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Pedro L Valenzuela,1 Nicola A Maffiuletti,2 Hugo Saner,3,4 Narayan Schütz,4 Beatrice Rudin,5 Tobias Nef,6 Prabitha Urwyler4,6,7 1Department of Systems Biology, University of Alcalá, Madrid, Spain; 2Human Performance Lab, Schulthess Clinic, Zurich, Switzerland; 3Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; 4Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; 5Höhere Fachschule Pflege, Berufsbildungszentrum Olten, Olten, Switzerland; 6ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; 7Department of Neurology, University Neurorehabilitation Unit, University Hospital Inselspital, Bern, SwitzerlandCorrespondence: Prabitha UrwylerUniversity of Bern, ARTORG Center for Biomedical Engineering Research, Murtenstrasse 50, Bern 3008, SwitzerlandTel +41 31 632 76 07Email prabitha.urwyler@artorg.unibe.chBackground: Isometric strength measures and timed up and go (TUG) tests are both recognized as valuable tools for fall prediction in older adults. However, results from direct comparison of these two tests are lacking. We aimed to assess the potential of isometric strength measures and the different modalities of the TUG test to detect individuals at risk of falling.Methods: This is a prospective cohort study including 24 community-dwelling older adults (≥ 65 years, 19 females, 88± 7 years). Participants performed three variations of the TUG test (standard, counting and holding a full cup) and three isometric strength tests (handgrip, knee extension and hip flexion) at several time points (at baseline and every ∼ 6 weeks) during a one-year follow-up. The association between these tests and the incidence of falls during the follow-up was assessed.Results: Twelve participants out of 24 participants experienced falls during the follow-up. Fallers showed a significantly lower handgrip strength (− 5.7 kg, 95% confidence interval: − 10.4 to − 1.1, p=0.019) and knee extension strength (− 4.9 kg, − 9.6 to − 0.2, p=0.042) at follow-up, while no significant differences were found for any TUG variation.Conclusions: Handgrip and knee extension strength measures – particularly when assessed regularly over time – have the potential to serve as a simple and easy tool for detecting individuals at risk of falling as compared to functional mobility measures (ie, TUG test).Keywords: functional assessment, geriatrics, elderly, physical performance, muscle strength, sarcopenia

ObjectiveTo summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis.DesignWe conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment.ResultsNine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion).ConclusionsVarious radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.

This study compared between maximal voluntary (VOL) and electrically stimulated (ES) isometric contractions of the elbow flexors for changes in indirect markers of muscle damage to investigate whether ES would induce greater muscle damage than VOL. Twelve non-resistance-trained men (23-39 years) performed VOL with one arm and ES with the contralateral arm separated by 2 weeks in a randomised, counterbalanced order. Both VOL and ES (frequency 75 Hz, pulse duration 250 μs, maximally tolerated intensity) exercises consisted of 50 maximal isometric contractions (4-s on, 15-s off) of the elbow flexors at a long muscle length (160°). Changes in maximal voluntary isometric contraction torque (MVC), range of motion, muscle soreness, pressure pain threshold and serum creatine kinase (CK) activity were measured before, immediately after and 1, 24, 48, 72 and 96 h following exercise. The average peak torque over the 50 isometric contractions was greater (P < 0.05) for VOL (32.9 ± 9.8 N m) than ES (16.9 ± 6.3 N m). MVC decreased greater and recovered slower (P < 0.05) after ES (15% lower than baseline at 96 h) than VOL (full recovery). Serum CK activity increased (P < 0.05) only after ES, and the muscles became more sore and tender after ES than VOL (P < 0.05). These results showed that ES induced greater muscle damage than VOL despite the lower torque output during ES. It seems likely that higher mechanical stress imposed on the activated muscle fibres, due to the specificity of motor unit recruitment in ES, resulted in greater muscle damage. [ABSTRACT FROM AUTHOR]

Background: Quadriceps muscle strength, which is essential for the function and stability of the knee, has been found to be impaired even years after arthroscopic partial meniscectomy. However, the neuromuscular alterations that could account for such muscle weakness remain unclear.Questions/purposes: We investigated (1) the side-to-side asymmetries in quadriceps muscle strength 6 months after arthroscopic partial meniscectomy, (2) the physiologic mechanisms (neural versus muscular) underlying muscle weakness, and (3) the impact of quadriceps weakness on muscle control at submaximal force levels.Patients and Methods: We tested 14 volunteers (10 men, four women) with an average age of 44 +/- 9 years (range, 24-59 years) at 6 +/- 1 months after unilateral medial arthroscopic partial meniscectomy. We measured maximal voluntary strength and muscle activation during isometric, concentric, and eccentric contractions using isokinetic dynamometry and surface EMG, respectively. We assessed vastus lateralis muscle size and architecture using ultrasonography. We measured muscle control at submaximal force levels with a repositioning test (knee proprioception) and a low-force target-tracking task (steadiness, accuracy).Results: Isometric and concentric quadriceps strength and vastus lateralis EMG activity were lower on the involved than on the uninvolved side. Muscle architecture and muscle control did not differ between the involved and uninvolved sides.Conclusions: Our results showed quadriceps weakness exists 6 months after arthroscopic partial meniscectomy. As suggested by the EMG results, this is likely attributable to neural impairments (activation failure) that affect muscle control at maximal but not submaximal force outputs.Level Of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

PURPOSE: Postactivation potentiation (PAP), i.e., the increase in twitch torque following a maximal voluntary conditioning contraction, has been shown to depend on muscle contractile conditions (e.g., muscle length). Few studies, however, have investigated the extent of twitch PAP under dynamic conditions in human subjects. Therefore, the aim of the present experiment was to test the twitch PAP during passive dynamic movements following isometric conditioning contractions on nine healthy men. METHODS: Maximal twitches were evoked on the knee extensor muscles before and exactly 5 s after a 3-s conditioning maximal voluntary isometric contraction. PAP was determined at a constant joint angle under isometric conditions, during and immediately after passive shortening and lengthening with slow and fast angular velocities (30 and 150 degrees .s). RESULTS: Our results indicate a significant PAP increase with increasing shortening angular velocity (34.6 +/- 13.2% and 51.9 +/- 21.1% at 30 degrees .s and 150 degrees .s velocities, respectively), whereas PAP was significantly lower during lengthening (15.2 +/- 15.2%) as compared with isometric conditions (28.5 +/- 18.3%). Similar results were obtained when PAP was determined isometrically but immediately following passive shortening or lengthening (30 degrees .s). CONCLUSION: These data indicate that PAP affects dynamic torque production capacity and that PAP is dependent on contractile conditions. Furthermore, the similar extent of PAP during and immediately after passive movements suggests a PAP history dependency. Our results therefore suggest that PAP is recommended more for improving shortening performance than for lengthening. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare voluntary and electrically evoked knee extensor torque, surface electromyography (EMG), and activation level obtained under seated versus supine position, i.e., with shortened versus lengthened rectus femoris (RF) muscle. METHODS: The knee extensor torque obtained during maximal voluntary contractions (MVC) and after single and paired stimuli applied at rest was measured under seated (i.e., 90 degrees hip angle) and supine (i.e., 180 degrees hip angle) conditions. The associated EMG activity from biarticular RF and monoarticular vasti was also recorded, and activation level was estimated by means of the twitch interpolation technique. RESULTS: Knee extensor MVC was 10.6% higher in the seated compared with the supine position (P < 0.01). EMG normalized to the M-wave amplitude for respective muscles and for respective positions was significantly lower under supine conditions, and deficits averaged approximately 20% for vasti and approximately 41% for RF (P < 0.05). Similarly, activation level estimated in the supine position was approximately 4% lower than the seated counterpart. Relative MVC losses observed supinely were significantly correlated with the corresponding activation level deficits (P < 0.05). On the other hand, both single and paired stimuli resulted in higher torque amplitudes in the supine with respect to the seated position, and mean differences were comprised between 10% (single twitch, P < 0.05) and 20% (potentiated doublet, P < 0.001). RF M-wave amplitude recorded supinely was 19% higher than the seated counterpart (P < 0.01). CONCLUSION: The higher neural activation observed for the knee extensor muscles in the seated versus supine position, likely attributable to improved motor unit recruitment, may reflect a neurophysiological mechanism partly compensating the neuromuscular transmission-propagation impairment and/or mechanical disadvantage of shortened RF muscle. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to examine the construct validity of the 7-point Likert scale of muscle soreness, assessing its relationship with Visual Analogue Scale (VAS). An additional aim was to examine its sensitivity as measure of symptom of eccentric-contraction muscle damage. DESIGN: Correlational study. SETTING: Self-administered questionnaires collected in field setting. PARTICIPANTS: Twenty-six soccer players. INTERVENTIONS: 4-week preseason training camp, which included high-intensity plyometric training sessions. MAIN OUTCOME MEASUREMENTS: Players self-reported the perceived muscle soreness of the lower limbs using the VAS (criterion measure) and the 7-point Likert scale of muscle soreness. RESULTS: Significant individual correlations were found between the 2 muscle soreness scales (mean r=0.80+/-0.07; range, 0.65 to 0.94). The correlation using the pooled data was 0.81. No significant muscle soreness scale x time interaction was found for standardized measures of muscle soreness (P=0.98). The main factor for time (24, 48, 72, and 96 hours after the first plyometric training session) was significant (P=0.0001). Effect sizes for the changes in the Likert and VAS absolute scores during the first 96 hours were similar (partial eta=0.13). CONCLUSIONS: The results of this study provide further convergent evidence for the construct validity of the 7-point Likert scale of muscle soreness. The 2 scales showed similar sensitivity to muscle soreness caused by eccentric contractions during the first 96 hours after plyometric exercises. [ABSTRACT FROM AUTHOR]

Abstract: Gereduz Agapito, L, Brownstein, CG, and Maffiuletti, NA. Effects of soccer match-play on muscle strength, physical performance, and perceptual responses in elite female players. J Strength Cond Res 39(1): 79-85, 2025-The purpose of this study was to investigate the impact of actual soccer match-play on muscle strength, physical performance, and perceptual responses in elite female players. Twelve Swiss elite players were tested before (pre), after (post) and 48 hours after a 90-minute soccer match for knee and hip muscle strength, vertical jump height, and sprint time. Perceptual responses were also evaluated up to 72 hours postmatch with a self-reported questionnaire. Muscle strength, jump, and sprint performance were impaired at post compared with pre (p < 0.001), but fully recovered at 48 hours. Percent strength losses were higher for knee flexors (∼20%) compared with both hip adductors (∼12%; p = 0.005) and abductors (8-12%; p < 0.001), and for knee extensors compared with hip abductors (p = 0.013). Regardless of muscle group, strength losses were higher on the dominant than on the nondominant side (p = 0.010). Most perceptual responses were altered after the match (p < 0.001) and some items such as motivation to train and readiness to play remained unrecovered at 72 hours (p < 0.01). Soccer match-play induced a significant decline of knee and hip muscle strength in elite female players that was more marked for knee flexors than for hip muscles. This was accompanied by performance impairments and by altered perceptual responses that still persisted 72 hours after the match. These findings offer implications for the optimization of postmatch recovery strategies in elite female soccer players., (Copyright © 2024 National Strength and Conditioning Association.)

Background: Hip osteoarthritis patients display higher levels of fatty infiltration (FI) in the gluteus minimus (GM) compared to other hip muscles. We investigated specific histological factors such as fiber type composition and collagen deposition, and functional outcomes like muscle strength and activation associated with FI in these patients., Methods: In twelve men (67 ± 6 y) undergoing total hip replacement (THR), hip and knee muscle strength and activation (electromyography, EMG) were assessed bilaterally. Magnetic resonance imaging (MRI) was used to compare the relative FI area and muscle cross sectional area (CSA) of the GM, rectus femoris (RF), tensor fascia latae (TFL) and vastus lateralis (VL). Adipocyte content, fiber type composition, grouping, fiber size, centrally nucleated fiber frequency, collagen deposition, satellite cell density and capillarization were assessed in intraoperative biopsies of the four muscles. Differences between GM and other muscles were assessed with repeated-measures one-way ANOVA followed by Dunnett's post-hoc test. Pearson coefficients were calculated for the correlations between FI measurements and the other histological and functional parameters., Results: Strength was lower in the affected limb. Knee extensor weakness was accompanied by lower VL muscle activation. Muscle CSA and FI did not differ between sides. In the affected limb, GM displayed larger relative FI area (MRI) compared to RF and VL. Biopsy adipocyte content was higher in GM than RF and TFL. Compared to the other hip muscles, GM displayed higher type 1 fiber content while its type 2X fiber content was lower. Fiber grouping levels were higher in GM than the other muscles. Collagen content was higher in GM than TFL and VL.  FI in GM was associated with type 1 (r = 0.43) and type 2X (r = -0.34) fiber content, fiber grouping (r = 0.39), and collagen deposition (r = 0.37). FI in VL was negatively associated with maximal knee extension strength (r = -0.65)., Conclusions: In patients undergoing THR, the higher FI levels of GM compared to other hip muscles were associated with fiber type composition and grouping, and with higher collagen deposition. Experimental studies exploring these associations could potentially uncover new targets for the treatment of intramuscular FI and related impairments in muscle function., Trial Registration: KEK number: 2016-01852, date of registration: 12-4-2017., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted according to the Declaration of Helsinki and the protocol was approved by the Ethics Committee of the Canton of Zurich (KEK number: 2016–01852). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Acoustical knee health assessment has long promised an alternative to clinically available medical imaging tools, but this modality has yet to be adopted in medical practice. The field is currently led by machine learning models processing acoustical features, which have presented promising diagnostic performances. However, these methods overlook the intricate multi-source nature of audio signals and the underlying mechanisms at play. By addressing this critical gap, the present paper introduces a novel causal framework for validating knee acoustical features. We argue that current machine learning methodologies for acoustical knee diagnosis lack the required assurances and thus cannot be used to classify acoustic features as biomarkers. Our framework establishes a set of essential theoretical guarantees necessary to validate this claim. We apply our methodology to three real-world experiments investigating the effect of researchers' expectations, the experimental protocol, and the wearable employed sensor. We reveal latent issues such as underlying shortcut learning and performance inflation. This study is the first independent result reproduction study in acoustical knee health evaluation. We conclude by offering actionable insights that address key limitations, providing valuable guidance for future research in knee health acoustics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study was to investigate the effect of vastus lateralis (VL) selective fatigue induced by neuromuscular electrical stimulation (NMES) on knee extensor electromyographic (EMG) activity during a sustained submaximal isometric contraction., Methods: Thirteen healthy men (28 ± 5 years) completed two experimental sessions in which either the VL was pre-fatigued for 17 min (NMES session) or no intervention was performed (control session, CTRL). Subsequently, participants were asked to sustain an isometric knee extension at 20 % of maximal voluntary contraction (MVC) torque until task failure., Results: VL M-wave amplitude was reduced (-34 ± 26 %, P = 0.008) following the NMES intervention, while MVC torque was reduced by 26 ± 10 %. The time to task failure was 23 ± 10 % shorter (P = 0.002) in NMES (186 ± 75 s) than in CTRL (251 ± 128 s). EMG activity measured during the sustained contraction was higher for vastus medialis and rectus femoris muscles in NMES compared to CTRL (P < 0.001), but was comparable for VL (P > 0.05). The extent and origin of neuromuscular fatigue at task failure measured through MVCs combined with electrically-evoked contractions did not differ between NMES and CTRL., Conclusion: Compensatory activity from synergist muscles occurred in response to a pre-fatigue intervention, which reduced the time to task failure of a sustained submaximal contraction but did not affect the extent and origin of neuromuscular fatigue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Hip and groin problems are common among team-sport athletes. However, few studies have been conducted in female athletes that have used the Doha Agreement classification system to categorize these problems., Purpose: The purpose of this study was to examine the preseason point prevalence of hip and groin problems in elite female team-sport athletes. Secondary aims were to categorize the groin problems according to the Doha Agreement classification system and to explore the association between hip muscle strength and self-reported hip and groin function., Study Design: Cross-sectional study., Methods: Female athletes who participated in various sports underwent preseason assessment of isometric hip adduction and abduction strength, with pain levels recorded during respective contractions, and self-reported function on the Copenhagen Hip and groin Outcome Score (HAGOS). If any athlete reported current hip and groin problems during this screening assessment, a full, standardized clinical hip and groin examination was undertaken. These hip and groin problems were then categorized according to the Doha Agreement classification system. Comparisons between the participants with vs without hip and groin problems were made, and correlational statistics were used to examine relationships between strength and HAGOS scores., Results: Ninety-one elite female athletes from six different sports were included in the study. Thirteen athletes reported current hip and groin problems, with an overall prevalence rate of 14.3%. Iliopsoas-related groin pain was the most common category diagnosed, accounting for 58.8% of cases, followed by hip-related groin pain (17.6%), adductor-related (11.8%), and inguinal- and pubic-related pain (both 5.9%). No association was found between strength and function., Conclusion: The hip and groin point prevalence in female athletes documented during preseason appears to be similar to those reported in male athletes. Iliopsoas-related groin pain was the most common clinical entity reported in female athletes in this study. There was no association between hip muscle strength and self-reported hip and groin function., Level of Evidence: 3b., Competing Interests: The authors report no conflicts of interest., (© The Author(s).)

Objective: To examine the specificities and limitations of bilateral and unilateral tasks for the assessment of hip abductor and adductor strength with a commercially-available fixed-frame dynamometer., Design: Correlational/validity study., Methods: Maximal voluntary isometric strength of hip abductors and adductors was evaluated in 130 healthy participants using unilateral and bilateral tasks. Surface EMG activity of agonist and stabilizer muscles was concomitantly recorded in a subgroup of 15 participants., Results: For both muscle groups, bilateral tasks resulted in higher strength values than unilateral tasks (∼25%; p < 0.001). The correlation between left- and right-side data was higher for bilateral than unilateral tasks (p < 0.05), thereby resulting in lower interlimb asymmetries (p < 0.001). Agonist EMG activity was lower for unilateral than bilateral tasks (p < 0.01). Stabilizer EMG activity (external abdominal oblique) was higher for unilateral than bilateral tasks (p < 0.05) on the ipsilateral and contralateral side for hip abductors and adductors, respectively., Conclusions: A large (25%) and quasi-systematic bilateral facilitation of strength was observed for both hip abductors and adductors. Bilateral testing led to an underestimation of interlimb asymmetries, due to higher side equivalence than unilateral tasks. Unilateral testing resulted in lower agonist EMG activity and higher stabilizer activity than bilateral tasks, especially in weaker subjects., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Wide-pulse high-frequency neuromuscular electrical stimulation (WPHF NMES) can generate a progressive increase in tetanic force through reflexive recruitment of motor units, called extra force. This phenomenon has previously been observed on different muscle groups, but little is known on potential inter-muscle differences. We compared extra force and sustained electromyographic (EMG) activity induced by NMES between plantar flexors, knee extensors, elbow flexors and within muscle groups using pulse durations of 0.2, 1 and 2 ms and stimulation frequencies of 20, 50, 100 and 147 Hz. Extra force production and sustained EMG activity were higher for plantar flexors compared to elbow flexors at all tested parameters (except 0.2 ms for extra force). When compared to elbow flexors, extra force of the knee extensors was only higher at 100 Hz and with 1 ms while sustained EMG activity was higher at all frequencies with pulse durations of 0.2 and 2 ms. Peripheral nerve architecture as well as muscle typology and function could influence the occurrence and magnitude of centrally-mediated responses to NMES. The present findings suggest that the use of wide-pulse high-frequency NMES to promote reflexive recruitment seems to be more pertinent for lower limb muscles, plantar flexors in particular., (© 2024. The Author(s).)

Context: The evaluation of quadriceps muscle inhibition with the interpolated twitch technique is usually performed by stimulating the femoral nerve (FN). However, there are some problems related to the use of this stimulation site, which may be partially overcome by delivering the stimulation over the motor point (MP). This study sought to compare MP to FN stimulation at different joint angles for the evaluation of quadriceps muscle inhibition, resting peak torque, and discomfort in healthy women., Design: Cross-sectional study., Methods: Sixteen healthy women (age: 28 [4] y; body mass: 60 [5] kg; height: 162 [5] cm) participated in this study. Supramaximal paired stimuli were delivered to the FN and to the rectus femoris MP before and during maximal voluntary contractions at different knee angles (15°, 30°, 45°, 60°, and 90° of knee flexion) to assess muscle inhibition and resting peak torque. Discomfort was also recorded for each stimulation site and knee angle., Results: Muscle inhibition was similar between the 2 stimulation sites (P > .05) and was higher at 45° than at 90° (P = .03). MP stimulation evoked lower resting peak torque at 30° (P = .004), 60° (P = .006), and 90° (P = .006) and higher discomfort at 30° (P = .008) and 90° (P = .027) compared to FN stimulation., Conclusions: Despite lower resting peak torque and higher discomfort at some angles, MP stimulation provided similar muscle inhibition to FN stimulation at all knee angles and is therefore a valid method to evaluate quadriceps muscle inhibition in healthy women. MP stimulation can be used as an alternative to FN stimulation for the evaluation of quadriceps muscle inhibition with no added discomfort at the angles where muscle inhibition is the highest.

Background: Haglund exostosis-related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists., Methods: Fifteen patients (15 feet) with Haglund exostosis-related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed., Results: Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as "helped" or "helped a lot" (Global Treatment Outcome)., Conclusion: In this relatively small cohort, we found that patients treated for Haglund exostosis-related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up., Level of Evidence: Level II, observational prospective cohort study., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

Background: This study aimed to determine the effect of different carbohydrate (CHO) doses on exercise capacity in patients with McArdle disease-the paradigm of "exercise intolerance", characterized by complete muscle glycogen unavailability-and to determine whether higher exogenous glucose levels affect metabolic responses at the McArdle muscle cell (in vitro) level., Methods: Patients with McArdle disease (n = 8) and healthy controls (n = 9) underwent a 12-min submaximal cycling constant-load bout followed by a maximal ramp test 15 min after ingesting a non-caloric placebo. In a randomized, double-blinded, cross-over design, patients repeated the tests after consuming either 75 g or 150 g of CHO (glucose:fructose = 2:1). Cardiorespiratory, biochemical, perceptual, and electromyographic (EMG) variables were assessed. Additionally, glucose uptake and lactate appearance were studied in vitro in wild-type and McArdle mouse myotubes cultured with increasing glucose concentrations (0.35, 1.00, 4.50, and 10.00 g/L)., Results: Compared with controls, patients showed the "classical" second-wind phenomenon (after prior disproportionate tachycardia, myalgia, and excess electromyographic activity during submaximal exercise, all p < 0.05) and an impaired endurance exercise capacity (-51% ventilatory threshold and -55% peak power output, both p < 0.001). Regardless of the CHO dose (p < 0.05 for both doses compared with the placebo), CHO intake increased blood glucose and lactate levels, decreased fat oxidation rates, and attenuated the second wind in the patients. However, only the higher dose increased ventilatory threshold (+27%, p = 0.010) and peak power output (+18%, p = 0.007). In vitro analyses revealed no differences in lactate levels across glucose concentrations in wild-type myotubes, whereas a dose-response effect was observed in McArdle myotubes., Conclusion: CHO intake exerts beneficial effects on exercise capacity in McArdle disease, a condition associated with total muscle glycogen unavailability. Some of these benefits are dose dependent., (Copyright © 2024. Production and hosting by Elsevier B.V.)

Independent physiotherapy at home is a crucial element of rehabilitative care for a wide range of conditions as it constitutes a large portion of the overall therapy dose. However, up to 80% of individuals who are prescribed at-home physiotherapy do not consistently adhere to their treatment schedule, resulting in poor treatment outcomes. This is likely due to a lack of motivation and progress tracking in the current standard of care. We have developed a novel software prototype that allows users to control commercial entertainment content, such as video games or interactive music videos, with their movements during physiotherapy. By connecting therapy to proven entertainment content, we aim to improve on the current motivational deficits. This study investigated the safety and feasibility of this concept in a controlled environment over four physical therapy sessions with seven patients suffering from musculoskeletal and neurological conditions. As a secondary outcome, patients were asked about their enjoyment, perceived competence and effort using the Intrinsic Motivation Inventory (IMI) questionnaire. All participants were able to interact with the presented entertainment content and completed the study with no adverse events. Despite the diversity in pathology, age and training scenarios, the entertainment content maintained the patients' enjoyment with a high average rate of 6/7 on the IMI scale. Interacting with commercial entertainment content by doing physical therapy exercises was feasible, safe, and well-received over the six-week study period.

Purpose: The effectiveness of a neuromuscular electrical stimulation (NMES) program is proportional to the level of evoked torque, which can be achieved with either conventional or wide-pulse stimulations. The aim of this study was to compare evoked torque, objective fatigability, and related peripheral and central alterations, as well as changes in central nervous system (CNS) excitability induced by an acute session of conventional versus wide-pulse NMES., Methods: Seventeen young men underwent three 20-min NMES sessions: conventional (0.2 ms/50 Hz), wide-pulse at 50 Hz (1 ms/50 Hz), and wide-pulse at 100 Hz (1 ms/100 Hz). Neuromuscular measurements (i.e., maximal voluntary contraction, voluntary activation, evoked responses to femoral nerve stimulation, and CNS excitability) were performed on the right quadriceps femoris muscle before and after each NMES session. CNS excitability was measured using transcranial magnetic, thoracic, and transcutaneous spinal cord stimulations., Results: The level of evoked torque was not significantly different between conventional and wide-pulse protocols applied at the maximal tolerable current intensity. All NMES protocols induced objective fatigability (~14% decrease in maximal voluntary contraction torque, p < 0.001) associated with peripheral (decrease in doublet torque and potentiated M-wave amplitude, p = 0.002 and p < 0.001, respectively) but not central (unchanged voluntary activation, p = 0.79) alterations. However, these acute changes did not differ between NMES protocols and none of the NMES protocols modified markers of CNS excitability., Conclusion: These results may allow to conjecture that chronic effects and treatment effectiveness could be comparable between conventional and wide-pulse NMES., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The main aims of this study were to compare the magnitude of inter-limb asymmetry (ILA) and the relation with self-reported knee function between maximal and explosive knee extensor strength outcomes in professional soccer players. Forty-six male soccer players completed different maximal isokinetic and isometric contractions of the knee extensors for the assessment of maximal strength (peak torque and maximal voluntary contraction (MVC) torque) and explosive strength (early, intermediate, late, and peak rate of torque development (RTD)). Self-reported knee function was assessed with the International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales. Peak torque and MVC torque showed comparable ILAs (8-9%), both being significantly lower than all RTD ILAs (16% on average; p  < 0.001). ILAs for early RTD (21%) and peak RTD (19%) were significantly higher than all the other variables ( p  < 0.05). Only early and intermediate RTD were significantly correlated - though weakly - with both IKDC (rho = 0.32 for both) and Lysholm (rho = 0.36 and 0.30, respectively) scores. We conclude that explosive knee extensor strength - early RTD in particular - exhibited larger ILAs and better relations with self-reported knee function than peak torque and MVC torque in professional soccer players. These results confirm the validity and functional relevance of early RTD and the need for its inclusion in routine performance testing for soccer players. Highlights Professional soccer players exhibited larger inter-limb deficits in knee extension strength for explosive actions than for the widely-used isokinetic test.Self-reported knee function was significantly correlated with explosive strength of the knee extensor muscles but not with maximal strength.The first 50 ms of an explosive knee extension seem to be crucial for self-perceived sport performance and possibly for injury prevention.

Purpose: The effectiveness of a neuromuscular electrical stimulation (NMES) program has been shown to be proportional to the maximal evocable torque (MET), which is potentially influenced by pulse characteristics such as duration and frequency. The aim of this study was to compare MET between conventional and wide-pulse NMES at two different frequencies., Methods: MET-expressed as a percentage of maximal voluntary contraction (MVC) torque-and maximal tolerable current intensity were quantified on 71 healthy subjects. The right quadriceps was stimulated with three NMES protocols using different pulse duration/frequency combinations: conventional NMES (0.2 ms/50 Hz; CONV), wide-pulse NMES at 50 Hz (1 ms/50 Hz; WP50) and wide-pulse NMES at 100 Hz (1 ms/100 Hz; WP100). The proportion of subjects reaching the maximal stimulator output (100 mA) before attaining maximal tolerable current intensity was also quantified., Results: The proportion of subjects attaining maximal stimulator output was higher for CONV than WP50 and WP100 (p < 0.001). In subjects who did not attain maximal stimulator output in any protocol, MET was higher for both WP50 and WP100 than for CONV (p < 0.001). Maximal tolerable current intensity was lower for both WP50 and WP100 than for CONV and was also lower for WP100 than for WP50 (p < 0.001)., Conclusion: When compared to conventional NMES, wide-pulse protocols resulted in greater MET and lower maximal tolerable current intensity. Overall, this may lead to better NMES training/rehabilitation effectiveness and less practical issues associated with maximal stimulator output limitations., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To examine hip muscle strength deficits in patients with femoroacetabular impingent syndrome (FAIS), with special emphasis on potential sex- and comparison-related (between-subject vs within-subject) differences., Design: Cross-sectional comparative study., Participants: Forty FAIS patients (20 women), 40 healthy controls (20 women) and 40 athletes (20 women)., Main Outcome Measures: Hip abduction, adduction and flexion isometric strength was tested using a commercially-available dynamometer. Two between-subject comparisons (FAIS patients vs controls and FAIS patients vs athletes) and one within-subject comparison (inter-limb asymmetry) of strength deficits were conducted, based on the calculation of respective percent differences., Results: For all hip muscle groups, women were 14-18% weaker than men (p < 0.001), but no sex-related interactions were observed. For all hip muscle groups, FAIS patients were 16-19% weaker than controls (p = 0.001) and 24-30% weaker than athletes (p < 0.001). For FAIS patients, the involved hip abductors were 8.5% weaker than the uninvolved ones (p = 0.015), while no inter-limb asymmetry was observed for the other hip muscles., Conclusion: Sex had no influence on hip muscle strength deficits in FAIS patients while a major impact of comparison method/group was observed. Hip abductors showed consistent deficits for all comparison methods, suggestive of a possible greater impairment compared to hip flexors and adductors., Competing Interests: Declaration of competing interest None declared., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This historical review summarizes the major advances - particularly from the last 50 years - in transcutaneous motor-level electrical stimulation, which can be used either as a tool to investigate neuromuscular function and its determinants (electrical stimulation for testing; EST) or as a therapeutic/training modality to improve neuromuscular and physical function (neuromuscular electrical stimulation; NMES). We focus on some of the most important applications of electrical stimulation in research and clinical settings, such as the investigation of acute changes, chronic adaptations and pathological alterations of neuromuscular function with EST, as well as the enhancement, preservation and restoration of muscle strength and mass with NMES treatment programs in various populations. For both EST and NMES, several major advances converge around understanding and optimizing motor unit recruitment during electrically-evoked contractions, also taking into account the influence of stimulation site (e.g., muscle belly vs nerve trunk) and type (e.g., pulse duration, frequency, and intensity). This information is equally important both in the context of mechanistic research of neuromuscular function as well as for clinicians who believe that improvements in neuromuscular function are required to provide health-related benefits to their patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Fatty infiltration, the ectopic deposition of adipose tissue within skeletal muscle, is mediated via the adipogenic differentiation of fibro-adipogenic progenitors (FAPs). We used single-nuclei and single-cell RNA sequencing to characterize FAP heterogeneity in patients with fatty infiltration. We identified an MME + FAP subpopulation which, based on ex vivo characterization as well as transplantation experiments, exhibits high adipogenic potential. MME + FAPs are characterized by low activity of WNT, known to control adipogenic commitment, and are refractory to the inhibitory role of WNT activators. Using preclinical models for muscle damage versus fatty infiltration, we show that many MME + FAPs undergo apoptosis during muscle regeneration and differentiate into adipocytes under pathological conditions, leading to a reduction in their abundance. Finally, we utilized the varying fat infiltration levels in human hip muscles and found less MME + FAPs in fatty infiltrated human muscle. Altogether, we have identified the dominant adipogenic FAP subpopulation in skeletal muscle., (© 2023. The Author(s).)

Background: Patients with femoroacetabular impingement syndrome (FAIS) show sex-specific differences in hip muscle function, hip morphology, and symptoms. Possible differences in hip muscle characteristics between men and women with FAIS are unknown., Purpose: To compare hip muscle cross-sectional area (CSA) and fatty infiltration between men and women with FAIS and investigate possible associations with patient-reported outcomes., Study Design: Cohort study; Level of evidence, 3., Methods: We retrospectively analyzed preoperative axial pelvic magnetic resonance imaging scans of 104 patients (54 women) who underwent hip surgery for FAIS. The main outcome measures were side-to-side percentage asymmetry in hip muscle CSA and involved-side fatty infiltration as measured with the Goutallier scale for a total of 10 hip muscles. Patient-reported outcomes included duration of hip symptoms, iHOT-12 (12-item International Hip Outcome Tool), and Hip Sports Activity Scale., Results: Women showed larger hip abductor muscle CSA asymmetry than men ( P = .018), particularly for the gluteus medius ( P = .049), while men exhibited more fatty streaks (grade 1) in the gluteus medius ( P = .015) than women. Duration of symptoms was associated only with fatty infiltration of obturator externus in men ( r S = -0.55, P = .018). iHOT-12 was associated with CSA asymmetry of the gluteus minimus ( r = -0.41, P = .011) and iliopsoas ( r = -0.36, P = .028) in men and with piriformis fatty infiltration ( r S = -0.56, P = .030) in women. The Hip Sports Activity Scale was associated with iliopsoas CSA asymmetry ( r S = 0.32, P = .026) and with fatty infiltration of the tensor fasciae latae ( r S = -0.45, P = .046) and obturator externus ( r S = -0.50, P = .023) in women., Conclusion: Patients with FAIS demonstrated few sex-specific quantitative and qualitative alterations of hip muscles. Women showed greater hip abductor muscle atrophy than men, particularly for the gluteus medius, while men showed a higher degree of fatty infiltration in this same muscle. The duration of hip symptoms was not associated with muscle atrophy. Patient-reported hip pain/function and sport activity level were only moderately associated with isolated muscular variables., Competing Interests: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

Contralateral facilitation, i.e., the increase in contralateral maximal voluntary strength that is observed when neuromuscular electrical stimulation (NMES) is applied to the ipsilateral homonymous muscle, has previously been reported for the knee extensors but the neurophysiological mechanisms remain to be investigated. The aim of this study was to compare plantar flexor contralateral facilitation between a submaximal voluntary contraction (~10% MVC torque) and two evoked contractions (conventional and wide-pulse high-frequency NMES) of the ipsilateral plantar flexors, with respect to a resting condition. Contralateral MVC torque and voluntary activation level were measured in 22 healthy participants while the ipsilateral plantar flexors were at rest, voluntarily contracted or stimulated for 15 s. Additional neurophysiological parameters ( soleus H-reflex and V-wave amplitude and tibialis anterior coactivation level) were quantified in a subgroup of 12 participants. Conventional and wide-pulse high-frequency NMES of the ipsilateral plantar flexors did not induce any contralateral facilitation of maximal voluntary strength and activation with respect to the resting condition. Similarly, no alteration of neurophysiological parameters was observed in the different conditions. This absence of contralateral facilitation contrasts with some results previously obtained on the knee extensors but is consistent with the absence of neurophysiological changes on the contralateral soleus .

Purposes: To evaluate peripheral muscle function of the knee extensors during repeated changes of direction in professional soccer players by examining differences between competitive levels, periods of the season and playing positions, and to investigate the relationships between peripheral muscle function and physical activities during matches., Methods: Knee extensor peripheral muscle function (twitch peak torque, PT) of 593 male soccer players from 13 European professional clubs competing at 3 different levels was evaluated 4 times during the season. The main outcomes were PT max (maximal PT, muscle contractility), MP max (maximal metabolic power exercise intensity) and PT dec (PT decline, muscle fatigability) obtained during intermittent runs of increasing intensity with multiple changes of direction interspersed with electrically evoked contractions. Relative total and sprint distances covered during a whole match and during short intervals were quantified from a sub-sample., Results: PT max and MP max were higher for first than for second division (p < 0.047; d = 0.15-0.23) and Under-19 players (p < 0.007; d = 0.17-0.25). MP max was lower (p < 0.016; d = 0.23-0.32) and PT dec was higher (p < 0.004; d = 0.26-0.39) in the pre-season compared to all the other time points. MP max was higher for fullbacks than attackers and defenders (p < 0.041; d = 0.20-0.22). PT dec was higher for defenders than fullbacks, midfielders and wings (p < 0.029; d = 0.21-0.28). PT max was associated with whole-match relative total distance (p = 0.004; d = 0.26). PT dec was associated with whole-match relative total distance and relative short-interval sprint distance (p < 0.050; d = 0.18-0.22)., Conclusion: The ability to sustain repeated change of direction efforts at high intensities while preserving peripheral muscle function should be considered an important determinant of soccer physical performance., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)