Interhemispheric Inhibition Between Primary Motor Cortices is Not Altered in Individuals With Chronic Lateral Epicondylalgia.

Lateral epicondylalgia (LE), commonly referred to as tennis elbow, is a musculoskeletal condition characterized by pain and sensorimotor dysfunction. In some individuals with chronic unilateral LE, sensorimotor symptoms develop on the unaffected side despite no evidence of tissue damage. Altered interhemispheric inhibition (IHI) is one mechanism that could underpin this phenomenon. The aim of this cross-sectional study was to examine IHI between the primary motor cortices (M1) in individuals with chronic LE and healthy controls. In 20 individuals with chronic LE and 20 healthy participants, transcranial magnetic stimulation was used to assess 1) short and long-latency IHI from the affected (corresponding to the injured side) to the unaffected M1 and 2) corticomotor excitability of the affected and unaffected M1. Sensorimotor function was evaluated bilaterally at the extensor carpi radialis brevis muscle using pressure pain threshold, grip strength, 2-point discrimination, and temporal summation tests. Short- and long-latency IHI from the affected to the unaffected M1 and corticomotor excitability of the affected and unaffected M1 were not altered in individuals with LE compared with healthy participants. No differences in sensorimotor function were observed for the affected or unaffected extensor carpi radialis brevis muscles when individuals with LE were compared with healthy participants. IHI is not altered in individuals with chronic LE. Further studies are required to determine the mechanisms that underpin the development of bilateral sensorimotor symptoms in unilateral LE. PERSPECTIVE: IHI is unaltered from the affected M1 (corresponding to the painful muscle) to unaffected M1 in individuals with LE compared to healthy controls. The absence of bilateral sensorimotor dysfunction and low pain severity in this cohort of individuals with LE may explain this finding.

Transition from upright to greater forward lean posture predicts faster acceleration during the run-to-sprint transition.

BACKGROUND: Forward body lean and greater horizontal ground reaction force have been associated with being able to accelerate during running. However, kinematic features which may predict acceleration during the run-to-sprint transition have not been determined. The purpose of this study was to determine which kinematic changes occur in recreationally active adults and which kinematic features may predict greater acceleration during the run-to-sprint transition. METHODS: Forty-seven healthy adults completed straight line running along a 30 m track by running in at ∼4 m.s-1. A minimum of 20 trials were completed, with 25 % triggering a light to signal the participant to accelerate as fast as possible. Step characteristics (velocity, length, duration, cadence) and kinematics (neck, trunk, hip, knee and ankle angles and excursions) were determined using a radar gun and inertial measurement units, respectively. ANOVA was used to determine the step-to-step differences and a multiple linear regression was used to determine the relationship between kinematics and acceleration. RESULTS: There was an initial increase in trunk flexion angle during early acceleration (p < 0.001) with knee joint excursion significantly lower (p < 0.001) during loading and propulsion compared to the run-in steps. Greater acceleration was predicted using a stepwise linear regression by five variables including less neck flexion excursion and trunk flexion angle during swing of the 1st step, greater trunk flexion angle and extension excursion of the neck during propulsion of the 2nd step and greater hip flexion angle at foot strike of the 3rd step (r2 =0.804, p < 0.001). SIGNIFICANCE: Faster acceleration was observed when participants transitioned from an upright posture to greater forward trunk lean in the early phase of acceleration. Training the run-to-sprint transition, which was shown to have the greatest increase in velocity over the first 5 m, may be encouraged as a sports specific exercise.

A scoping review on the methods of assessment and role of resilience on function and movement-evoked pain when experiencing a musculoskeletal injury.

BACKGROUND: Resilience refers to an individual's ability to maintain effective functioning, by resisting, withstanding or recovering from stressors or adversity, including pain associated with physical injury (J Clin Psychol Med Settings 28:518-28, 2021). The aim of this scoping review is to determine the role of resilience in the experience of movement-evoked pain (MEP) and return to functional activity following a musculoskeletal injury. METHODS: This review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the scoping review protocol of the Joanna Briggs Institute (JBI). Five databases and one grey literature database were searched using predetermined key words and index terms to capture published and unpublished records on the topic. Two authors independently screened the title and abstract of each record, with the full-text of eligible records being reviewed. Papers were eligible for inclusion if they examined the population, concept and context of interest, were written in English and the full text was available. Data were extracted from each eligible record to guide discussion of the available literature on this topic. RESULTS: Of 4771 records, 2695 articles underwent screening based on their title and abstract. After title and abstract screening 132 articles were eligible for full text review, with 24 articles included in the final analysis. This review identified that psychological resilience has primarily been investigated in the context of a range of age-related pathologies. The choice of functional and movement-evoked pain assessments in the included studies were often guided by the pathology of interest, with some being general or injury specific. CONCLUSION: This scoping review identified inconsistent conclusions regarding the role of resilience in the experience of MEP and the ability to return to function for older adults with a musculoskeletal injury. This scoping review highlights the need for longitudinal research to be conducted that allows a broader age range, including younger adults, to determine if multidimensional resilience may promote recovery form musculoskeletal injury.

Interhemispheric Inhibition Between Primary Sensory Cortices is not Influenced by Acute Muscle Pain.

Bilateral deficits in sensorimotor function have been observed in unilateral musculoskeletal pain conditions. Altered interhemispheric inhibition (IHI) between primary sensory cortices (S1s) is one mechanism that could explain this phenomenon. However, IHI between S1s in response to acute muscle pain, and the relationship between IHI and pressure pain sensitivity in the unaffected limb have not been examined. In 21 healthy individuals, IHI was assessed using somatosensory evoked potentials in response to paired median nerve electrical stimulation at: 1) baseline; 2) immediately following pain resolution; and 3) at 30-minutes follow-up. Acute muscle pain was induced by injection of hypertonic saline into the right abductor pollicis brevis (APB) muscle. Pressure pain thresholds were assessed at the right and left APB muscles before and 30-minutes after pain resolution. Compared to baseline, IHI from the affected to unaffected S1 was unaltered in response to acute muscle pain immediately following pain resolution, or at 30-minutes follow-up. Pressure pain thresholds were reduced over the right (P = .001) and left (P = .001) APB muscles at 30-minutes follow-up. These findings suggest IHI between S1s is unaffected by acute, short-lasting muscle pain, despite the development of increased sensitivity to pressure in the unaffected APB muscle. PERSPECTIVE: IHI from the affected S1 (contralateral to the side of pain) to unaffected S1 is unaltered following the resolution of acute muscle pain. This finding suggests that IHI between S1s may not be relevant in the development of bilateral sensorimotor symptoms in unilateral pain conditions.

A comparison of gait stability between younger and older adults while head turning.

Head turning while walking may challenge stability by altering visual and vestibular information. Whether there are age-related changes that affect gait stability while head turning during walking remains unknown. The aim of the current study was to compare gait stability between younger and older adults immediately following a head turn while walking. Ten younger [mean (SD)] [23.4 (3.3) years] and ten older [68.8 (6.0) years] healthy adults walked on a treadmill at their preferred gait velocity and performed head turns by responding to a visual cue. The margin of stability (MoS) in the mediolateral (MoSML), anterior (MoSA) and posterior (MoSP) directions, foot placement (mean step length and width) and rotation of the head, trunk and pelvis were calculated for the four steps immediately following a cue to head turn and compared to walking only. Older adults increased their MoSML and younger adults increased their MoSP immediately following a head turn. However, older adults had a significantly greater MoSP than younger adults during this time. Older adults also had greater pelvic rotation velocity and a trend towards smaller head-on-trunk rotation compared to younger adults. Age does not compromise the stability of healthy older compared to younger adults immediately following or when completing a head turn. However, older adults may use a different motor strategy to perform a head turn to limit isolated movement of the head and the effects of a changing sensory frame of reference.

Medial Gastrocnemius Muscle Activity during Single-Leg Hopping to Exhaustion.

This study described changes in leg muscle activation characteristics during exhaustive single-leg hopping. Twenty-seven healthy men performed trials (132 hops/min) to exhaustion, without a target height, to a target height with visual feedback and target height with tactile feedback. Mean muscle activation amplitude of the medial gastrocnemius (MG) decreased during the anticipatory period while duration of MG activity was maintained when hopping to a target height and contrasted the changes during hopping without a target height. Changes to MG activity were specific to whether the hopping height had been maintained or not. Changes during the anticipatory period of MG activity, indicative of adaptation in descending motor pathways, implicate utility of a motor learning strategy to allow completion of an exhaustive task.

Measuring Vertical Stiffness in Sport With Accelerometers: Exercise Caution!

Eggers, TM, Massard, TI, Clothier, PJ, and Lovell, R. Measuring vertical stiffness in sport with accelerometers: Exercise caution! J Strength Cond Res 32(7): 1919-1922, 2018-This study aimed to determine the measurement accuracy of triaxial accelerometers, to determine vertical stiffness (Kvert) during overground running, and to examine the influence of device location. Seventeen healthy adults wore 2 triaxial accelerometers (positioned between scapulae and at lumbar spine) during a 2-minute continuous 20-m shuttle run (12 km·h), which was repeated 7 days later. Accelerometer-derived Kvert data were compared with that calculated from corresponding force-plate ground contacts (criterion measure). Moderate correlations (r = 0.65-0.66) between the accelerometer and criterion measure were identified, irrespective of unit location. However, accelerometer-determined Kvert had questionable reliability in both positions (intraclass correlation coefficient = 0.70-0.71). These results suggest caution be taken when using accelerometer-derived Kvert during overground running.

A Comparison of Vertical Stiffness Values Calculated from Different Measures of Center of Mass Displacement in Single-Leg Hopping.

This study assessed the agreement between Kvert calculated from 4 different methods of estimating vertical displacement of the center of mass (COM) during single-leg hopping. Healthy participants (N = 38) completed a 10-s single-leg hopping effort on a force plate, with 3D motion of the lower limb, pelvis, and trunk captured. Derived variables were calculated for a total of 753 hop cycles using 4 methods, including: double integration of the vertical ground reaction force, law of falling bodies, a marker cluster on the sacrum, and a segmental analysis method. Bland-Altman plots demonstrated that Kvert calculated using segmental analysis and double integration methods have a relatively small bias (0.93 kN⋅m-1) and 95% limits of agreement (-1.89 to 3.75 kN⋅m-1). In contrast, a greater bias was revealed between sacral marker cluster and segmental analysis (-2.32 kN⋅m-1), sacral marker cluster and double integration (-3.25 kN⋅m-1), and the law of falling bodies compared with all methods (17.26-20.52 kN⋅m-1). These findings suggest the segmental analysis and double integration methods can be used interchangeably for the calculation of Kvert during single-leg hopping. The authors propose the segmental analysis method to be considered the gold standard for the calculation of Kvert during single-leg, on-the-spot hopping.

Adaptation of lower limb movement patterns when maintaining performance in the presence of muscle fatigue.

Adaptations in lower limb movement patterns were examined when performance was maintained during a fatiguing repetitive loading task. Forty recreationally active male and female participants performed single-leg hopping to volitional exhaustion at 2.2Hz to a submaximal height. Spatio-temporal characteristics, mechanical characteristics and variability of the knee-ankle and hip-knee joint couplings were determined at 20% increments during the duration of the hopping task. Variability of the knee-ankle and hip-knee couplings in the flexion/extension axis significantly increased during the loading and propulsion phases during the hopping task (p<0.05). Performance (vertical stiffness, hopping frequency and height) did not change significantly during the task (p>0.05), however foot contact time increased progressively during this task (p<0.05) and maximum hop height significantly decreased after the task (p<0.05). The observed increase in variability between adjoining lower limb segments demonstrated the ability of the neuromotor system to adapt and maintain performance even with the onset of fatigue. This finding highlights that during the performance of a rapid and repetitive loading activity, performance can be preserved when there is variability in the neuromotor system.

Does providing real-time augmented feedback affect the performance of repeated lower limb loading to exhaustion?

INTRODUCTION: This study aimed to determine whether real-time augmented feedback influenced performance of single-leg hopping to volitional exhaustion. METHODS: Twenty-seven healthy, male participants performed single-leg hopping (2.2 Hz) with (visual and tactile feedback for a target hop height) or without feedback on a force plate. Repeated measures ANOVA were used to determine differences in vertical stiffness (k), duration of flight (tf) and loading (tl) and vertical height displacement during flight (zf) and loading (zl). A Friedman 2-way ANOVA was performed to compare the percentage of trials between conditions that were maintained at 2.2 Hz ± 5%. Correlations were performed to determine if the effects were similar when providing tactile or visual feedback synchronously with the audible cue. RESULTS: Augmented feedback resulted in maintenance of the tf, zf and zl between the start and end of the trials compared to hopping with no feedback (p<0.01). With or without feedback there was no change in tl and k from start to end. Without feedback, 21 of 27 participants maintained >70% of total hops at 2.2 ± 5% Hz and this was significantly lower (p=0.01) with tactile (13/27) and visual (15/27) feedback. There was a strong correlation between tactile and visual feedback for duration of hopping cycle (Spearman's r=0.74, p ≤ 0.01). CONCLUSION: Feedback was detrimental to being able to maintain hopping cadence in some participants while other participants were able to achieve the cadence and target hop height. This indicates variability in the ability to use real-time augmented feedback effectively.

The reliability of determining the onset of medial gastrocnemius muscle activity during a stretch-shorten-cycle action.

The instant at which a muscle increases its level of activity from baseline represents the onset of muscle activity. Accurate identification of muscle onset allows determination of temporal and amplitude characteristics of the surface electromyography (sEMG) signal. This investigation determined the intra- and inter-tester reliability for determining the onset of medial gastrocnemius (MG) activity using visual and automated methods. One hundred hop cycles, performed at 2.2Hz, were selected from sEMG recordings (bandpass filtered 50-500Hz and full wave rectified) of ten participants who performed three trials of single-leg hopping. The onset of MG muscle activity was identified by 3 separate investigators on two separate occasions and an automated method (10% of the peak activation amplitude). The duration of the anticipatory period, from muscle onset to initial ground contact, was then determined. Intra-tester (ICC from 0.72 to 0.95) and inter-tester reliability (ICC from 0.70 to 0.88) were high as was comparison to the automated method (ICC=0.90). These findings indicate that visual onset detection was highly reproducible between testing sessions, independent investigators and comparable to an automated method. These methods may be used reliably to determine the onset of MG muscle activity during a stretch-shorten-cycle muscle action.