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Background and objectives: Drop jumps (DJs) are well-established exercise drills during plyometric training. Several sports are performed under unstable surface conditions (e.g., soccer, beach volleyball, gymnastics). To closely mimic sport-specific demands, plyometric training includes DJs on both stable and unstable surfaces. According to the mechanical properties of the unstable surface (e.g., thickness, stiffness), altered temporal, mechanical, and physiological demands have been reported from previous cross-sectional studies compared with stable conditions. However, given that the human body simultaneously interacts with various factors (e.g., drop height, footwear, gender) during DJs on unstable surfaces, the investigation of isolated effects of unstable surface conditions might not be sufficient for designing an effective and safe DJ stimulus. Instead, the combined investigation of different factors and their interaction with surface instability have to be taken into consideration. Therefore, the present doctoral thesis seeks to complement our knowledge by examining the main and interaction effects of surface instability, drop height, footwear, and gender on DJ performance, knee joint kinematics, and neuromuscular activation.
Methods: Healthy male and female physically active sports science students aged 19-26 years participated in the cross-sectional studies. Jump performance, sagittal and frontal plane knee joint kinematics, and leg muscle activity were measured during DJs on stable (i.e., firm force plate) and (highly) unstable surfaces (i.e., one or two AIREX® balance pads) from different drop heights (i.e., 20 cm, 40 cm, 60 cm) or under multiple footwear conditions (i.e., barefoot, minimal shoes, cushioned shoes).
Results: Findings revealed that surface instability caused a DJ performance decline, reduced sagittal plane knee joint kinematics, and lower leg muscle activity during DJs. Sagittal plane knee joint kinematics as well as leg muscle activity decreased even more with increasing surface instability (i.e., two vs. one AIREX® balance pads). Higher (60 cm) compared to lower drop heights (≤ 40 cm) resulted in a DJ performance decline. In addition, increased sagittal plane knee joint kinematics as well as higher shank muscle activity were found during DJs from higher (60 cm) compared to lower drop heights (≤ 40 cm). Footwear properties almost exclusively affected frontal plane knee joint kinematics, indicating larger maximum knee valgus angles when performing DJs barefoot compared to shod. Between the different shoe properties (i.e., minimal vs. cushioned shoes), no significant differences during DJs were found at all. Only a few significant surface-drop height as well as surface-footwear interactions were found during DJs. They mainly indicated that drop height- and footwear-related effects are more pronounced during DJs on unstable compared to stable surfaces. In this regard, the maximum knee valgus angle was significantly greater when performing DJs from high drop heights (60 cm), but only on highly unstable surface. Further, braking and push-off times were significantly longer when performing DJs barefoot compared to shod, but only on unstable surface. Finally, analyses indicated no significant interactions with the gender factor.
Conclusions: The findings of the present cumulative thesis indicate that stable rather than unstable surfaces as well as moderate (≤ 40 cm) rather than high (60 cm) drop heights provide sufficient stimuli to perform DJs. Furthermore, findings suggest that DJs on highly unstable surfaces (i.e., two AIREX® balance pads) from high drop heights (60 cm) as well as barefoot compared to shod seem to increase maximal knee valgus angle/stress by providing a more harmful DJ stimulus. Neuromuscular activation strategies appear to be modified by surface instability and drop height. However, leg muscle activity is only marginally effected by footwear and by the interactions of various external factors i.e., surface instability, drop height, footwear). Finally, gender did not significantly modulate the main or interaction effects of the observed external factors during DJs.
BACKGROUND: The etiology of low back pain (LBP), one of the most prevalent and costly diseases of our time, is accepted to be multi-causal, placing functional factors in the focus of research. Thereby, pain models suggest a centrally controlled strategy of trunk stiffening in LBP. However, supporting biomechanical evidence is mostly limited to static measurements during maximum voluntary contractions (MVC), probably influenced by psychological factors in LBP. Alternatively, repeated findings indicate that the neuromuscular efficiency (NME), characterized by the strength-to-activation relationship (SAR), of lower back muscles is impaired in LBP. Therefore, a dynamic SAR protocol, consisting of normalized trunk muscle activation recordings during submaximal loads (SMVC) seems to be relevant. This thesis aimed to investigate the influence of LBP on the NME and activation pattern of trunk muscles during dynamic trunk extensions.
METHODS: The SAR protocol consisted of an initial MVC reference trial (MVC1), followed by SMVCs at 20, 40, 60 and 80% of MVC1 load. An isokinetic trunk dynamometer (Con-Trex TP, ROM: 45° flexion to 10° extension, velocity: 45°/s) and a trunk surface EMG setup (myon, up to 12 leads) was used. Extension torque output [Nm] and muscular activation [V] were assessed in all trials. Finally, another MVC trial was performed (MVC2) for reliability analysis. For SAR evaluation the SMVC trial values were normalized [%MVC1] and compared inter- and intra-individually.
The methodical validity of the approach was tested in an isometric SAR single-case pilot study (S1a: N = 2, female LBP patient vs. healthy male). In addition, the validity of the MVC reference method was verified by comparing different contraction modes (S1b: N = 17, healthy individuals). Next, the isokinetic protocol was validated in terms of content for its applicability to display known physiological differences between sexes in a cross-sectional study (S2: each n = 25 healthy males/females). Finally, the influence of acute pain on NME was investigated longitudinally by comparing N = 8 acute LBP patients with the retest after remission of pain (S3). The SAR analysis focused on normalized agonistic extensor activation and abdominal and synergistic extensor co-activation (t-tests, ANOVA, α = .05) as well as on reliability of MVC1/2 outcomes.
RESULTS: During the methodological validation of the protocol (S1a), the isometric SAR was found to be descriptively different between individuals. Whereas torque output was highest during eccentric MVC, no relevant difference in peak EMG activation was found between contraction modes (S1b). The isokinetic SAR sex comparison (S2), though showing no significant overall effects, revealed higher normalized extensor activation at moderate submaximal loads in females (13 ± 4%), primarily caused by pronounced thoracic activation. Similarly, co-activation analysis resulted in significantly higher antagonistic activation at moderate loads compared to males (33 ± 9%). During intra-individual analysis of SAR in LBP patients (S3), a significant effect of pain status on the SAR has been identified, manifesting as increased normalized EMG activation of extensors during acute LBP (11 ± 8%) particularly at high load. Abdominal co-activation tended to be elevated (27 ± 11%) just as the thoracic extensor parts seemed to take over proportions of lumbar activation. All together, the M. erector spinae behaviour during the SAR protocol was rather linear with the tendency to rise exponentially during high loads. For the level of normalized EMG activation during SMVCs, a clear increasing trend from healthy males to females over to non-acute and acute LBP patients was discovered. This was associated by elevated antagonistic activation and a shift of synergistic towards lumbar extensor activation. The MVC data revealed overall good reliability, with clearly higher variability during acute LBP.
DISCUSSION: The present thesis demonstrates that the NME of lower back muscles is impaired in LBP patients, especially during an acute pain episode. A new dynamic protocol has been developed that makes it possible to display the underlying SAR using normalized trunk muscle EMG during submaximal isokinetic loads. The protocol shows promise as a biomechanical tool for diagnostic analysis of NME in LBP patients and monitoring of rehabilitation progress. Furthermore, reliability not of maximum strength but rather of peak EMG of MVC measurements seems to be decreased in LBP patients. Meanwhile, the findings of this thesis largely substantiate the assumptions made by the recently presented ‘motor adaptation to pain’ model, suggesting a pain-related intra- and intermuscular activation redistribution affecting movement and stiffness of the trunk. Further research is needed to distinguish the grade of NME impairment between LBP subgroups.
Biological materials, in addition to having remarkable physical properties, can also change shape and volume. These shape and volume changes allow organisms to form new tissue during growth and morphogenesis, as well as to repair and remodel old tissues. In addition shape or volume changes in an existing tissue can lead to useful motion or force generation (actuation) that may even still function in the dead organism, such as in the well known example of the hygroscopic opening or closing behaviour of the pine cone. Both growth and actuation of tissues are mediated, in addition to biochemical factors, by the physical constraints of the surrounding environment and the architecture of the underlying tissue. This habilitation thesis describes biophysical studies carried out over the past years on growth and swelling mediated shape changes in biological systems. These studies use a combination of theoretical and experimental tools to attempt to elucidate the physical mechanisms governing geometry controlled tissue growth and geometry constrained tissue swelling. It is hoped that in addition to helping understand fundamental processes of growth and morphogenesis, ideas stemming from such studies can also be used to design new materials for medicine and robotics.