Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls.

BACKGROUND: Maximum oxygen uptake is an established measurement of diagnosing chronic heart failure and underlies various central and peripheral factors. However, central and peripheral factors are little investigated, because they are usually measured invasively. The aim of this study was to compare non-invasively measured central and peripheral factors of oxygen uptake between patients with chronic heart failure and healthy controls. METHODS: Ten male patients with heart failure with reduced ejection fraction (62 ± 4 years; body mass index: 27.7 ± 1.8 kg/m2; ejection fraction: 30 ± 4%) and ten male healthy controls (59 ± 3 years; body mass index: 27.7 ± 1.3 kg/m2) were tested for blood pressure, heart rate, stroke volume, cardiac output, and cardiac power output (central factors) as well as muscle oxygen saturation of the vastus lateralis and biceps brachii muscle (peripheral factors) during an incremental cycling test. Stroke volume and muscle oxygen saturation were non-invasively measured by a bioreactance analysis and near-infrared spectroscopy, respectively. Additionally, a maximum isometric strength test of the knee extensors was conducted. Magnitude-based inferences were computed for statistical analyses. RESULTS: Patients had a likely to most likely lower oxygen uptake, mean arterial pressure, and heart rate at maximum load as well as very likely lower isometric peak torque. Contrary, patients had a possibly to likely higher stroke volume and muscle oxygen saturation of the vastus lateralis muscle at maximum load. Differences in cardiac output, cardiac power output, and muscle oxygen saturation of the biceps brachii muscle at maximum load were unclear. CONCLUSIONS: Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls. Therefore, it is promising to measure both types of factors in patients with chronic heart failure to optimize the diagnosis and therapy.

Validity of a Local Positioning System during Outdoor and Indoor Conditions for Team Sports.

This study aimed to compare the validity of a local positioning system (LPS) during outdoor and indoor conditions for team sports. The impact of different filtering techniques was also investigated. Five male team sport athletes (age: 27 ± 2 years; maximum oxygen uptake: 48.4 ± 5.1 mL/min/kg) performed 10 trials on a team sport-specific circuit on an artificial turf and in a sports hall. During the circuit, athletes wore two devices of a recent 20-Hz LPS. From the reported raw and differently filtered velocity data, distances covered during different walking, jogging, and sprinting sections within the circuit were computed for which the circuit was equipped with double-light timing gates as criterion measures. The validity was determined by comparing the known and measured distances via the relative typical error of estimate (TEE). The LPS validity for measuring distances covered was good to moderate during both environments (TEE: 0.9-7.1%), whereby the outdoor validity (TEE: 0.9-6.4%) was superior than indoor validity (TEE: 1.2-7.1%). During both environments, validity outcomes of an unknown manufacturer filter were superior (TEE: 0.9-6.2%) compared to those of a standard Butterworth filter (TEE: 0.9-6.4%) and to unprocessed raw data (TEE: 1.0-7.1%). Our findings show that the evaluated LPS can be considered as a good to moderately valid tracking technology to assess running-based movement patterns in team sports during outdoor and indoor conditions. However, outdoor was superior to indoor validity, and also impacted by the applied filtering technique. Our outcomes should be considered for practical purposes like match and training analyses in team sport environments.

Sex Differences in Physical Capacities of German Bundesliga Soccer Players.

Cardoso de Araújo, M, Baumgart, C, Jansen, CT, Freiwald, J, and Hoppe, MW. Sex differences in physical capacities of German Bundesliga soccer players. J Strength Cond Res 34(8): 2329-2337, 2020-Sex differences in physical capacities of elite soccer players have received limited attention. Therefore, this study investigated sex differences in linear and nonlinear sprint, squat and countermovement jump, core endurance, as well as incremental and intermittent endurance capacities in German Bundesliga soccer players. A total of 76 field players (29 women) were tested for the mentioned anaerobic- and aerobic-related physical capacities in a noninterventional cross-sectional design. The largest sex differences were evident in the explosive- and intermittent endurance-related capacities, with women presenting largely to extremely largely lower values in sprints, jumps, and intermittent endurance (effect size [ES] ≥1.77, p < 0.01). The differences in the total core endurance, running velocity at 2 and 4 mmol·L capillary blood lactate (v2 and v4), maximal heart rate (HR) (ES ≤ 0.72, p ≥ 0.06), and distance covered during the incremental endurance test (ES = 1.09, p = 0.01) were trivially to moderately lower for women. However, women had small to moderately higher ventral and dorsal core endurance (ES ≤ 0.69, p ≥ 0.07) and largely higher relative HR at the lactate thresholds (ES ≥ 1.54, p < 0.01). The individual data of female players showed more variability. Some individual data of women overlapped those of men, most evident in the total core endurance and v2. The findings indicate that there are sex differences in physical capacities according to the underlying amount of anaerobic and aerobic energy supply. The sex specificities should be considered to optimize training and testing procedures for soccer players.

Different Effects of Foam Rolling on Passive Tissue Stiffness in Experienced and Nonexperienced Athletes.

CONTEXT: Foam rolling (FR) has been developed into a popular intervention and has been established in various sports disciplines. However, its effects on target tissue, including changes in stiffness properties, are still poorly understood. OBJECTIVE: To investigate muscle-specific and connective tissue-specific responses after FR in recreational athletes with different FR experience. DESIGN: Case series. SETTING: Laboratory environment. PARTICIPANTS: The study was conducted with 40 participants, consisting of 20 experienced (EA) and 20 nonexperienced athletes (NEA). INTERVENTION: The FR intervention included 5 trials per 45 seconds of FR of the lateral thigh in the sagittal plane with 20 seconds of rest between each trial. MAIN OUTCOME MEASURES: Acoustic radiation force impulse elastosonography values, represented as shear wave velocity, were obtained under resting conditions (t0) and several times after FR exercise (0 min [t1], 30 min [t2], 6 h [t3], and 24 h [t4]). Data were assessed in superficial and deep muscle (vastus lateralis muscle; vastus intermedius muscle) and in connective tissue (iliotibial band). RESULTS: In EA, tissue stiffness of the iliotibial band revealed a significant decrease of 13.2% at t1 (P ≤ .01) and 12.1% at t3 (P = .02). In NEA, a 6.2% increase of stiffness was found at t1, which was not significantly different to baseline (P = .16). For both groups, no significant iliotibial band stiffness changes were found at further time points. Also, regarding muscle stiffness, no significant changes were detected at any time for EA and NEA (P > .05). CONCLUSIONS: This study demonstrates a significant short-term decrease of connective tissue stiffness in EA, which may have an impact on the biomechanical output of the connective tissue. Thus, FR effects on tissue stiffness depend on the athletes' experience in FR, and existing studies have to be interpreted cautiously in the context of the enrolled participants.

Contrasts in intermittent endurance performance and heart rate response between female and male soccer players of different playing levels.

This study compared intermittent endurance performance and heart rate (HR) response, as well as their relationship, by sex and competitive level in soccer. A total of 68 outfield (18 elite and 16 sub-elite female, 17 elite and 17 sub-elite male) soccer players performed the Interval Shuttle Run Test (ISRT) with monitored HR. Sex and level effects were evaluated by two-way analysis of variance (ANOVA) and the relationships between parameters using Pearson's correlation coefficient. Female players presented lower performance (effect sizes [ES]: 2.12-4.71, p < 0.01) and higher submaximal HR during the ISRT (ES: 1.66-3.40, p < 0.01). Elite players showed higher performance and reduced submaximal HR compared with their sub-elite counterparts, with a large level effect only evident between the female groups (ES: 1.22-1.56, p < 0.01). The maximum and the HR recovery 1 min after the ISRT (HRR) did not differ among all groups (ES: 0.01-0.51, p ≥ 0.18). The HRR was slightly related to the test performance for all groups (r = 0.20, p = 0.12). Large to very large negative correlations were verified between HR at 6 and 9 min during the ISRT and the test performance for each group (r = -0.54 to -0.84, p ≤ 0.04). However, 16 (3 elite and 13 sub-elite) female players did not reach the 9th minute of the test. The gap between competitive levels among female soccer players is greater than that observed for male players in intermittent endurance performance and submaximal HR response. The HRR had only a minor impact on performance and was influenced neither by sex nor by level.

Intramuscular Perfusion Response in Delayed Onset Muscle Soreness (DOMS): A Quantitative Analysis with Contrast-Enhanced Ultrasound (CEUS).

The purpose of this study was to analyse intramuscular perfusion response in ultrastructural muscle lesions, by applying contrast-enhanced ultrasound (CEUS) to a delayed onset muscle soreness (DOMS) model. Results of this analysis were compared to high-resolution 3 Tesla MRI T2-weighted sequences. 14 healthy participants were recruited. Average perfusion parameters, represented as Peak enhancement (contrast agent inflow) and wash-in area under curve (WiAUC) of the gastrocnemius (GM) and soleus muscle (SM) were assessed before (baseline) and 60 h after inducing DOMS by eccentric exercise. Additionally, conventional ultrasound, high-resolution 3T MRI, creatine kinase level, range of motion (ROM) of the ankle joint, calf circumference and muscle soreness data were collected. Perfusion quantification revealed a statistically significant increase of intramuscular perfusion, corresponding to an increase in peak enhancement of 129.6% (p=0.0031) and in WiAUC of 115.2% (p=0.0107) in the gastrocnemius muscle at post-intervention. At follow-up, the MRI investigations showed intramuscular oedema for GM in all participants corresponding to a significant rise in T2 signal intensity (p=0.001) and in T2 time value (p=0.005). CEUS seems to be able to detect intramuscular perfusion changes and therefore may contribute to gaining deeper insight into the histopathology, inflammatory reactions and regeneration processes of ultrastructural muscle lesions.

Do ground reaction forces during unilateral and bilateral movements exhibit compensation strategies following ACL reconstruction?

PURPOSE: The aims of the study were (1) to evaluate the leg asymmetry assessed with ground reaction forces (GRFs) during unilateral and bilateral movements of different knee loads in anterior cruciate ligament (ACL) reconstructed patients and (2) to investigate differences in leg asymmetry depending on the International Knee Documentation Committee Subjective Form (IKDC) in order to identify potential compensation strategies. METHODS: The knee function of 50 ACL reconstructed (patella tendon) patients was examined at 31 ± 7 months after the surgery. GRFs were quantified during the sit-to-stand and stand-to-sit test, the step-up and step-down test, and the two- and one-leg vertical jump. Further, the IKDC score, the anterior-posterior knee laxity, and the concentric torque of the quadriceps and hamstring muscles were evaluated. RESULTS: Differences between the operated and non-operated leg were found in the knee laxity, the quadriceps torque, and GRFs. The patients with low IKDC scores demonstrated greater leg asymmetries in GRFs compared to the patients with high IKDC scores. CONCLUSIONS: ACL reconstructed patients showed GRF asymmetries during unilateral and bilateral movements of different knee loads. Three compensation strategies were found in patients with low subjective knee function: (1) a reduced eccentric load, (2) an inter-limb compensation during bilateral movements, and (3) the avoidance of high vertical impact forces. These compensation strategies may be indicative of a protective adaptation to avoid excessive ACL strain. GRF measurements are practicable and efficient tools to identify individual compensation strategies during early rehabilitation.

Effects of Static Stretching and Playing Soccer on Knee Laxity.

OBJECTIVE: This study investigated exercise-induced effects of static stretching and playing soccer on anterior tibial translation (ATT) of the knee joint. DESIGN: Randomized controlled trial. SETTING: University biomechanics laboratory. PARTICIPANTS: Thirty-one athletes were randomly assigned into a stretching (26.9 ± 6.2 years, 1.77 ± 0.09 m, 67.9 ± 10.7 kg) and a control group (27.9 ± 7.4 years, 1.75 ± 0.08 m, 72.0 ± 14.9 kg). Thirty-one amateur soccer players in an additional soccer group (25.1 ± 5.6 years, 1.74 ± 0.10 m, 71.8 ± 14.8 kg). All participants had no history of knee injury requiring surgery and any previous knee ligament or cartilage injury. INTERVENTIONS: The stretching group performed 4 different static stretching exercises with a duration of 2 × 20 seconds interspersed with breaks of 10 seconds. The soccer group completed a 90-minute soccer-specific training program. The control group did not perform any physical activity for approximately 30 minutes. MAIN OUTCOME MEASURES: Anterior tibial translation was measured with the KT-1000 knee arthrometer at forces of 67 N, 89 N, and maximal manual force (Max) before and after the intervention. RESULTS: There was a significant increase in ATT after static stretching and playing soccer at all applied forces. Maximal manual testing revealed a mean increase of ATT after static stretching of 2.1 ± 1.6 mm (P < 0.0005) and after playing soccer of 1.0 ± 1.5 mm (P = 0.001). The ATT increase after static stretching at 67 and 89 N is significantly higher than in controls. At maximum manual testing, significant differences were evident between all groups. CONCLUSIONS: Static stretching and playing soccer increase ATT and may consequently influence mechanical factors of the anterior cruciate ligament. The ATT increase after static stretching was greater than after playing soccer. CLINICAL RELEVANCE: The observed increase in ATT after static stretching and playing soccer may be associated with changes in kinesthetic perception and sensorimotor control, activation of muscles, joint stability, overall performance, and higher injury risk.

Running activity profile of adolescent tennis players during match play.

The aims of this study were (1) to assess the running activities of adolescent tennis players during match play with respect to velocity, acceleration, and deceleration; (2) to characterize changes in these activities during the course of a match; and (3) to identify potential differences between winners and losers. Twenty well-trained adolescent male athletes (13 ± 1 y) played one simulated match each (giving a total of 10 matches), during which distances covered at different velocity categories (0 to < 1, 1 to < 2, 2 to < 3, 3 to < 4, and ≥ 4 m·s(-1)) and number of running activities involving high velocity (≥ 3 m·s(-1)), acceleration (≥ 2 m·s(-2)), and deceleration (≤ -2 m·s(-2)) were monitored using a global positioning system (10 Hz). Heart rate was also assessed. The total match time, total distance covered, peak velocity, and mean heart rate were 81.2 ± 14.6 min, 3362 ± 869 m, 4.4 ± 0.8 m·s(-1), and 159 ± 12 beats·min(-1), respectively. Running activities involving high acceleration (0.6 ± 0.2 n·min(-1)) or deceleration (0.6 ± 0.2 n·min(-1)) were three times as frequent as those involving high velocity (0.2 ± 0.1 n·min(-1)). No change in the pattern of running activities (P ≥ .13, d ≤ 0.39) and no differences between winners and losers (P ≥ .22, d ≤ 0.53) were evident during match play. We conclude that training of well-trained adolescent male tennis players need not focus on further development of their running abilities, since this physical component of multifactorial tennis performance does not change during the course of a match and does not differ between the winners and losers.

Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies: support of pioneer work using invasive or non-continuous measures.

Introduction: It is known that maximum oxygen uptake depends on age, sex, endurance capacity, and chronic heart failure. However, due to the required invasive or often applied non-continuous approaches, less is known on underlying central and peripheral factors. Thus, this study aimed to investigate the effects of age, sex, endurance capacity, and chronic heart failure on non-invasively and continuously measured central and peripheral factors of oxygen uptake. Methods: 15 male children (11 ± 1 years), 15 male (24 ± 3 years) and 14 female recreationally active adults (23 ± 2 years), 12 male highly trained endurance athletes (24 ± 3 years), and 10 male elders (59 ± 6 years) and 10 chronic heart failure patients (62 ± 7 years) were tested during a cardiopulmonary exercise test on a cycling ergometer until exhaustion for: blood pressure, heart rate, stroke volume, cardiac output, cardiac power output, vastus lateralis muscle oxygen saturation, and (calculated) arterio-venous oxygen difference. For the non-invasive and continuous measurement of stroke volume and muscle oxygen saturation, bioreactance analysis and near-infrared spectroscopy were used, respectively. A two-factor repeated measure ANOVA and partial eta-squared effect sizes (ηp2) were applied for statistical analyses at rest, 80, and 100% of oxygen uptake. Results: For the age effect, there were statistically significant group differences for all factors (p ≤ .033; ηp2≥.169). Concerning sex, there were group differences for all factors (p ≤ .010; ηp2≥.223), except diastolic blood pressure and heart rate (p ≥ .698; ηp2≤.006). For the effect of endurance capacity, there were no group differences for any of the factors (p ≥ .065; ηp2≤.129). Regarding chronic heart failure, there were group differences for the heart rate and arterio-venous oxygen difference (p ≤ .037; ηp2≥.220). Discussion: Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies. Since most of our findings support pioneer work using invasive or non-continuous measures, the validity of our applied technologies is indirectly confirmed. Our outcomes allow direct comparison between different groups serving as reference data and framework for subsequent studies in sport science and medicine aiming to optimise diagnostics and interventions in athletes and patients.

An International Multidisciplinary Delphi-Based Consensus on Heat Therapy in Musculoskeletal Pain.

INTRODUCTION: Musculoskeletal pain (MP) is prevalent in our society, having a strong negative impact on physical and psychosocial quality of life. Heat therapy (HT) has been frequently described as a treatment strategy for musculoskeletal pain, but scientific evidence is still poor. The aim of the present Delphi method study is to gather a consensus among European experts on the role of HT in MP. METHODS: To address this topic, a list of 54 statements was developed, concerning mechanism of action of heat on muscle, types of MP eligible for heat treatment, efficacy of HT, time and modalities of treatment, maximizing compliance to HT, safety (based on heat wraps), wrong beliefs and common errors in the prescription of HT and the role of HT in preventing muscular damage in athletes. The survey was distributed to 116 European experts, using a 5-point Likert scale to express agreement or disagreement with the statements; 66% concordance with the statements was needed to define a consensus. RESULTS: Consensus was reached on 78% of statements. There was a strong consensus on the mechanism of action of heat on muscle, the indication in chronic MP, its effectiveness as part of a multimodal approach to MP and the safety and tolerability of superficial heat therapy. A low-level of consensus was obtained on the role of heat in preventing muscular damage and in acute MP. CONCLUSION: This Delphi consensus recognizes the role of HT mostly in chronic MP and highlights the need for stronger scientific evidence to regulate the use of this therapy in clinical practice.

Effects of Different Orthoses on Neuromuscular Activity of Superficial and Deep Shoulder Muscles during Activities of Daily Living and Physiotherapeutic Exercises in Healthy Participants.

BACKGROUND: This study aimed to investigate the effects of different shoulder orthoses on the neuromuscular activity of superficial and deep shoulder muscles during activities of daily living (ADL) and physiotherapeutic exercises. METHODS: Ten participants with healthy shoulders (31 ± 3 years, 23.1 ± 3.8 kg/m2) were randomized to receive a "shoulder sling", an "abduction pillow" and a "variably adjustable orthosis" on the dominant side. With each orthosis, they completed seven ADL with and four physiotherapeutic exercises without wearing the orthoses. An electromyographic system was used to record the neuromuscular activity of three superficial (trapezius, deltoid, pectoralis major) and two deep shoulder muscles (infraspinatus, supraspinatus) using surface and intramuscular fine-wire electrodes. RESULTS: The neuromuscular activity differs between the orthoses during ADL (p ≤ 0.045), whereby the "variably adjustable orthosis" mostly showed the highest activation levels associated with the worst subjective wearing comfort rated on a visual analog scale. In addition, differences exist between the physiotherapeutic exercises (p ≤ 0.006) demonstrating the highest activations of the infra- and supraspinatus muscles for assistive elevation and wipe across a table, middle for pendulum and lowest for continuous passive motion exercises. CONCLUSIONS: The neuromuscular activity of superficial and deep shoulder muscles differs between the orthoses during ADL and also between the physiotherapeutic exercises.

Effects of Hip Flexion on Knee Extension and Flexion Isokinetic Angle-Specific Torques and HQ-Ratios.

BACKGROUND AND METHODS: During isokinetic knee strength testing, the knee flexion angles that correspond to the measured torque values are rarely considered. Additionally, the hip flexion angle during seated testing diverges from that in the majority of daily life and sporting activities. Limited information concerning the influence of hip angle, muscle contraction mode, and velocity on the isokinetic knee strength over the entire range of motion (ROM) is available. Twenty recreational athletes (10 females, 10 males; 23.3 ± 3.2 years; 72.1 ± 16.5 kg; 1.78 ± 0.07 m) were tested for isokinetic knee flexion and extension at 10° and 90° hip flexion with the following conditions: (i) concentric at 60°/s, (ii) concentric at 180°/s, and (iii) eccentric at 60°/s. The effects of hip angle, contraction mode, and velocity on angle-specific torques and HQ-ratios as well as conventional parameters (peak torques, angles at peak torque, and HQ-ratios) were analyzed using statistical parametric mapping and parametric ANOVAs, respectively. RESULTS: Generally, the angle-specific and conventional torques and HQ-ratios were lower in the extended hip compared to a flexed hip joint. Thereby, in comparison to the knee extension, the torque values decreased to a greater extent during knee flexion but not consistent over the entire ROM. The torque values were greater at the lower velocity and eccentric mode, but the influence of the velocity and contraction mode were lower at shorter and greater muscle lengths, respectively. CONCLUSIONS: Isokinetic knee strength is influenced by the hip flexion angle. Therefore, a seated position during testing and training is questionable, because the hip joint is rarely flexed at 90° during daily life and sporting activities. Maximum knee strength is lower in supine position, which should be considered for training and testing. The angle-specific effects cannot be mirrored by the conventional parameters. Therefore, angle-specific analyses are recommended to obtain supplemental information and consequently to improve knee strength testing.

Rehabilitation after a Complete Avulsion of the Proximal Rectus Femoris Muscle: Considerations from a Case Report.

BACKGROUND: A complete avulsion of the proximal rectus femoris muscle is a rare but severity injury. There is a lack of substantial information for its operative treatment and rehabilitation; in particular there is a lack of biomechanical data to evaluate long-term outcomes. CASE PRESENTATION: The case report presents the injury mechanism and surgical treatment of a complete avulsion of the proximal rectus femoris muscle in a 41-year-old recreational endurance athlete. Moreover, within a one-year follow-up period, different biomechanical tests were performed to get more functional insights into changes in neuromuscular control, structural muscle characteristics, and endurance performance. Within the first month post-surgery, an almost total neuromuscular inhibition of the rectus femoris muscle was present. A stepwise reduction in inter-limb compensations was observable (e.g., in crank torque during cycling) during the rehabilitation. Muscular intra-limb compensations were shown at six months post-surgery and even one year after surgery, which were also represented in the long-term adaption of the muscle characteristics and leg volumes. A changed motor control strategy was shown by asymmetric muscle activation patterns during ergometer cycling, while the power output was almost symmetric. During rehabilitation, there might be a benefit to normalizing neuromuscular muscle activation in ergometer cycling using higher loads. CONCLUSIONS: While the endurance performance recovered after six months, asymmetries in neuromuscular control and structural muscle characteristics indicate the long-term presence of inter- and intra-limb compensation strategies.

Expert Consensus on the Contraindications and Cautions of Foam Rolling-An International Delphi Study.

BACKGROUND: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts' consensus on contraindications and cautions of foam rolling by means of a Delphi process. METHODS: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. RESULTS: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. DISCUSSION: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds.

A Role for Superficial Heat Therapy in the Management of Non-Specific, Mild-to-Moderate Low Back Pain in Current Clinical Practice: A Narrative Review.

Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient's quality of life, limits their daily living activities, and reduces their work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of superficial heat therapy in the management of non-specific mild-to-moderate LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LBP), and finally review the published evidence regarding the impact of superficial heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is relevant for the management of non-specific mild or moderate low back pain in current clinical practice.

Quantifiable Contrast-Enhanced Ultrasound Explores the Role of Protection, Rest, Ice (Cryotherapy), Compression and Elevation (PRICE) Therapy on Microvascular Blood Flow.

The aim of this randomized controlled laboratory study was to evaluate the role of standardized protection, rest, ice (cryotherapy), compression and elevation (PRICE) therapy on microvascular blood flow in human skeletal muscle. Quantifiable contrast-enhanced ultrasound was used to analyze intramuscular tissue perfusion (ITP) of the rectus femoris (RF) and vastus intermedius (VI) muscles in 20 healthy athletes who were randomly assigned to PRICE or control groups. Baseline perfusion measurements (resting conditions, T0) were compared with cycling exercise (T1), intervention (PRICE or control, T2) and follow-up at 60 min post-intervention (T3). The 20 min PRICE intervention included rest, cryotherapy (3°C), compression (35 mm Hg) and elevation. After intervention, PRICE demonstrated a decrease of ITP in VI (-47%, p = 0.01) and RF (-50%, p = 0.037) muscles. At T3, an ongoing decreased ITP for the RF (p = 0.003) and no significant changes for the VI were observed. In contrast, the control group showed an increased ITP at T2 and no significant differences at T3. PRICE applied after exercise led to a down-regulation of ITP, and the termination of PRICE does not appear to be associated with a reactive hyperemia for at least 60 min after treatment.

Contrary to endurance, power associated capacities differ between different aged and starting-nonstarting elite junior soccer players.

This study aimed to investigate differences in anthropometric characteristics and physical capacities (1) between under (U) 17, 19, and 21 years old elite junior soccer players, and also (2) between starting and nonstarting players within each age group. Ninety-two male elite German junior field players were tested for height, mass, fat, and fat-free mass as well as aerobic endurance, squat (SJ) and counter movement jump (CMJ), linear sprint, core strength-endurance, and one repetition maximum (1RM) bench press performance. According to their age and competitive match playing times, the players were divided into the mentioned different groups. Magnitude-based inferences and effect sizes (ES) were computed for statistical analyses. The fat-free mass, SJ and CMJ, 1RM bench press, and linear sprinting performances increased likely to most likely from U17 to U21 players (ES: moderate to large), whereas the body fat, core strength-endurance, and aerobic endurance performances remain constant. The fat-free mass, 1RM bench press, and linear sprinting performances were likely to most likely higher in U21 starting compared to nonstarting players (ES: moderate to large). Our study shows that contrary to endurance, power associated capacities differ between different aged and starting-nonstarting elite junior soccer players. This outcome should be considered for training, testing, and talent selection procedures in elite junior soccer players.

Low-intensity blood flow restriction calf muscle training leads to similar functional and structural adaptations than conventional low-load strength training: A randomized controlled trial.

The purpose of this study was to investigate whether a six-week, twice weekly resistance training (4 sets at 30% 1-RM until failure) with practical blood flow restriction (BFR) using 7cm wide cuffs with a twist lock placed below the patella is superior to training without BFR (NoBFR) concerning muscle mass and strength gains in calf muscles. A two-group (BFR n = 12, mean age 27.33 (7.0) years, training experience 7.3 (7.0) years; NoBFR n = 9, mean age 28.9 (7.4) years, training experience 7.1 (6.6) years) randomized matched pair design based on initial 1-RM was used to assess the effects on structural and functional adaptations in healthy males (Perometer calf volume [CV], gastrocnemius muscle thickness using ultrasound [MT], 7-maximal hopping test for leg stiffness [LS], 1-RM smith machine calf raise [1-RM], and visual analogue scale as a measure of pain intensity [VAS]). The mean number of repetitions completed per training session across the intervention period was higher in the NoBFR group compared to the BFR group (70 (16) vs. 52 (9), p = 0.002). VAS measured during the first session increased similarly in both groups from first to fourth set (p<0.001). No group effects or time×group interactions were found for CV, MT, LS, and 1-RM. However, there were significant time effects for MT (BFR +0.07 cm; NoBFR +0.04; p = 0.008), and 1-RM (BFR +40 kg; NoBFR +34 kg; p<0.001). LS and CV remained unchanged through training. VAS in both groups were similar, and BFR and NoBFR were equally effective for increasing 1-RM and MT in trained males. However, BFR was more time efficient, due to lesser repetition per training session.

Effects of passive, active, and mixed playing strategies on external and internal loads in female tennis players.

This study aimed to investigate the effects of different playing strategies on external and internal loads in female tennis players during match play. Also, the underlying effects on the technical-tactical actions and activity profiles were examined. Twelve well-trained female players (age: 25±5 years; maximum oxygen uptake: 40.9±4.3 ml/kg/min) played points against an opponent of similar ability outdoors on red-clay courts. The players played points over five playing conditions. Before each condition, the players were instructed to apply either a passive, an active, or their own playing strategy (free play) to succeed. The five conditions were played in a randomized order, whereas the condition with the own strategy was always played first and served as control. During play, the external and internal loads were investigated by 10 Hz global positioning system, 100 Hz inertial measurement unit, short-range telemetry, capillary blood, and visual analog scale procedures. A 25 Hz video camera was used to examine the technical-tactical actions and activity profiles. Compared to the control condition, the passive, active, and mixed playing strategy conditions induce up to large effects on the external loads (running distances with high acceleration and deceleration), up to moderate effects on the internal loads (energy expenditures spent with high metabolic power, lactate concentration, and rating of effort), and up to very large effects on the technical-tactical actions (number of ground strokes and errors) and activity profiles (strokes per rally, rally duration, work to rest ratio, and effective playing time). Our study shows that passive, active, and mixed playing strategies have an impact on the external and internal loads, technical-tactical actions, and activity profiles of female tennis players during match play. This finding should be considered for practical purposes like match analyses and training procedures in the tennis environment.