meniscus was sutured to the capsule and to the remnant of the anterior horn of the native meniscus. Seven patients (58%) underwent concurrent procedures. All patients were evaluated at follow-up by the Tegner, Lysholm, International Knee Documentation Committee (IKDC) subjective, IKDC objective, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale (VAS) for pain scores. Information regarding rehabilitation, return to play, and return to official competition was recorded. RESULTS: Eleven of the 12 patients (92%) returned to play soccer. At 36-month follow-up, 9 patients (75%) were still playing as professionals (Tegner score of 10), whereas 2 patients (17%) were playing as semiprofessionals (Tegner score of 9). The mean time from surgery to the end of rehabilitation was 7.5 ± 2 months, whereas the mean time to official competition was 10.5 ± 2.6 months. Patients demonstrated significant improvements on the median Tegner score from 8 (interquartile range, 3-10) to 10 (interquartile range, 9-10) (P = .0391); the mean Lysholm score from 67 ± 14 to 92 ± 10 (P = .0021); the mean IKDC subjective score from 61.8 ± 16.3 to 85.3 ± 9.8 (P = .0026); the mean IKDC objective score from 1 A, 8 B, 1 C, and 2 D to 7 A and 5 B (P = .0077); the mean WOMAC score from 77.1 ± 15.9 to 92.2 ± 9.1 (P = .0242); and the mean VAS score from 61 ± 16 to 29 ± 32 (P = .0029) at 12-month follow-up. There were no significant improvements in these outcomes at 36-month follow-up. One patient developed a knee infection after MAT plus anterior cruciate ligament allograft reconstruction. This complication was successfully treated, but the patient stopped playing soccer (Tegner score of 3 at 36-month follow-up), and this was considered a failure (8%). CONCLUSION: Arthroscopic MAT in professional soccer players allowed a return to play at the same level (Tegner score of 10) in 75% of the cases at 36-month follow-up.

Typical balance exercises or exergames for balance improvement?

BACKGROUND AND OBJECTIVES: Balance training is an effective intervention to improve static postural sway and balance. The purpose of the present study was to investigate the effectiveness of the Nintendo Wii Fit Plus exercises for improving balance ability in healthy collegiate students in comparison with a typical balance training program. METHODS: Forty students were randomly divided into two groups, a traditional (T group) and a Nintendo Wii group (W group) performed an 8 week balance program. The "W group" used the interactive games as a training method, while the "T group" used an exercise program with mini trampoline and inflatable discs (BOSU). Pre and Post-training participants completed balance assessments. RESULTS: Two-way repeated measures analyses of variance (ANOVAs) were conducted to determine the effect of training program. Analysis of the data illustrated that both training program groups demonstrated an improvement in Total, Anterior-posterior and Medial Lateral Stability Index scores for both limbs. Only at the test performed in the balance board with anterior-posterior motion, the improvement in balance ability was greater in the "T group" than the "W group", when the assessment was performed post-training (p=0.023). CONCLUSIONS: Findings support the effectiveness of using the Nintendo Wii gaming console as a balance training intervention tool.

Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review.

PURPOSE: A general agreement on the best surgical treatment option of chronic proximal patellar tendinopathy is still lacking. The purpose of this systematic review was to investigate if arthroscopically assisted procedures have been reported better results compared to open surgery and to assess the methodology of studies. METHODS: Twenty-one studies were included in the review. Surgical outcomes were defined referring to the functional classification described by Kelly et al. (Am J Sports Med 12(5):375-380, [11]): return to sport was regarded as the ability of training at the original level before injury with mild or moderate pain and success as the improvement after surgery with symptom reduction. Methodological analysis was performed by two reviewers adopting the Coleman Methodology Score (CMS) (range 0-100, best score 100). RESULTS: Only one randomized controlled trial (RCT) met inclusion criteria; all other included studies were case series. Median sample size 24, range 11-138, mean age at surgery 26.8 ± 3.2 years, mean follow-up 32.5 ± 18.4 (median 31, range 6-60) months. Return to sport rate: global 78.5 %, open group 76.6 % and arthroscopic group 84.2 %. Success rate: global 84.6 %, open group 87.2 % and arthroscopic group 92.4 %. Differences between groups were not statistically significant. CMSs were positively correlated with the year of publication (P < 0.05). CONCLUSIONS: Minimally invasive arthroscopically assisted procedures have not reported better statistically significant results when compared to open surgery in the treatment of chronic proximal patellar tendinopathy. The methodology of studies in this field has improved over the past 15 years, but well-designed RCTs using validated patient-based outcome measures are still lacking. LEVEL OF EVIDENCE: Systematic Review, Level IV.