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Achilles tendinopathy (AT) is a debilitating injury in athletes, especially for those engaged in repetitive stretch-shortening cycle activities. Clinical risk factors are numerous, but it has been suggested that altered biomechanics might be associated with AT. No systematic review has been conducted investigating these biomechanical alterations in specifically athletic populations. Therefore, the aim of this systematic review was to compare the lower-limb biomechanics of athletes with AT to athletically matched asymptomatic controls. Databases were searched for relevant studies investigating biomechanics during gait activities and other motor tasks such as hopping, isolated strength tasks, and reflex responses. Inclusion criteria for studies were an AT diagnosis in at least one group, cross-sectional or prospective data, at least one outcome comparing biomechanical data between an AT and healthy group, and athletic populations. Studies were excluded if patients had Achilles tendon rupture/surgery, participants reported injuries other than AT, and when only within-subject data was available.. Effect sizes (Cohen's d) with 95% confidence intervals were calculated for relevant outcomes. The initial search yielded 4,442 studies. After screening, twenty studies (775 total participants) were synthesised, reporting on a wide range of biomechanical outcomes. Females were under-represented and patients in the AT group were three years older on average. Biomechanical alterations were identified in some studies during running, hopping, jumping, strength tasks and reflex activity. Equally, several biomechanical variables studied were not associated with AT in included studies, indicating a conflicting picture. Kinematics in AT patients appeared to be altered in the lower limb, potentially indicating a pattern of “medial collapse”. Muscular activity of the calf and hips was different between groups, whereby AT patients exhibited greater calf electromyographic amplitudes despite lower plantar flexor strength. Overall, dynamic maximal strength of the plantar flexors, and isometric strength of the hips might be reduced in the AT group. This systematic review reports on several biomechanical alterations in athletes with AT. With further research, these factors could potentially form treatment targets for clinicians, although clinical approaches should take other contributing health factors into account. The studies included were of low quality, and currently no solid conclusions can be drawn.
Background: The prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.
Objective: We aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.
Methods: Sixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.
Results: No statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p < 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p < 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p < 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p < 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p < 0.001; d = 1.28).
Conclusions: This study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.
Trunk loading and back pain
(2017)
An essential function of the trunk is the compensation of external forces and loads in order to guarantee stability. Stabilising the trunk during sudden, repetitive loading in everyday tasks, as well as during performance is important in order to protect against injury. Hence, reduced trunk stability is accepted as a risk factor for the development of back pain (BP). An altered activity pattern including extended response and activation times as well as increased co-contraction of the trunk muscles as well as a reduced range of motion and increased movement variability of the trunk are evident in back pain patients (BPP). These differences to healthy controls (H) have been evaluated primarily in quasi-static test situations involving isolated loading directly to the trunk. Nevertheless, transferability to everyday, dynamic situations is under debate. Therefore, the aim of this project is to analyse 3-dimensional motion and neuromuscular reflex activity of the trunk as response to dynamic trunk loading in healthy (H) and back pain patients (BPP).
A measurement tool was developed to assess trunk stability, consisting of dynamic test situations. During these tests, loading of the trunk is generated by the upper and lower limbs with and without additional perturbation. Therefore, lifting of objects and stumbling while walking are adequate represents. With the help of a 12-lead EMG, neuromuscular activity of the muscles encompassing the trunk was assessed. In addition, three-dimensional trunk motion was analysed using a newly developed multi-segmental trunk model. The set-up was checked for reproducibility as well as validity. Afterwards, the defined measurement set-up was applied to assess trunk stability in comparisons of healthy and back pain patients.
Clinically acceptable to excellent reliability could be shown for the methods (EMG/kinematics) used in the test situations. No changes in trunk motion pattern could be observed in healthy adults during continuous loading (lifting of objects) of different weights. In contrast, sudden loading of the trunk through perturbations to the lower limbs during walking led to an increased neuromuscular activity and ROM of the trunk. Moreover, BPP showed a delayed muscle response time and extended duration until maximum neuromuscular activity in response to sudden walking perturbations compared to healthy controls. In addition, a reduced lateral flexion of the trunk during perturbation could be shown in BPP.
It is concluded that perturbed gait seems suitable to provoke higher demands on trunk stability in adults. The altered neuromuscular and kinematic compensation pattern in back pain patients (BPP) can be interpreted as increased spine loading and reduced trunk stability in patients. Therefore, this novel assessment of trunk stability is suitable to identify deficits in BPP. Assignment of affected BPP to therapy interventions with focus on stabilisation of the trunk aiming to improve neuromuscular control in dynamic situations is implied. Hence, sensorimotor training (SMT) to enhance trunk stability and compensation of unexpected sudden loading should be preferred.
Die Ausprägung der Lateralität der Körperextremitäten steht in engem Zusammenhang mit der Hemisphärenspezialisierung des menschlichen Gehirns. Die Lateralität und die Dominanz einer Hemisphäre mit ihren Auswirkungen auf die Leistungsfähigkeit ist ein bislang unvollständig untersuchtes Phänomen im Sport. In der vorliegenden Arbeit soll daher die Bedeutung der Seitigkeitsausprägung im Rahmen sportlicher Bewegungsabläufe geprüft werden. Sowohl bei Messungen im "Freiwasser", als auch in der "Kanu–Gegenstromanlage" im Bereich des Kanurennsportes werden seit einigen Jahren sich in Qualität und Quantität unterscheidende Kraft–Zeit–Funktionen der linken und rechten Körperseite beobachtet, die zwar dokumentiert, aber bislang ungeprüft in ihrer Bedeutung als leistungsbeeinflussend angenommen werden. Im Zeitraum von Oktober 1997 bis Oktober 2000 wurden 275 Kajakfahrer und Canadierfahrer im Alter zwischen 11 und 20 Jahren zweimal jährlich (März und Oktober) mit einem umfangreichen trainings- und bewegungswissenschaftlichen sowie biomechanischen Instrumentarium untersucht. Die Athleten gehören zum Nachwuchs- und Anschlusskader des LKV Brandenburg. Schwerpunkt der Fragestellung ist der Zusammenhang von auftretenden Kraftdifferenzen zwischen der linken und rechten oberen Extremität und sportartspezifischen Leistungen unter Laborbedingungen und Feldbedingungen. Es wurden objektive Daten zu ausgewählten Kraftfähigkeiten der oberen Arm–Beuge–Schlinge an einem Kraftdiagnosegerät, Kraftverläufe am Messpaddel während Leistungsüberprüfungen im "Kanu–Gegenstromkanal" und im "Freiwasser" über 250 m und 2.000 m im Jahresverlauf erhoben. Die Ergebnisse zeigen einen Trend der im Altersverlauf ansteigenden Differenz der Mittelwertunterschiede in der Maximalkraft zwischen dem linken und rechten Arm. Bei bestehenden Maximalkraftdifferenzen zwischen linker und rechter oberer Extremität in der Längsschnittgruppe liegen die Leistungen mit dem rechten Arm deutlich über den Kraftleistungen des linken Arms und sind nicht zufällig. Mit steigendem Maximalkraftniveau nimmt überraschenderweise auch die Differenz der Maximalkraft zwischen der linken und rechten oberen Extremität trotz bilateralen Trainings zu. Die Ergebnisse der EMG–Analyse bestätigen, dass die Maximalkraft leistungsbestimmend für die Bootsleistungen ist. In den EMG–Signalverläufen werden die unterschiedlichen Belastungen der Labor– und Feldbedingungen mit individuellen Charakteristika nachgezeichnet. Deutlich unterscheiden sich die Kraftverläufe im "Freiwasser" gegenüber den Kraftverläufen in der "Kanu–Gegenstromanlage". Bei der vorliegenden Untersuchung handelt es sich um eine erste empirische Arbeit zur Auswirkung von Seitigkeitsunterschieden in zyklischen Sportarten auf der Expertiseebene. In der Untersuchung wurden methodische Verfahren eingesetzt, die dem derzeitigen Forschungsstand in der Trainings- und Bewegungswissenschaft entsprechen. Neben varianzanalytischen Verfahren der Auswertung zur Darstellung von Mittelwertunterschieden und Zusammenhänge prüfenden Verfahren wurden ebenso explorative EMG–Analysen angewandt. Die Ergebnisse aus dem Längsschnitt belegen bei ausschließlich rechtshändigen Probanden, dass die Schlussfolgerung von bevorzugter Extremität auf ein höheres Kraftniveau nicht eineindeutig ist. Zwischen den oberen Extremitäten bei Kanurennsportlern bestehen nicht nur zufällige Kraftunterschiede, trotz des bilateralen Trainings. Kontrovers diskutiert wird die Beziehung von bevorzugter Extremität und der Höhe der Kraftentfaltung. Im Alltagsverständnis wird häufig angenommen, dass ein höheres Maximalkraftniveau in der Extremität vorliegen muss, die auch die bevorzugte (z.B. Schreibhand) ist (WIRTH & LIPHARDT, 1999). Diese Eindeutigkeit konnte in der durchgeführten Untersuchung nicht bestätigt werden. Wie die Ergebnisse dieser Untersuchung deutlich zeigen, nimmt mit der höheren Maximalkraft aber auch die Differenz der Kraftleistungen zwischen dem linken und rechten Arm bei bilateral ausgerichtetem Training zu. FISCHER (1988; 1992) wies nach, dass sich ein Training auf der subdominanten Seite in einem kontralateralen Leistungstransfer auf der dominanten Seite positiv auswirkte. Erkenntnisse von KUHN (1986) und HOLLMANN & HETTINGER (2000) unterstützen nachhaltig die Ergebnisse. Die EMG–Ergebnisse zeigen die individuelle Reaktion auf die Belastungsanforderungen. Die elektromyographischen Daten beziehen sich auf den neuromuskulären Komplex. Somit sprechen hohe Amplitudenwerte einerseits für eine hohe Innervation der beteiligten motorischen Einheiten an der Bewegungsausführung und andererseits für einsetzende Ermüdungserscheinungen im Muskel. In Bezug auf die Ermüdung der oberen Extremitätenmuskeln der rechten und linken Seite beschreiben WILLIAMS, SHARMA & BILODEAU (2002) keine signifikanten Unterschiede zwischen der dominanten und nichtdominanten Handseite.