Referiert
Refine
Year of publication
Document Type
Is part of the Bibliography
- yes (181)
Keywords
- sonography (13)
- EMG (7)
- young athletes (7)
- MiSpEx (6)
- Basketball (5)
- Exercise (5)
- Functional ankle instability (5)
- back pain (5)
- performance (5)
- reliability (5)
This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of 0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC.
The Star Excursion Balance Test (SEBT) is effective in measuring dynamic postural control (DPC). This research aimed to determine whether DPC measured by the SEBT in young athletes (YA) with back pain (BP) is different from those without BP (NBP). 53 BP YA and 53 NBP YA matched for age, height, weight, training years, training sessions/week and training minutes/session were studied. Participants performed 4 practice trials after which 3 measurements in the anterior, posteromedial and posterolateral SEBT reach directions were recorded. Normalized reach distance was analyzed using the mean of all 3 measurements. There was no statistical significant difference (p > 0.05) between the reach distance of BP (87.2 ± 5.3, 82.4 ± 8.2, 78.7 ± 8.1) and NBP (87.8 ± 5.6, 82.4 ± 8.0, 80.0 ± 8.8) in the anterior, posteromedial and posterolateral directions respectively. DPC in YA with BP, as assessed by the SEBT, was not different from NBP YA.
Background: Athletes may differ in their resting metabolic rate (RMR) from the general population. However, to estimate the RMR in athletes, prediction equations that have not been validated in athletes are often used. The purpose of this study was therefore to verify the applicability of commonly used RMR predictions for use in athletes. Methods: The RMR was measured by indirect calorimetry in 17 highly trained rowers and canoeists of the German national teams (BMI 24 ± 2 kg/m2, fat-free mass 69 ± 15 kg). In addition, the RMR was predicted using Cunningham (CUN) and Harris-Benedict (HB) equations. A two-way repeated measures ANOVA was calculated to test for differences between predicted and measured RMR (α = 0.05). The root mean square percentage error (RMSPE) was calculated and the Bland-Altman procedure was used to quantify the bias for each prediction. Results: Prediction equations significantly underestimated the RMR in males (p < 0.001). The RMSPE was calculated to be 18.4% (CUN) and 20.9% (HB) in the entire group. The bias was 133 kcal/24 h for CUN and 202 kcal/24 h for HB. Conclusions: Predictions significantly underestimate the RMR in male heavyweight endurance athletes but not in females. In athletes with a high fat-free mass, prediction equations might therefore not be applicable to estimate energy requirements. Instead, measurement of the resting energy expenditure or specific prediction equations might be needed for the individual heavyweight athlete.
In the context of back pain, great emphasis has been placed on the importance of trunk stability, especially in situations requiring compensation of repetitive, intense loading induced during high-performance activities, e.g., jumping or landing. This study aims to evaluate trunk muscle activity during drop jump in adolescent athletes with back pain (BP) compared to athletes without back pain (NBP). Eleven adolescent athletes suffering back pain (BP: m/f: n = 4/7; 15.9 ± 1.3 y; 176 ± 11 cm; 68 ± 11 kg; 12.4 ± 10.5 h/we training) and 11 matched athletes without back pain (NBP: m/f: n = 4/7; 15.5 ± 1.3 y; 174 ± 7 cm; 67 ± 8 kg; 14.9 ± 9.5 h/we training) were evaluated. Subjects conducted 3 drop jumps onto a force plate (ground reaction force). Bilateral 12-lead SEMG (surface Electromyography) was applied to assess trunk muscle activity. Ground contact time [ms], maximum vertical jump force [N], jump time [ms] and the jump performance index [m/s] were calculated for drop jumps. SEMG amplitudes (RMS: root mean square [%]) for all 12 single muscles were normalized to MIVC (maximum isometric voluntary contraction) and analyzed in 4 time windows (100 ms pre- and 200 ms post-initial ground contact, 100 ms pre- and 200 ms post-landing) as outcome variables. In addition, muscles were grouped and analyzed in ventral and dorsal muscles, as well as straight and transverse trunk muscles. Drop jump ground reaction force variables did not differ between NBP and BP (p > 0.05). Mm obliquus externus and internus abdominis presented higher SEMG amplitudes (1.3–1.9-fold) for BP (p < 0.05). Mm rectus abdominis, erector spinae thoracic/lumbar and latissimus dorsi did not differ (p > 0.05). The muscle group analysis over the whole jumping cycle showed statistically significantly higher SEMG amplitudes for BP in the ventral (p = 0.031) and transverse muscles (p = 0.020) compared to NBP. Higher activity of transverse, but not straight, trunk muscles might indicate a specific compensation strategy to support trunk stability in athletes with back pain during drop jumps. Therefore, exercises favoring the transverse trunk muscles could be recommended for back pain treatment.
In the context of back pain, great emphasis has been placed on the importance of trunk stability, especially in situations requiring compensation of repetitive, intense loading induced during high-performance activities, e.g., jumping or landing. This study aims to evaluate trunk muscle activity during drop jump in adolescent athletes with back pain (BP) compared to athletes without back pain (NBP). Eleven adolescent athletes suffering back pain (BP: m/f: n = 4/7; 15.9 ± 1.3 y; 176 ± 11 cm; 68 ± 11 kg; 12.4 ± 10.5 h/we training) and 11 matched athletes without back pain (NBP: m/f: n = 4/7; 15.5 ± 1.3 y; 174 ± 7 cm; 67 ± 8 kg; 14.9 ± 9.5 h/we training) were evaluated. Subjects conducted 3 drop jumps onto a force plate (ground reaction force). Bilateral 12-lead SEMG (surface Electromyography) was applied to assess trunk muscle activity. Ground contact time [ms], maximum vertical jump force [N], jump time [ms] and the jump performance index [m/s] were calculated for drop jumps. SEMG amplitudes (RMS: root mean square [%]) for all 12 single muscles were normalized to MIVC (maximum isometric voluntary contraction) and analyzed in 4 time windows (100 ms pre- and 200 ms post-initial ground contact, 100 ms pre- and 200 ms post-landing) as outcome variables. In addition, muscles were grouped and analyzed in ventral and dorsal muscles, as well as straight and transverse trunk muscles. Drop jump ground reaction force variables did not differ between NBP and BP (p > 0.05). Mm obliquus externus and internus abdominis presented higher SEMG amplitudes (1.3–1.9-fold) for BP (p < 0.05). Mm rectus abdominis, erector spinae thoracic/lumbar and latissimus dorsi did not differ (p > 0.05). The muscle group analysis over the whole jumping cycle showed statistically significantly higher SEMG amplitudes for BP in the ventral (p = 0.031) and transverse muscles (p = 0.020) compared to NBP. Higher activity of transverse, but not straight, trunk muscles might indicate a specific compensation strategy to support trunk stability in athletes with back pain during drop jumps. Therefore, exercises favoring the transverse trunk muscles could be recommended for back pain treatment.
Background
Back pain patients (BPP) show delayed muscle onset, increased co-contractions, and variability as response to quasi-static sudden trunk loading in comparison to healthy controls (H). However, it is unclear whether these results can validly be transferred to suddenly applied walking perturbations, an automated but more functional and complex movement pattern. There is an evident need to develop research-based strategies for the rehabilitation of back pain. Therefore, the investigation of differences in trunk stability between H and BPP in functional movements is of primary interest in order to define suitable intervention regimes. The purpose of this study was to analyse neuromuscular reflex activity as well as three-dimensional trunk kinematics between H and BPP during walking perturbations.
Methods
Eighty H (31m/49f;29±9yrs;174±10cm;71±13kg) and 14 BPP (6m/8f;30±8yrs;171±10cm;67±14kg) walked (1m/s) on a split-belt treadmill while 15 right-sided perturbations (belt decelerating, 40m/s2, 50ms duration; 200ms after heel contact) were randomly applied. Trunk muscle activity was assessed using a 12-lead EMG set-up. Trunk kinematics were measured using a 3-segment-model consisting of 12 markers (upper thoracic (UTA), lower thoracic (LTA), lumbar area (LA)). EMG-RMS ([%],0-200ms after perturbation) was calculated and normalized to the RMS of unperturbed gait. Latency (TON;ms) and time to maximum activity (TMAX;ms) were analysed. Total motion amplitude (ROM;[°]) and mean angle (Amean;[°]) for extension-flexion, lateral flexion and rotation were calculated (whole stride cycle; 0-200ms after perturbation) for each of the three segments during unperturbed and perturbed gait. For ROM only, perturbed was normalized to unperturbed step [%] for the whole stride as well as the 200ms after perturbation. Data were analysed descriptively followed by a student´s t-test to account for group differences. Co-contraction was analyzed between ventral and dorsal muscles (V:R) as well as side right:side left ratio (Sright:Sleft). The coefficient of variation (CV;%) was calculated (EMG-RMS;ROM) to evaluate variability between the 15 perturbations for all groups. With respect to unequal distribution of participants to groups, an additional matched-group analysis was conducted. Fourteen healthy controls out of group H were sex-, age- and anthropometrically matched (group Hmatched) to the BPP.
Results
No group differences were observed for EMG-RMS or CV analysis (EMG/ROM) (p>0.025). Co-contraction analysis revealed no differences for V:R and Srigth:Sleft between the groups (p>0.025). BPP showed an increased TON and TMAX, being significant for Mm. rectus abdominus (p = 0.019) and erector spinae T9/L3 (p = 0.005/p = 0.015). ROM analysis over the unperturbed stride cycle revealed no differences between groups (p>0.025). Normalization of perturbed to unperturbed step lead to significant differences for the lumbar segment (LA) in lateral flexion with BPP showing higher normalized ROM compared to Hmatched (p = 0.02). BPP showed a significant higher flexed posture (UTA (p = 0.02); LTA (p = 0.004)) during normal walking (Amean). Trunk posture (Amean) during perturbation showed higher trunk extension values in LTA segments for H/Hmatched compared to BPP (p = 0.003). Matched group (BPP vs. Hmatched) analysis did not show any systematic changes of all results between groups.
Conclusion
BPP present impaired muscle response times and trunk posture, especially in the sagittal and transversal planes, compared to H. This could indicate reduced trunk stability and higher loading during gait perturbations.
Background
Back pain patients (BPP) show delayed muscle onset, increased co-contractions, and variability as response to quasi-static sudden trunk loading in comparison to healthy controls (H). However, it is unclear whether these results can validly be transferred to suddenly applied walking perturbations, an automated but more functional and complex movement pattern. There is an evident need to develop research-based strategies for the rehabilitation of back pain. Therefore, the investigation of differences in trunk stability between H and BPP in functional movements is of primary interest in order to define suitable intervention regimes. The purpose of this study was to analyse neuromuscular reflex activity as well as three-dimensional trunk kinematics between H and BPP during walking perturbations.
Methods
Eighty H (31m/49f;29±9yrs;174±10cm;71±13kg) and 14 BPP (6m/8f;30±8yrs;171±10cm;67±14kg) walked (1m/s) on a split-belt treadmill while 15 right-sided perturbations (belt decelerating, 40m/s2, 50ms duration; 200ms after heel contact) were randomly applied. Trunk muscle activity was assessed using a 12-lead EMG set-up. Trunk kinematics were measured using a 3-segment-model consisting of 12 markers (upper thoracic (UTA), lower thoracic (LTA), lumbar area (LA)). EMG-RMS ([%],0-200ms after perturbation) was calculated and normalized to the RMS of unperturbed gait. Latency (TON;ms) and time to maximum activity (TMAX;ms) were analysed. Total motion amplitude (ROM;[°]) and mean angle (Amean;[°]) for extension-flexion, lateral flexion and rotation were calculated (whole stride cycle; 0-200ms after perturbation) for each of the three segments during unperturbed and perturbed gait. For ROM only, perturbed was normalized to unperturbed step [%] for the whole stride as well as the 200ms after perturbation. Data were analysed descriptively followed by a student´s t-test to account for group differences. Co-contraction was analyzed between ventral and dorsal muscles (V:R) as well as side right:side left ratio (Sright:Sleft). The coefficient of variation (CV;%) was calculated (EMG-RMS;ROM) to evaluate variability between the 15 perturbations for all groups. With respect to unequal distribution of participants to groups, an additional matched-group analysis was conducted. Fourteen healthy controls out of group H were sex-, age- and anthropometrically matched (group Hmatched) to the BPP.
Results
No group differences were observed for EMG-RMS or CV analysis (EMG/ROM) (p>0.025). Co-contraction analysis revealed no differences for V:R and Srigth:Sleft between the groups (p>0.025). BPP showed an increased TON and TMAX, being significant for Mm. rectus abdominus (p = 0.019) and erector spinae T9/L3 (p = 0.005/p = 0.015). ROM analysis over the unperturbed stride cycle revealed no differences between groups (p>0.025). Normalization of perturbed to unperturbed step lead to significant differences for the lumbar segment (LA) in lateral flexion with BPP showing higher normalized ROM compared to Hmatched (p = 0.02). BPP showed a significant higher flexed posture (UTA (p = 0.02); LTA (p = 0.004)) during normal walking (Amean). Trunk posture (Amean) during perturbation showed higher trunk extension values in LTA segments for H/Hmatched compared to BPP (p = 0.003). Matched group (BPP vs. Hmatched) analysis did not show any systematic changes of all results between groups.
Conclusion
BPP present impaired muscle response times and trunk posture, especially in the sagittal and transversal planes, compared to H. This could indicate reduced trunk stability and higher loading during gait perturbations.
BACKGROUND: Reproducible measurements of tendon structural properties are a prerequisite for accurate diagnosis of tendon disorders and for determination of their mechanical properties. Despite the widely used application of Ultrasonography (US) in musculoskeletal assessment, its operator dependency and lack of standardization influences the consistency of the measurement.
OBJECTIVE: To evaluate the intra-rater reproducibility of a standardized US method assessing the structural properties of the Achilles tendon (AT).
METHODS: Sixteen asymptomatic participants were positioned prone on an isokinetic dynamometer with the knee extended and ankle at 90. flexion. US was used to assess AT-length, cross-sectional area (CSA), and AT-elongation during isometric plantarflexion contraction. The intra-rater reproducibility was assessed by ICC (2.1), Test-Retest Variability (TRV, %), Bland-Altman analyses (Bias +/- LoA [1.96*SD]), and Standard-Error of Measurement (SEM).
RESULTS: Measurements of AT-length demonstrated an ICC of 0.93, TRV of 4.5 +/- 3.9%, Bias +/- LoA of -2.8 +/- 25.0 mm and SEM of 6.6 mm. AT-CSA showed an ICC of 0.79, TRV of 8.7 +/- 9.6%, Bias +/- LoA of 1.7 +/- 19.4 mm(2) and SEM of 5.3 mm(2). AT-elongation revealed an ICC of 0.92, TRV of 12.9 +/- 8.9%, Bias +/- LoA of 0.3 +/- 5.7 mm and SEM of 1.5 mm.
CONCLUSIONS: The presented methodology allows a reproducible assessment of Achilles tendon structural properties when performed by a single rater.
Background: In physical activity (PA) counseling, primary care physicians (PCPs) play a key role because they are in regular contact with large sections of the population and are important contact people in all health-related issues. However, little is known about their attitudes, knowledge, and perceived success, as well as about factors associated with the implementation of PA counseling. Methods: We collected data from 4074 PCPs including information on physician and practice characteristics, attitudes toward cardiovascular disease (CVD) prevention, and measures used during routine practice to prevent CVD. Here, we followed widely the established 5 A's strategy (Assess, Advise, Agree, Assist, Arrange). Results: The majority (87.2%) of PCPs rated their own level of competence in PA counseling as 'high,' while 52.3% rated their own capability to motivate patients to increase PA as 'not good.' Nine of ten PCPs routinely provided at least 1 measure of the modified 5 A's strategy, while 9.5% routinely used all 5 intervention strategies. Conclusions: The positive attitude toward PA counseling among PCPs should be supported by other stakeholders in the field of prevention and health promotion. An example would be the reimbursement of health counseling services by compulsory health insurance, which would enable PCPs to invest more time in individualized health promotion.
Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 +/- 1.9 years; 160 +/- 13cm; 50 +/- 14kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy.
Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are affected, especially the Achilles and patellar tendons. Repeated overuse in sports and/or daily activities is assumed as the aetiology. Besides the clinical examination including a comprehensive anamnesis of pain and training/loading, sonographic imaging has a high training/loading relevance for the diagnosis of tendon pathologies of the lower extremity. Training concepts are considered in first line as the treatment of choice. A combination with physical therapy interventions can be useful. In cases of a more severe pathology and long-standing complaints multimodal therapeutic options should be employed. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment.
Neural control of synergist muscles is not well understood. Presumably, each muscle in a synergistic group receives some unique neural drive and some drive that is also shared in common with other muscles in the group. In this investigation, we sought to characterize the strength, frequency spectrum, and force dependence of the neural drive to the human vastus lateralis and vastus medialis muscles during the production of isometric knee extension forces at 10 and 30% of maximum voluntary effort. High-density surface electromyography recordings were decomposed into motor unit action potentials to examine the neural drive to each muscle. Motor unit coherence analysis was used to characterize the total neural drive to each muscle and the drive shared between muscles. Using a novel approach based on partial coherence analysis, we were also able to study specifically the neural drive unique to each muscle (not shared). The results showed that the majority of neural drive to the vasti muscles was a cross-muscle drive characterized by a force-dependent strength and bandwidth. Muscle-specific neural drive was at low frequencies (<5 Hz) and relatively weak. Frequencies of neural drive associated with afferent feedback (6 - 12 Hz) and with descending cortical input (similar to 20 Hz) were almost entirely shared by the two muscles, whereas low-frequency (<5 Hz) drive comprised shared (primary) and muscle-specific (secondary) components. This study is the first to directly investigate the extent of shared versus independent control of synergist muscles at the motor neuron level.
Back pain is a complex phenomenon that goes beyond a simple medical diagnosis. The aetiology and chronification of back pain can be best described as an interaction between biological, psychological, and social processes. However, to date, multimodal prevention and intervention programs for back pain that target all three aetiological factors have demonstrated limited effectiveness. This lack of supportive evidence for multimodal programmes in the treatment of back pain could be due to the fact that few programs are suitable for long-term and unsupervised use in everyday life. Moreover, in combining the elements from various therapies, little attention has been paid to the mechanisms underlying the synergistic effects of the separate components. In this contribution, we will describe the development of a new multimodal intervention for back pain that set out to address these limitations. To this end, the biological elements of neuromuscular adaptation is supplemented with cognitive behavioral and psychophysiological techniques in an intervention that can be followed at home as well as in clinics, and that is suitable for all grades of pain. The efficacy of this intervention will be tested in a multicentric randomized controlled longitudinal trial (n = 714) at five time points over a period of 6 months. Here we will describe the development and the content of this new intervention.
Subcutaneous adipose tissue (SAT) measurements with ultrasound have recently been introduced to assess body fat in elite athletes. However, appropriate protocols and data on various groups of athletes are missing. We investigated intra-rater reliability of SAT measurements using ultrasound in elite canoe athletes. 25 international level canoeists (18 male, 7 female; 23 +/- 4 years; 81 +/- 11 kg; 1.83 +/- 0.09 m; 20 +/- 3 training h/wk) were measured on 2 consecutive days. SAT was assessed with B-mode ultrasound at 8 sites (ISAK): triceps, subscapular, biceps, iliac crest, supraspinal, abdominal, front thigh, medial calf, and quantified using image analysis software. Data was analyzed descriptively (mean +/- SD, [range]). Coefficient of variation (CV %), intraclass correlation coefficient (ICC, 2.1) and absolute (LoA) and ratio limits of agreement (RLoA) were calculated for day-to-day reliability. Mean sum of SAT thickness was 30.0 +/- 19.4 mm [8.0, 80.1 mm], with 3.9 +/- 1.8 mm [1.2 mm subscapular, 8.0 mm abdominal] for individual sites. CV for the sum of sites was 4.7 %, ICC 0.99, LoA 1.7 +/- 3.6 mm, RLoA 0.940 (*/divided by 1.155). Measuring SAT with ultrasound has proved to have excellent day-to-day reliability in elite canoe athletes. Recommendations for standardization of the method will further increase accuracy and reproducibility.
Mueller, J, Mueller, S, Stoll, J, Baur, H, and Mayer, F. Trunk extensor and flexor strength capacity in healthy young elite athletes aged 11-15 years. J Strength Cond Res 28(5): 1328-1334, 2014-Differences in trunk strength capacity because of gender and sports are well documented in adults. In contrast, data concerning young athletes are sparse. The purpose of this study was to assess the maximum trunk strength of adolescent athletes and to investigate differences between genders and age groups. A total of 520 young athletes were recruited. Finally, 377 (n = 233/144 M/F; 13 +/- 1 years; 1.62 +/- 0.11 m height; 51 +/- 12 kg mass; training: 4.5 +/- 2.6 years; training sessions/week: 4.3 +/- 3.0; various sports) young athletes were included in the final data analysis. Furthermore, 5 age groups were differentiated (age groups: 11, 12, 13, 14, and 15 years; n = 90, 150, 42, 43, and 52, respectively). Maximum strength of trunk flexors (Flex) and extensors (Ext) was assessed in all subjects during isokinetic concentric measurements (60 degrees center dot s(-1); 5 repetitions; range of motion: 55 degrees). Maximum strength was characterized by absolute peak torque (Flex(abs), Ext(abs); N center dot m), peak torque normalized to body weight (Flex(norm), Ext(norm); N center dot m center dot kg(-1) BW), and Flex(abs)/Ext(abs) ratio (RKquot). Descriptive data analysis (mean +/- SD) was completed, followed by analysis of variance (alpha = 0.05; post hoc test [Tukey-Kramer]). Mean maximum strength for all athletes was 97 +/- 34 N center dot m in Flex(abs) and 140 +/- 50 N center dot m in Ext(abs) (Flex(norm) = 1.9 +/- 0.3 N center dot m center dot kg(-1) BW, Ext(norm) = 2.8 +/- 0.6 N center dot m center dot kg(-1) BW). Males showed statistically significant higher absolute and normalized values compared with females (p < 0.001). Flex(abs) and Ext(abs) rose with increasing age almost 2-fold for males and females (Flex(abs), Ext(abs): p < 0.001). Flex(norm) and Ext(norm) increased with age for males (p < 0.001), however, not for females (Flex(norm): p = 0.26; Ext(norm): p = 0.20). RKquot (mean +/- SD: 0.71 +/- 0.16) did not reveal any differences regarding age (p = 0.87) or gender (p = 0.43). In adolescent athletes, maximum trunk strength must be discussed in a gender- and age-specific context. The Flex(abs)/Ext(abs) ratio revealed extensor dominance, which seems to be independent of age and gender. The values assessed may serve as a basis to evaluate and discuss trunk strength in athletes.
Objectives-Sonography of muscle architecture provides physicians and researchers with information about muscle function and muscle-related disorders. Inter-rater reliability is a crucial parameter in daily clinical routines. The aim of this study was to assess the inter-rater reliability of sonographic muscle architecture assessments and quantification of errors that arise from inconsistent probe positioning and image interpretation.
Results-Inter-rater reliability was good overall (ICC, 0.77-0.90; IRV, 9.0%-13.4%; bias LoA, 0.2 +/- 0.2-1.7 +/- 3.0). Superior and inferior pennation angles showed high systematic bias and LoA in all setups, ranging from 2.0 degrees +/- 2.2 degrees to 3.4 degrees +/- 4.1 degrees. The highest IRV was found for muscle thickness (13.4%). "When the probe position was standardized, the SEM for muscle thickness decreased from 0.1 to 0.05 cm.
Conclusions-Sonographic examination of muscle architecture of the medial gastrocnemius has good to high reliability. In contrast to pennation angle measurements, length measurements can be improved by standardization of the probe position.
Reliability of ultrasound measurements for subcutaneous adipose tissue in elite canoe athletes
(2014)
Flexion-extension ratio of trunk peak torque measures and antagonistic activity in males and females
(2014)
We sought to investigate the effects of wearing a mobile respiratory gas analysis system during a treadmill test on blood lactate (bLa) concentrations and commonly applied bLa thresholds. A total of 16 recreational athletes (31 +/- 3 years, V0205: 58 6 ml min(-1)-kg(-1)) performed one multistage treadmill test with and one without gas exchange measurements (GEM and noGEM). The whole bLa curve, the lactate threshold (LT), the individual anaerobic thresholds according to Stegmann(IAT(sr)) and Dickhuth (IAT(Di)), and a fixed bLa concentration of 4 mmob.l(-1) (OBLA) were evaluated. The bLa curve was shifted slightly leftward in GEM compared to noGEM (P<0.05), whereas the heart rate response was not different between conditions (P= 0.89). There was no difference between GEM and noGEM for LT (2.61 +/- 0.34 vs. 2.64 +/- 0.39 m(-1) s(-1) P=0.49) and IAT(st) (3.47 +/- 0.42 vs. 3.55 +/- 0.47m-s(-1), P=0.12). However, IATD(Di) (3.57 +/- 0.39 vs. 3.66 +/- 0.44m-s(-1), P<0.01) and OBLA (3.85 +/- 0.46 vs. 3.96 +/- 0.47m-s-1, P<0.01) occurred at slower running velocities in GEM. The bLa response to treadmill tests is mildly affected by wearing a mobile gas analysis system. This also applies to bLa thresholds located at higher exercise intensities. While the magnitude of the effects is of little importance for recreational athletes, it might be relevant for elite athletes and scientific studies.
Changes in performance parameters over four consecutive maximal incremental cycling tests were investigated to determine how many tests can be performed within one single day without negatively affecting performance. Sixteen male and female subjects (eight trained (T): 25 +/- 3 yr, BMI 22.6 +/- 2.5 kg center dot m(-2), maximal power output (P-max) 4.6 +/- 0.5 W center dot kg(-1); eight untrained (UT): 27 +/- 3 yr, BMI 22.3 +/- 1.2 kg center dot m(-2), P-max 2.9 +/- 0.3 W center dot kg(-1)) performed four successive maximal incremental cycling tests separated by 1.5 h of passive rest. Individual energy requirements were covered by standardised meals between trials. Maximal oxygen uptake (VO2max) remained unchanged over the four tests in both groups (P = 0.20 and P = 0.33, respectively). P-max did not change in the T group (P = 0.32), but decreased from the third test in the UT group (P < 0.01). Heart rate responses to submaximal exercise were elevated from the third test in the T group and from the second test in the UT group (P < 0.05). The increase in blood lactate shifted rightward over the four tests in both groups (P < 0.001 and P < 0.01, respectively). Exercise-induced net increases in epinephrine and norepinephrine were not different between the tests in either group (P 0.15). If VO2max is the main parameter of interest, trained and untrained individuals can perform at least four maximal incremental cycling tests per day. However, because other parameters changed after the first and second test, respectively, no more than one test per day should be performed if parameters other than VO2max are the prime focus.
Isokinetic dynamometry is a standard technique for strength testing and training. Nevertheless reliability and validity is limited due to inertia effects, especially for high velocities. Therefore in a first methodological approach the purpose was to evaluate a new isokinetic measurement mode including inertia compensation compared to a classic isokinetic measurement mode for single and multijoint movements at different velocities.
Isokinetic maximum strength measurements were carried out in 26 healthy active subjects. Tests were performed using classic isokinetic and new isokinetic mode in random order. Maximum torque/force, maximum movement velocity and time for acceleration were calculated. For inter-instrument agreement Bland and Altman analysis, systematic and random error was quantified. Differences between both methods were assessed (ANOVA alpha = 0.05).
Bland and Altman analysis showed the highest agreement between the two modes for strength and velocity measurements (bias: < +/- 1.1%; LOA: < 14.2%) in knee flexion/extension at slow isokinetic velocity (60 degrees/s). Least agreement (range: bias: -67.6% +/- 119.0%; LOA: 53.4% 69.3%) was observed for shoulder/arm test at high isokinetic velocity (360 degrees/s). The Isokin(new) mode showed higher maximum movement velocities (p < 0.05).
For low isokinetic velocities the new mode agrees with the classic mode. Especially at high isokinetic velocities the new isokinetic mode shows relevant benefits coupled with a possible trade-off with the force/torque measurement. In conclusion, this study offers for the first time a comparison between the 'classical' and inertia-compensated isokinetic dynamometers indicating the advantages and disadvantages associated with each individual approach, particularly as they relate to medium or high velocities in testing and training.
Since the legend of the ancient Marathon run, the risk of endurance exercise-induced cardiovascular damage or sudden cardiac death is discussed. In recent studies, the exercise-induced increases in cardiac biomarkers in endurance athletes as well as acute alterations in cardiac function and cardiovascular abnormalities have been reported. As elevations of the cardiac biomarkers troponin and BM) have been observed frequently for the vast majority of athletes after Marathon runs or strenuous exercise bouts followed by a decrease within a short period, a physiological reaction rather than a pathologicial cause is presumed. Also a transient decrease of cardiac function demonstrated by newer echocardiographic techniques (tissue Doppler or speckle tracking imaging, 3D echocardiography) after strenuous exercise often termed "cardiac fatigue" should not be considered necessarily as pathologic, as cardiac function also depends on hemodynamic load and heart rate. Furthermore, exercise-induced changes in cardiac function did not correlate with exercise-induced increases in cardiac biomarkers in most studies. The functional cardiac alterations can also be detected by magnetic resonance imaging (MRI) after Marathon runs. However, no signs of acute or chronic myocardial damage have been demonstrated in MRI studies in cardiovascular healthy athletes after running a Marathon, although especially in older athletes undetected cardiovascular diseases such as coronary artery disease or myocardial necrosis or fibrosis can be present. hi conclusion, according to recent studies. there seems to be a lack of evidence to support endurance exercise-induced cardiac damage in the healthy heart which is adapted tostrenous exercise by regular endurance training. Nevertheless, as running a Marathon results in a high cardiac load, a sufficient endurance training period as well as a preparticipation or regular medical screening to exclude relevant congenital or aquired cardiovascular diseases is recommended from a sports cardiology perspective to exclude relevant congenital or acquired cardiovascular diseases
Background: Athletes may differ in their resting metabolic rate (RMR) from the general population. However, to estimate the RMR in athletes, prediction equations that have not been validated in athletes are often used. The purpose of this study was therefore to verify the applicability of commonly used RMR predictions for use in athletes. Methods: The RMR was measured by indirect calorimetry in 17 highly trained rowers and canoeists of the German national teams (BMI 24 +/- 2 kg/m(2), fat-free mass 69 +/- 15 kg). In addition, the RMR was predicted using Cunningham (CUN) and Harris-Benedict (HB) equations. A two-way repeated measures ANOVA was calculated to test for differences between predicted and measured RMR (alpha = 0.05). The root mean square percentage error (RMSPE) was calculated and the Bland-Altman procedure was used to quantify the bias for each prediction. Results: Prediction equations significantly underestimated the RMR in males (p < 0.001). The RMSPE was calculated to be 18.4% (CUN) and 20.9% (HB) in the entire group. The bias was 133 kcal/24 h for CUN and 202 kcal/24 h for HB. Conclusions: Predictions significantly underestimate the RMR in male heavyweight endurance athletes but not in females. In athletes with a high fat-free mass, prediction equations might therefore not be applicable to estimate energy requirements. Instead, measurement of the resting energy expenditure or specific prediction equations might be needed for the individual heavyweight athlete.
On utilise de plus en plus les tests de verification pour confirmer l'atteinte du consommation d'oxygene maximale (VO(2 max)). Toutefois, le moment et les methodes d'evaluation varient d'un groupe de travail a l'autre. Les objectifs de cette etude sont de constater si on peut administrer un test de verification apres un test d'effort progressif ou s'il est preferable de le faire une autre journee et si on peut determiner le VO(2 max) tout de meme lors de la premiere seance chez des sujets ne repondant pas au critere de verification. Quarante sujets (age, 24 +/- 4 ans; VO(2 max), 50 +/- 7 mL center dot min(-1)center dot kg(-1)) participent a un test d'effort progressif sur tapis roulant et, 10 min plus tard, a un test de verification (VerifDay1) a 110 % de la velocite maximale (v(max)). Le critere de verification est un VO(2) de pointe au VerifDay1 < 5,5 % a la valeur retenue au test d'effort progressif. Les sujets ne repondant pas au critere de verification passent un autre test de verification, mais a 115 % du VerifDay1', et ce, 10 min plus tard pour confirmer le VO(2) de pointe du VerifDay1 en tant que VO(2 max). Tous les autres sujets repassent le VerifDay1 a un jour different (VerifDay2). Six sujets sur quarante ne repondent pas au critere de verification. Chez quatre d'entre eux, on confirme l'atteinte du VO(2 max) au VerifDay1'. Le VO(2) de pointe au VerifDay1 est equivalent a celui du VerifDay2 (3722 +/- 991 mL center dot min(-1) comparativement a 3752 +/- 995 mL center dot min(-1), p = 0,56), mais le temps jusqu'a l'epuisement est significativement plus long au VerifDay2 (2:06 +/- 0:22 min:s comparativement a 2:42 +/- 0:38 min:s, p < 0,001, n = 34). Le VO(2) de pointe obtenu au test de verification ne semble pas conditionne par un test d'effort progressif maximal prealable. On peut donc realiser le test d'effort progressif et le test de verification lors de la meme seance d'evaluation. Chez presque tous les individus ne repondant pas au critere de verification, on peut determiner le VO(2 max) au moyen d'un autre test de verification plus intense.
Adequate energy intake in adolescent athletes is considered important. Total energy expenditure (TEE) can be calculated from resting energy expenditure (REE) and physical activity level (PAL). However, validated PAL recommendations are available for adult athletes only. Purpose was to comprise physical activity data in adolescent athletes and to establish PAL recommendations for this population. In 64 competitive athletes (15.3 +/- 1.5yr, 20.5 +/- 2.0kg/m(2)) and 14 controls (15.1 +/- 1.1yr, 21 +/- 2.1kg/m(2)) TEE was calculated using 7-day activity protocols validated against doubly-labeled water. REE was estimated by Schofield-HW equation, and PAL was calculated as TEE:REE. Observed PAL in adolescent athletes (1.90 +/- 0.35) did not differ compared with controls (1.84 +/- 0.32, p = .582) and was lower than recommended for adult athletes by the WHO. In conclusion, applicability of PAL values recommended for adult athletes to estimate energy requirements in adolescent athletes must be questioned. Instead, a PAL range of 1.75-2.05 is suggested.
Background: The elderly need strength training more and more as they grow older to stay mobile for their everyday activities. The goal of training is to reduce the loss of muscle mass and the resulting loss of motor function. The dose-response relationship of training intensity to training effect has not yet been fully elucidated.
Methods: PubMed was selectively searched for articles that appeared in the past 5 years about the effects and dose-response relationship of strength training in the elderly.
Results: Strength training in the elderly (> 60 years) increases muscle strength by increasing muscle mass, and by improving the recruitment of motor units, and increasing their firing rate. Muscle mass can be increased through training at an intensity corresponding to 60% to 85% of the individual maximum voluntary strength. Improving the rate of force development requires training at a higher intensity (above 85%), in the elderly just as in younger persons. It is now recommended that healthy old people should train 3 or 4 times weekly for the best results; persons with poor performance at the outset can achieve improvement even with less frequent training. Side effects are rare.
Conclusion: Progressive strength training in the elderly is efficient, even with higher intensities, to reduce sarcopenia, and to retain motor function.
How much is too much? - a case report of nutritional supplement use of a high-performance athlete
(2011)
Although dietary nutrient intake is often adequate, nutritional supplement use is common among elite athletes. However, high-dose supplements or the use of multiple supplements may exceed the recommended daily allowance (RDA) of particular nutrients or even result in a daily intake above tolerable upper limits (UL). The present case report presents nutritional intake data and supplement use of a highly trained male swimmer competing at international level. Habitual energy and micronutrient intake were analysed by 3 d dietary reports. Supplement use and dosage were assessed, and total amount of nutrient supply was calculated. Micronutrient intake was evaluated based on RDA and UL as presented by the European Scientific Committee on Food, and maximum permitted levels in supplements (MPL) are given. The athlete's diet provided adequate micronutrient content well above RDA except for vitamin D. Simultaneous use of ten different supplements was reported, resulting in excess intake above tolerable UL for folate, vitamin E and Zn. Additionally, daily supplement dosage was considerably above MPL for nine micronutrients consumed as artificial products. Risks and possible side effects of exceeding UL by the athlete are discussed. Athletes with high energy intake may be at risk of exceeding UL of particular nutrients if multiple supplements are added. Therefore, dietary counselling of athletes should include assessment of habitual diet and nutritional supplement intake. Educating athletes to balance their diets instead of taking supplements might be prudent to prevent health risks that may occur with long-term excess nutrient intake.
Neuromuscular control in functional situations and possible impairments due to Achilles tendinopathy are not well understood.
Thirty controls (CO) and 30 runners with Achilles tendinopathy (AT) were tested on a treadmill at 3.33 m s(-1) (12 km h(-1)). Neuromuscular activity of the lower leg (tibialis anterior, peroneal, and gastrocnemius muscle) was measured by surface electromyography. Mean amplitude values (MAV) for the gait cycle phases preactivation, weight acceptance and push-off were calculated and normalised to the mean activity of the entire gait cycle.
MAVs of the tibialis anterior did not differ between CO and AT in any gait cycle phase. The activation of the peroneal muscle was lower in AT in weight acceptance (p = 0.006), whereas no difference between CO and AT was found in preactivation (p = 0.71) and push-off (p = 0.83). Also, MAVs of the gastrocnemius muscle did not differ between AT and CO in preactivity (p = 0.71) but were reduced in AT during weight acceptance (p = 0.001) and push-off (p = 0.04).
Achilles tendinopathy does not seem to alter pre-programmed neural control but might induce mechanical deficits of the lower extremity during weight bearing (joint stability). This should be addressed in the therapy process of AT.
BAUR, H., A. HIRSCHMULLER, S. MULLER, and F. MAYER. Neuromuscular Activity of the Peroneal Muscle after Foot Orthoses Therapy in Runners. Med. Sci. Sports Exerc., Vol. 43, No. 8, pp. 1500-1506, 2011. Purpose: Foot orthoses are a standard option to treat overuse injury. Biomechanical data providing mechanisms of foot orthoses' effectiveness are sparse. Stability of the ankle joint complex might be a key factor. The purpose was therefore to analyze neuromuscular activity of the musculus peroneus longus in runners with overuse injury symptoms treated with foot orthoses. Methods: A total of 99 male and female runners with overuse injury symptoms randomized in a control group (CO) and an orthoses group (OR) were analyzed on a treadmill at 3.3 m.s(-1) before and after an 8-wk foot orthoses intervention. Muscular activity of the musculus peroneus longus was measured and quantified in the time domain (initial onset of activation (T-ini), time of maximal activity (T-max), total time of activation (T-tot)) and amplitude domain (amplitude in preactivation (A(pre)), weight acceptance (A(wa)), push-off (A(po))). Results: Peroneal activity in the time domain did not differ initially between CO and OR, and no effect was observed after therapy (T-ini: CO = -0.88 +/- 0.09, OR = -0.88 +/- 0.08 / T-max: CO = 0.14 +/- 0.06, OR = 0.15 +/- 0.06 / T-tot: CO = 0.40 +/- 0.09, OR = 0.41 +/- 0.09; P > 0.05). In preactivation (Apre), muscle activity was higher in OR after intervention (CO = 0.97 +/- 0.32, 95% confidence interval = 0.90-1.05; OR = 1.18 +/- 0.43, 95% confidence interval = 1.08-1.28; P = 0.003). There was no group or intervention effect during stance (A(wa): CO = 2.33 +/- 0.66, OR = 2.33 +/- 0.74 / A(po): CO = 0.80 +/- 0.41, OR = 0.88 +/- 0.40; P > 0.05). Conclusions: Enhanced muscle activation of the musculus peroneus longus in preactivation suggests an altered preprogrammed activity, which might lead to better ankle stability providing a possible mode of action for foot orthoses therapy.
Background and objectives Treatment of chronic running-related overuse injuries by orthopaedic shoe orthoses is very common but not evidence-based to date.
Hypothesis Polyurethane foam orthoses adapted to a participant's barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners.
Design Prospective, randomised, controlled clinical trial.
Intervention 51 patients with running injuries were treated with custom-made, semirigid running shoe orthoses for 8 weeks. 48 served as a randomised control group that continued regular training activity without any treatment.
Main outcome measures Evaluation was made by the validated pain questionnaire Subjective Pain Experience Scale, the pain disability index and a comfort index in the orthoses group (ICI).
Results There were statistically significant differences between the orthoses and control groups at 8 weeks for the pain disability index (mean difference 3.2; 95% CI 0.9 to 5.5) and the Subjective Pain Experience Scale (6.6; 2.6 to 10.6). The patients with orthoses reported a rising wearing comfort (pre-treatment ICI 69/100; post-treatment ICI 83/100) that was most pronounced in the first 4 weeks (ICI 80.4/100).
Conclusion Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners.
Neuromuscular activity of the lower leg is dependent on the task performed, speed of movement and gender. Whether training volume influences neuromuscular activity is not known. The EMG of physically active persons differing in running mileage was analysed to investigate this. 55 volunteers were allocated to a low (LM: < 30 km), intermediate (IM: > 30 km & < 45 km) or high mileage (HM: > 45 km) group according to their weekly running volume. Neuromuscular activity of the lower leg was measured during running (3.33 m.s(-1)). Mean amplitude values for preactivation, weight acceptance and push-off were calculated and normalised to the mean activity of the entire gait cycle. Higher activity in the gastrocnemius group was observed in weight acceptance in LM compared to IM (+30%) and HM (+25%) but lower activity was present in the push-off for LM compared to IM and HM. For the peroneal muscle, differences were present in the push-off where HM showed increased activity compared to IM (+24%) and LM (+60%). The tibial muscle revealed slightly lower activity during preactivation for the high mileage runners. Neuromuscular activity differs during stance between the high and intermediate group compared to low mileage runners. Slight adaptations in neuromuscular activation indicate a more target-oriented activation strategy possibly due to repetitive training in runners with higher weekly mileage.
Background: Isokinetic measurements are widely used to assess strength capacity in a clinical or research context. Nevertheless, the validity of isokinetic measures for identifying strength deficits and the evaluation of therapeutic process regarding different pathologies is yet to be established. Therefore, the purpose of this review is to evaluate the validity of isokinetic measures in a specific case: that of muscular capacity in low back pain (LBP).
Methods: A literature search (PubMed; ISI Web of Knowledge; The Cochrane Library) covering the last 10 years was performed. Relevant papers regarding isokinetic trunk strength measures in healthy and patients with low back pain (PLBP) were searched. Peak torque values [Nm] and peak torque normalized to body weight [Nm/kg BW] were extracted for healthy and PLBP. Ranked mean values across studies were calculated for the concentric peak torque at 60 degrees/s as well as the flexion/extension (F/E) ratio.
Results: 34 publications (31 flexion/extension; 3 rotation) were suitable for reporting detailed isokinetic strength measures in healthy or LBP (untrained adults, adolescents, athletes). Adolescents and athletes were different compared to normal adults in terms of absolute trunk strength values and the F/E ratio. Furthermore, isokinetic measures evaluating therapeutic process and isokinetic rehabilitation training were infrequent in literature (8 studies).
Conclusion: Isokinetic measurements are valid for measuring trunk flexion/extension strength and F/E ratio in athletes, adolescents and (untrained) adults with/without LBP. The validity of trunk rotation is questionable due to a very small number of publications whereas no reliable source regarding lateral flexion could be traced. Therefore, isokinetic dynamometry may be utilized for identifying trunk strength deficits in healthy adults and PLBP.
Intra- and interrater variability of sonographic investigations of patella and achilles tendons
(2012)
Background: Clinical examinations of tendon disorders routinely include ultrasound examinations, despite the fact that availability of data concerning validity criteria of these measurements are limited. The present study therefore aims to evaluate the reliability of measurements of Achilles- and Patella tendon diameter and in the detection of structural adaptations.
Materials and Methods: In 14 healthy, recreationally active subjects both asymptomatic Achilles (AT) and patella tendons (PT) were measured twice by two examiners in a test-retest design. Besides the detection of anteroposterior (a.p.-) and mediolateral (m.l.-) diameters, areas of hypoechogenicity and neovascularisation were registered. Data were analysed descriptively with calculation of test-retest variability (TRV), intraclass-correlation coefficient (ICC) and Bland and Altman's plots with bias and 95% limits of agreement (LOA).
Results: Intra- and interrater differences of AT- and PT-a.p.-diameter varied from 0.2 - 1.2 mm, those of AT- and PT-m.l-diameter from 0.7-5.1 mm. Areas of hypoechogenicity were visible in 24% of the tendons, while 15% showed neovascularisations. Intrarater AT-a.p.-diameters showed sparse deviations (TRV 4.5-7.4%; ICC 0.60-0.84; bias -0.05-0.07 mm; LOA-0.6-0.5 to -1.1 - 1.0 mm), while interrater AT- and PT-m.l.-diameters were highly variable (TRV 13.7-19.7%; ICC 0.11-0.20; bias -1.4-4.3 mm; LOA-5.5-2.7 to -10.5 - 1.9 mm).
Conclusion: Our results suggest that the measurement of AT- and PT-a.p.-diameters is a reliable parameter. In contrast, reproducibility of AT- and PT-m.l.-diameters is questionable. The study corroborates the presence of hypoechogenicity and neovascularisation in asymptomatic tendons.
Background: Several equipment interventions like optimizing seat position or optimizing shoe/insole/pedal interface are suggested to reduce overuse injury in cycling. Data analyzing clinical or biomechanical effects of those interventions is sparse. Foot orthoses out of carbon fiber are one possibility to alter the interface between foot and pedal. The aim of this study was therefore to analyze plantar pressure distribution in carbon fiber foot orthoses in comparison to standard insoles of commercially available cycling shoes. Materials and Methods: 11 pain-free triathletes (Age: 29 +/- 9, 1.77 +/- 0.04 m, 68 5 kg) were tested on a cycle ergometer at 60 and 90 rotations per minute (rpm) at workloads of 200 and 300 Watts. Subjects wore in randomized order a cycling shoe with its standard insole (control condition CO) or the shoe with carbon fiber foot orthoses (Condition CA). Mean peak pressure out of 30 movement cycles were extracted for the total foot and specific foot regions (rear, mid, fore foot (medial, central, lateral) and toe region). Three-factor ANOVAs (factor foot orthoses, rpm, workload) for repeated measures (alpha = 0.05) were used to analyze the main question of a foot orthoses effect on peak in-shoe plantar pressure. Results: Peak pressures in the total foot were in a range of 70-75 kPa for 200 Watts (W) (300 W: 85-110 kPa). The carbon fiber foot orthoses reduced peak pressures by -4,1% compared to the standard insole (p = 0,10). In the foot regions rear(-16,6%, p<0.001), mid (-20,0%, p<0.001) and fore foot (-5.9%, p < 0.03)CA reduced peak pressure compared to CO. In the toe region, peak pressure was higher in CA (+16,2%) compared to CO (p<0,001). The lateral fore foot showed higher peak pressures in CA (+34%) and CO (+59%) compared to medial and central fore foot. Conclusion: Carbon fiber can serve as a suitable material for foot orthoses manufacturing in cycling. Plantar pressures do not increase due to the stiffness of the carbon. Individual customization may have the potential to reduce peak pressure in certain foot areas.
The aim of this study was to acquire static and dynamic foot geometry and loading in childhood, and to establish data for age groups of a population of 1-13 year old infants and children.
A total of 10,382 children were recruited and 7788 children (48% males and 52% females) were finally included into the data analysis. For static foot geometry foot length and foot width were quantified in a standing position. Dynamic foot geometry and loading were assessed during walking on a walkway with self selected speed (Novel Emed X, 100 Hz, 4 sensors/cm(2)). Contact area (CA), peak pressure (PP), force time integral (FTI) and the arch index were calculated for the total, fore-, mid- and hindfoot.
Results show that most static and dynamic foot characteristics change continuously during growth and maturation. Static foot length and width increased with age from 13.1 +/- 0.8 cm (length) and 5.7 +/- 0.4 cm (width) in the youngest to 24.4 +/- 1.5 cm (length) and 8.9 +/- 0.6 cm (width) in the oldest. A mean walking velocity of 0.94 +/- 0.25 m/s was observed. Arch-index ranged from 0.32 +/- 0.04 [a.u.] in the one-year old to 0.21 +/- 0.13 [a.u.] in the 5-year olds and remains constant afterwards.
This study provides data for static and dynamic foot characteristics in children based on a cohort of 7788 subjects. Static and dynamic foot measures change differently during growth and maturation. Dynamic foot measurements provide additional information about the children's foot compared to static measures.
Intrasession reliability of insole in-shoe plantar pressure measurements in different foot areas
(2012)
Ultrasound evaluation of the patellar tendon cross-sectional area and its relation to maximum force
(2012)
Test-retest-reliability of metabolic and cardiovascular load during isokinetic strength testing
(2012)
Background Preparticipation examinations (PPE) are frequently used to evaluate eligibility for competitive sports in adolescent athletes. Nevertheless, the effectiveness of these examinations is under debate since costs are high and its validity is discussed controversial.
Purpose To analyse medical findings and consequences in adolescent athletes prior to admission to a sports school.
Methods In 733 adolescent athletes (318 girls, 415 boys, age 12.3+/-0.4, 16 sports disciplines), history and clinical examination (musculoskeletal, cardiovascular, general medicine) was performed to evaluate eligibility. PPE was completed by determination of blood parameters, ECG at rest and during ergometry, echocardiography and x-rays and ultrasonography if indicated. Eligibility was either approved or rated with restriction. Recommendations for therapy and/or prevention were given to the athletes and their parents.
Results Historical (h) and clinical (c) findings (eg, pain, verified pathologies) were more frequent regarding the musculoskeletal system (h: 120, 16.4%; c: 247, 33.7%) compared to cardiovascular (h: 9, 1.2%; c: 23, 3.1%) or general medicine findings (h: 116, 15.8%; c: 71, 9.7%). ECG at rest was moderately abnormal in 46 (6.3%) and severely abnormal in 25 athletes (3.4%). Exercise ECG was suspicious in 25 athletes (3.4%). Relevant echocardiographic abnormalities were found in 17 athletes (2.3%). In 52 of 358 cases (14.5%), x-rays led to diagnosis (eg, Spondylolisthesis). Eligibility was temporarily restricted in 41 athletes (5.6%). Three athletes (0.4%) had to be excluded from competitive sports. Therapy (eg, physiotherapy, medication) and/or prevention (sensorimotor training, vaccination) recommendations were deduced due to musculoskeletal (t:n = 76,10.3%; p:n = 71,9.8%) and general medicine findings (t:n = 80, 10.9%; p:n = 104, 14.1%).
Conclusion Eligibility for competitive sports is restricted in only 5.5% of adolescent athletes at age 12. Eligibility refusals are rare. However, recommendations for therapy and prevention are frequent, mainly regarding the musculoskeletal system. In spite of time and cost consumption, adolescent preparticipation before entering a career in high-performance sports is supported.
Dietary records are often biased, especially those of overweight individuals. The purpose of the study was to investigate underreporting among persons of normal weight with a very high energy intake (El).
The total energy expenditure (TEE) of 16 elite athletes (BMI 24 +/- 2 kg/m(2)) and 17 controls (BMI 23 3 kg/m2) was measured using the doubly-labeled water technique (DLW, 14d). El was estimated using 2 x 3-day dietary records. Underreporters were identified by BLACK'S cut-off (El:TEE < 0.76). 44% of athletes (El: 3584 824 kcal/d; TEE: 4621 1460 kcal/d) and 29% of controls (El: 2552 680 kcal/d; TEE: 3151 822 kcal/d) were identified as underreporters. TEE explains 52% of underreporting. In summary, a high energy intake seems to strongly predict underreporting. Prevalence and magnitude of underreporting increase with increasing energy intake.
The study was conducted to investigate the quantity and the main food sources of carbohydrate (CHO) intake of junior elite triathletes during a short-term moderate (MOD; 12 km swimming, 100 km cycling, 30 km running per wk) and intensive training period (INT; 23 km swimming, 200 km cycling, 45 km running per wk). Self-reported dietary-intake data accompanied by training protocols of 7 male triathletes (18.1 +/- 2.4 yr, 20.9 +/- 1.4 kg/m(2)) were collected on 7 consecutive days during both training periods in the same competitive season. Total energy and CHO intake were calculated based on the German Food Database. A paired t test was applied to test for differences between the training phases (alpha = .05). CHO intake was slightly higher in INT than in MOD (9.0 +/- 1.6 g . kg(-1) . d(-1) vs. 7.8 +/- 1.6 g . kg(-1) . d(-1); p = .041). Additional CHO in INT was mainly ingested during breakfast (115 +/- 37 g in MOD vs. 175 +/- 23 g in INT; p = .002) and provided by beverages (280.5 +/- 97.3 g/d vs. 174.0 +/- 58.3 g/d CHO; p = .112). Altogether, main meals provided approximately two thirds of the total CHO intake. Pre- and postexercise snacks additionally supplied remarkable amounts of CHO (198.3 +/- 84.3 g/d in INT vs. 185.9 +/- 112 g/d CHO in MOD; p = .231). In conclusion, male German junior triathletes consume CHO in amounts currently recommended for endurance athletes during moderate to intensive training periods. Main meals provide the majority of CHO and should therefore not be skipped. CHO-containing beverages, as well as pre- and postexercise snacks, may provide a substantial amount of CHO intake in training periods with high CHO requirements.
In dynamic H-reflex measurements, the standardisation of the nerve stimulation to the gait cycle is crucial to avoid misinterpretation due to altered pre-synaptic inhibition. In this pilot study, a plantar pressure sole was used to trigger the stimulation of the tibialis nerve with respect to the gait cycle. Consequently, the intersession reliability of the soleus muscle H-reflex during treadmill walking was investigated.
Seven young participants performed walking trials on a treadmill at 5 km/h. The stimulating electrode was placed on the tibial nerve in the popliteal fossa. An EMG was recorded from the soleus muscle. To synchronize the stimulus to the gait cycle, initial heel strike was detected with a plantar pressure sole. Maximum H-reflex amplitude and M-wave amplitude were obtained and the Hmax/Mmax ratio was calculated.
Data reveals excellent reliability, ICC = 0.89. Test-retest variability was 13.0% (+/- 11.8). The Bland-Altman analysis showed a systematic error of 2.4%.
The plantar pressure sole was capable of triggering the stimulation of the tibialis nerve in a reliable way and offers a simple technique for the evaluation of reflex activity during walking.
Introduction: Gait speed is one of the most commonly and frequently used parameters to evaluate gait development. It is characterized by high variability when comparing different steps in children. The objective of this study was to determine intra-individual gait speed variability in children.
Methods: Gait speed measurements (6-10 trials across a 3 m walkway) were performed and analyzed in 8263 children, aged 1-15 years. The coefficient of variation (CV) served as a measure for intra-individual gait speed variability measured in 6.6 +/- 1.0 trials per child. Multiple linear regression analysis was conducted to evaluate the influence of age and body height on changes in variability. Additionally, a subgroup analysis for height within the group of 6-year-old children was applied.
Results: A successive reduction in gait speed variability (CV) was observed for age groups (age: 1-15 years) and body height groups (height: 0.70-1.90 m). The CV in the oldest subjects was only one third of the CV (CV 6.25 +/- 3.52%) in the youngest subjects (CV 16.58 +/- 10.01%). Up to the age of 8 years (or 1.40 m height) there was a significant reduction in CV over time, compared to a leveling off for the older (taller) children.
Discussion: The straightforward approach measuring gait speed variability in repeated trials might serve as a fundamental indicator for gait development in children. Walking velocity seems to increase to age 8. Enhanced gait speed consistency of repeated trials develops up to age 15.
Aim: The aim of this cross-sectional study was to assess the frequency of tendinopathy-typical Doppler sonographic changes in the Achilles tendons of long distance runners and to correlate these findings with anamnestic and anthropometric data of the subjects. Materials and Methods: 1906 Achilles tendons of 953 long distance runners were examined by ultrasound and power Doppler (Toshiba Aplio SSA-770A/80 12 MHz). Ultrasound images (spindle-shaped thickening, hypoechoic/hyperechoic lesions, neovascularizations) were analyzed in relation to the runners' anthropometrical data and history of Achilles tendon complaints. Results: In asymptomatic runners as well as in the overall group, there was a statistically significant correlation between tendon thickness and age, height and weight (CC 0.24 - 0.38, p < 0.001). Runners with current or healed Achilles tendon complaints displayed a statistically significant thickening of the tendons, as well as an increase in hypoechoic lesions and neovascularizations (p < 0.001). While grayscale abnormalities were rarely found in asymptomatic runners (< 10%), neovascularization was detected in 35% of healthy test persons using the high-resolution power Doppler "Advanced Dynamic Flow". Conclusion: Contrary to frequent assumption, neovascularization is often found in tendons of asymptomatic runners, using modern power Doppler equipment. The pathological relevance of single microvessels in asymptomatic tendons must, therefore, be critically discussed.
Exercise may increase reactive oxygen species production, which might impair cell integrity and contractile function of muscle cells. However, little is known about the effect of regular exercise on the antioxidant status of adolescents. Purpose: This study aimed to evaluate the impact of exercise on the antioxidant status and protein modifications in adolescent athletes. Methods: In 90 athletes and 18 controls (16 +/- 2 yr), exercise-related energy expenditure was calculated on the basis of a 7-d activity protocol. Antioxidant intake and plasma concentrations of alpha-tocopherol, carotenoids, and uric acid were analyzed. Plasma antioxidant activity was determined by Trolox equivalent (TE) antioxidant capacity and electron spin resonance spectrometry. Protein modifications were assessed with structural changes of transthyretin using a matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Data were analyzed by two-way ANOVA and post hoc by the Tukey-Kramer test (alpha = 0.05). Results: Antioxidant intake correlated with energy intake and was within the recommended daily allowance for vitamins C and E and beta-carotene. Plasma levels of neither nutritional antioxidants nor uric acid differed between the groups. TE antioxidant capacity was higher in athletes (men = 1.47 perpendicular to 0.2 mmol TE per liter, women = 1.45 perpendicular to 0.2 mmol TE per liter) compared with controls (men = 1.17 +/- 0.04 mmol TE per liter, women = 1.14 +/- 0.04 mmol TE per liter) and increased with exercise-related energy expenditure (P = 0.007). Transthyretin cysteinylation rate differed between the groups, with the highest rate of protein modifications in moderately active subjects (P = 0.007). Conclusions: Results suggest that if the nutritional choice of athletes is well balanced, enough antioxidants are provided to meet recommended amounts. Moreover, regular exercise increases blood antioxidant capacity in young athletes, whereas chronic exercise was not shown to promote protein modifications. Thus, in young athletes who are sufficiently supplied with antioxidants, beneficial effects of exercise on antioxidant status rather than on oxidative stress may be anticipated.
Background: Gender-specific neuromuscular activity for the ankle (e.g., peroneal muscle) is currently not known. This knowledge may contribute to the understanding of overuse injury mechanisms. The purpose was therefore to analyse the neuromuscular activity of the peroneal muscle in healthy runners. Methods: Fifty-three male and 54 female competitive runners were tested on a treadmill at 3.33 m s(-1). Neuromuscular activity of the M. peroneus longus was measured by electromyography and analysed in the time domain (onset of activation, time of maximum of activation, total time of activation) in % of stride time in relation to touchdown (= 1.0). Additionally, mean amplitudes for the gait cycle phases preactivation, weight acceptance and push-off were calculated and normalised to the mean activity of the entire gait cycle. Findings: Onset of activation (mean; female: 0.86/male: 0.90, p<0.0001) and time of maximum of activation (female: 1.13/male: 1.16, p<0.0001) occurred earlier in female compared to male and the total time of activation was longer in women (female: 0.42/male: 0.39, p=0.0036). In preactivation, women showed higher amplitudes (+ 21%) compared to men (female: 1.16/male: 0.92, p<0.0001). Activity during weight acceptance (female: 2.26/male: 2.41, p = 0.0039) and push-off (female: 0.93/male: 1.07, p = 0.0027) were higher in men. Interpretation: Activation strategies of the peroneal muscle appear to be gender-specific. Higher preactivation amplitudes in females indicate a different neuromuscular control in anticipation of touchdown ("pre-programmed activity"). These data may help interpret epidemiologically reported differences between genders in overuse injury frequency and localisation.
Background
Recently, the incidence rate of back pain (BP) in adolescents has been reported at 21%. However, the development of BP in adolescent athletes is unclear. Hence, the purpose of this study was to examine the incidence of BP in young elite athletes in relation to gender and type of sport practiced.
Methods
Subjective BP was assessed in 321 elite adolescent athletes (m/f 57%/43%; 13.2 ± 1.4 years; 163.4 ± 11.4 cm; 52.6 ± 12.6 kg; 5.0 ± 2.6 training yrs; 7.6 ± 5.3 training h/week). Initially, all athletes were free of pain. The main outcome criterion was the incidence of back pain [%] analyzed in terms of pain development from the first measurement day (M1) to the second measurement day (M2) after 2.0 ± 1.0 year. Participants were classified into athletes who developed back pain (BPD) and athletes who did not develop back pain (nBPD). BP (acute or within the last 7 days) was assessed with a 5-step face scale (face 1–2 = no pain; face 3–5 = pain). BPD included all athletes who reported faces 1 and 2 at M1 and faces 3 to 5 at M2. nBPD were all athletes who reported face 1 or 2 at both M1 and M2. Data was analyzed descriptively. Additionally, a Chi2 test was used to analyze gender- and sport-specific differences (p = 0.05).
Results
Thirty-two athletes were categorized as BPD (10%). The gender difference was 5% (m/f: 12%/7%) but did not show statistical significance (p = 0.15). The incidence of BP ranged between 6 and 15% for the different sport categories. Game sports (15%) showed the highest, and explosive strength sports (6%) the lowest incidence. Anthropometrics or training characteristics did not significantly influence BPD (p = 0.14 gender to p = 0.90 sports; r2 = 0.0825).
Conclusions
BP incidence was lower in adolescent athletes compared to young non-athletes and even to the general adult population. Consequently, it can be concluded that high-performance sports do not lead to an additional increase in back pain incidence during early adolescence. Nevertheless, back pain prevention programs should be implemented into daily training routines for sport categories identified as showing high incidence rates.
Background
Recently, the incidence rate of back pain (BP) in adolescents has been reported at 21%. However, the development of BP in adolescent athletes is unclear. Hence, the purpose of this study was to examine the incidence of BP in young elite athletes in relation to gender and type of sport practiced.
Methods
Subjective BP was assessed in 321 elite adolescent athletes (m/f 57%/43%; 13.2 ± 1.4 years; 163.4 ± 11.4 cm; 52.6 ± 12.6 kg; 5.0 ± 2.6 training yrs; 7.6 ± 5.3 training h/week). Initially, all athletes were free of pain. The main outcome criterion was the incidence of back pain [%] analyzed in terms of pain development from the first measurement day (M1) to the second measurement day (M2) after 2.0 ± 1.0 year. Participants were classified into athletes who developed back pain (BPD) and athletes who did not develop back pain (nBPD). BP (acute or within the last 7 days) was assessed with a 5-step face scale (face 1–2 = no pain; face 3–5 = pain). BPD included all athletes who reported faces 1 and 2 at M1 and faces 3 to 5 at M2. nBPD were all athletes who reported face 1 or 2 at both M1 and M2. Data was analyzed descriptively. Additionally, a Chi2 test was used to analyze gender- and sport-specific differences (p = 0.05).
Results
Thirty-two athletes were categorized as BPD (10%). The gender difference was 5% (m/f: 12%/7%) but did not show statistical significance (p = 0.15). The incidence of BP ranged between 6 and 15% for the different sport categories. Game sports (15%) showed the highest, and explosive strength sports (6%) the lowest incidence. Anthropometrics or training characteristics did not significantly influence BPD (p = 0.14 gender to p = 0.90 sports; r2 = 0.0825).
Conclusions
BP incidence was lower in adolescent athletes compared to young non-athletes and even to the general adult population. Consequently, it can be concluded that high-performance sports do not lead to an additional increase in back pain incidence during early adolescence. Nevertheless, back pain prevention programs should be implemented into daily training routines for sport categories identified as showing high incidence rates.
Background
Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1-12 years.
Methods
A total of 10382 children aged one to twelve years were enrolled in the study. Finally, 7575 children (m/f: n = 3630/3945; 7.0 +/- 2.9yr; 1.23 +/- 0.19m; 26.6 +/- 10.6kg; BMI: 17.1 +/- 2.4kg/m(2)) were included for (complete case) data analysis. Children were categorized to normalweight (>= 3rd and <90th percentile; n = 6458), overweight (>= 90rd and <97th percentile; n = 746) or obese (>97th percentile; n = 371) according to the German reference system that is based on age and gender-specific body mass indices (BMI). Plantar pressure measurements were assessed during gait on an instrumented walkway. Contact area, arch index (AI), peak pressure (PP) and force time integral (FTI) were calculated for the total, fore-, mid-and hindfoot. Data was analyzed descriptively (mean +/- SD) followed by ANOVA/Welch-test (according to homogeneity of variances: yes/no) for group differences according to BMI categorization (normal-weight, overweight, obesity) and for each age group 1 to 12yrs (post-hoc Tukey Kramer/Dunnett's C; alpha = 0.05).
Results
Mean walking velocity was 0.95 +/- 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p< 0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight.
Conclusion
Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children.
Background
Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1-12 years.
Methods
A total of 10382 children aged one to twelve years were enrolled in the study. Finally, 7575 children (m/f: n = 3630/3945; 7.0 +/- 2.9yr; 1.23 +/- 0.19m; 26.6 +/- 10.6kg; BMI: 17.1 +/- 2.4kg/m(2)) were included for (complete case) data analysis. Children were categorized to normalweight (>= 3rd and <90th percentile; n = 6458), overweight (>= 90rd and <97th percentile; n = 746) or obese (>97th percentile; n = 371) according to the German reference system that is based on age and gender-specific body mass indices (BMI). Plantar pressure measurements were assessed during gait on an instrumented walkway. Contact area, arch index (AI), peak pressure (PP) and force time integral (FTI) were calculated for the total, fore-, mid-and hindfoot. Data was analyzed descriptively (mean +/- SD) followed by ANOVA/Welch-test (according to homogeneity of variances: yes/no) for group differences according to BMI categorization (normal-weight, overweight, obesity) and for each age group 1 to 12yrs (post-hoc Tukey Kramer/Dunnett's C; alpha = 0.05).
Results
Mean walking velocity was 0.95 +/- 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p< 0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight.
Conclusion
Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children.