This article discusses the possible association between impact forces and foot pronation and the development of running related injuries and proposed a new paradigm for impact forces and foot pronation
This document describes a biomechanical analysis of a lower limb strengthening device consisting of a harness connecting tension bands from the hips to the ankles. The analysis found that using the device increases muscle forces in the legs while improving load distribution across the knee joint. It also does not significantly increase forces on knee cartilage surfaces. The device thus has potential benefits for knee rehabilitation by strengthening muscles and joints in a balanced manner without excessive stress on cartilage.
Center of mass deviation fromcenter ofijbesjournal
Fall incidents remain a major issue for workers in the construction and industrial sites. From biomechanical perspectives the majority of falls occurredwhen the body’scenter of mass (CoM) leaves the base of support (BoS). Several measuresquantify stability based on the trajectories of the CoM, such as excursion, sway length, and mean displacement velocity. Nonetheless, none of these measures evaluate stability based on the optimal location of stability, which is the center of base of support (CBoS). Therefore, the main goal of this paper is to introduce new measures that evaluate stability by determining the deviation of the CoM from the CBoSin the Anterior-Posterior and Medio-Lateral directions. A lifting experiment was conducted to comparethe new measures with the existing stability measures. Participants lifted a box with different weights and placed it on a shelf with different heights. The trajectories of the CoM were captured through motion capturing system. The statistical analysis showed that the weight, height, and the interaction had statically significant effect on body stability. While comparing the intraclass correlation (ICC) values for each stability measure, (i.e. a measure of reliability), the proposed measures proved to be more reliable (i.e. highest ICC) than the existing stabilitymeasures.The high ICC values of the proposed stability measures, as compared to the existing stability measures, are a clear indication of their superior reliability. Moreover, the data indicated that increasing the load and the height resulted in an increaseofinstability.
This study investigated the effects of back extensor fatigue on jumping performance and muscle activity during countermovement jumps (CMJs) and lateral jumps (LJ) on stable and unstable surfaces. 14 experienced male jumpers performed maximal CMJs and submaximal LJs on stable and unstable surfaces before and after a back extensor fatigue protocol. Performance measures such as jump height for CMJs and contact time for LJs were analyzed. Electromyography (EMG) of leg and trunk muscles was also measured. The main findings were that back extensor fatigue decreased CMJ height and EMG activity of the biceps femoris and gastrocnemius muscles during CMJs. LJ contact time and EMG activity of the tibial
Resistance training can lead to improvements in strength and reverse some effects of aging in older adults. The study found increases in maximal torque of 9-37% after resistance training in adults aged 65-81. These gains were due to increases in neural drive to muscles without changes in co-activation of antagonist muscles. Resistance training also increased muscle size and altered muscle architecture, including longer fascicles and greater pennation angles. Tendon stiffness and modulus increased by 65-69% after training as well, indicating reversal of aging effects on tendons. In conclusion, resistance training can help mitigate many musculoskeletal changes associated with aging.
Walk and Run For Life! Through Lever Mechanisms Or Spring Mechanisms? Melbour...Dr. James Stoxen DC
Running, as decades of studies have shown, is one of the best ways for your patients to put distance between themselves and the aging process. The medical quandary, though, has been determining for mature patients when the physical demands of running – the wear and tear on bone and joints — outweigh the enormous anti-aging benefits. Many physicians err on the side of caution, supportive footwear, orthotics and even prematurely advising patients to stop running. It’s been a pleasure to be here in Australia. Many of you know the “Blue Wiggle” Anthony Field, and it’s interesting that you’re coming to a medical conference and you’re hearing a doctor talk about anti-aging medicine and the application of bare-foot running and that was certainly the exact same thing that the client said, when I recommended barefoot running and barefoot training to him back in 2004. What happened was this individual had chronic pain, chronic fatigue, fibromyalgia, which obviously was misdiagnosed, and he had clinical depression. To learn more about Dr. Stoxen’s other Lecture he gave entitled, ‘The Inflammation-Depression Connection at The 6th Annual A5M Conference In Anti-Aging & Aesthetic Medicine, click here I’m talking about the ‘Wiggles’ by the way and they were only in Chicago for approximately 48 hours, and we had a limited amount of time to try to fix this chronic condition that Anthony had for 25 years. What I did was what he called “the pain exorcism” which was a 15-hour-straight treatment broken up between, shows. Basically this was a grueling release of the human spring mechanism, and the flushing of the inflammatory chemicals with various therapies that was, extremely aggressive. - See more at: http://teamdoctorsblog.com/2013/03/lecture-video-and-power-point-notes-for-walk-and-run-for-life-through-lever-mechanisms-or-spring-mechanisms-melbourne-australia-august-19-2012/#sthash.oT1pIjK6.dpuf
The use of stretching in the training programs of recrea-
tional and competitive athletes has been historically common-
place. The role of stretching in enhancing athletic performance
has been debated (49). The purpose of this review was to
examine the literature regarding the effect of stretching on
performance, without regard to any of the other purported
effects of stretching, including improvements in joint range
of motion, muscle length, or recovery from or susceptibility
to injury.
Training the vertical jump to head the ball in soccer Fernando Farias
IN MODERN SOCCER, HEADING
THE BALL IS BOTH AN OFFENSIVE
TOOL USED TO SCORE GOALS
AND A DEFENSIVE MEASURE
AGAINST OPPOSING TEAMS. PRO-
FICIENCY IN HEADING THE BALL
REQUIRES PROPER TECHNIQUE IN
CONJUNCTION WITH AN EFFEC-
TIVE VERTICAL JUMP. THE AIM OF
THIS ARTICLE IS TO ADDRESS THE
FACTORS INVOLVED IN VERTICAL
JUMP PERFORMANCE AND HOW
THEY RELATE SPECIFICALLY TO
HEADING THE BALL
John Orchard
Adjunct Associate Professor, Sydney Medical School, University of Sydney.
-
Hamstrings are most susceptible to injury during the late stance phase of sprinting
This document describes a biomechanical analysis of a lower limb strengthening device consisting of a harness connecting tension bands from the hips to the ankles. The analysis found that using the device increases muscle forces in the legs while improving load distribution across the knee joint. It also does not significantly increase forces on knee cartilage surfaces. The device thus has potential benefits for knee rehabilitation by strengthening muscles and joints in a balanced manner without excessive stress on cartilage.
Center of mass deviation fromcenter ofijbesjournal
Fall incidents remain a major issue for workers in the construction and industrial sites. From biomechanical perspectives the majority of falls occurredwhen the body’scenter of mass (CoM) leaves the base of support (BoS). Several measuresquantify stability based on the trajectories of the CoM, such as excursion, sway length, and mean displacement velocity. Nonetheless, none of these measures evaluate stability based on the optimal location of stability, which is the center of base of support (CBoS). Therefore, the main goal of this paper is to introduce new measures that evaluate stability by determining the deviation of the CoM from the CBoSin the Anterior-Posterior and Medio-Lateral directions. A lifting experiment was conducted to comparethe new measures with the existing stability measures. Participants lifted a box with different weights and placed it on a shelf with different heights. The trajectories of the CoM were captured through motion capturing system. The statistical analysis showed that the weight, height, and the interaction had statically significant effect on body stability. While comparing the intraclass correlation (ICC) values for each stability measure, (i.e. a measure of reliability), the proposed measures proved to be more reliable (i.e. highest ICC) than the existing stabilitymeasures.The high ICC values of the proposed stability measures, as compared to the existing stability measures, are a clear indication of their superior reliability. Moreover, the data indicated that increasing the load and the height resulted in an increaseofinstability.
This study investigated the effects of back extensor fatigue on jumping performance and muscle activity during countermovement jumps (CMJs) and lateral jumps (LJ) on stable and unstable surfaces. 14 experienced male jumpers performed maximal CMJs and submaximal LJs on stable and unstable surfaces before and after a back extensor fatigue protocol. Performance measures such as jump height for CMJs and contact time for LJs were analyzed. Electromyography (EMG) of leg and trunk muscles was also measured. The main findings were that back extensor fatigue decreased CMJ height and EMG activity of the biceps femoris and gastrocnemius muscles during CMJs. LJ contact time and EMG activity of the tibial
Resistance training can lead to improvements in strength and reverse some effects of aging in older adults. The study found increases in maximal torque of 9-37% after resistance training in adults aged 65-81. These gains were due to increases in neural drive to muscles without changes in co-activation of antagonist muscles. Resistance training also increased muscle size and altered muscle architecture, including longer fascicles and greater pennation angles. Tendon stiffness and modulus increased by 65-69% after training as well, indicating reversal of aging effects on tendons. In conclusion, resistance training can help mitigate many musculoskeletal changes associated with aging.
Walk and Run For Life! Through Lever Mechanisms Or Spring Mechanisms? Melbour...Dr. James Stoxen DC
Running, as decades of studies have shown, is one of the best ways for your patients to put distance between themselves and the aging process. The medical quandary, though, has been determining for mature patients when the physical demands of running – the wear and tear on bone and joints — outweigh the enormous anti-aging benefits. Many physicians err on the side of caution, supportive footwear, orthotics and even prematurely advising patients to stop running. It’s been a pleasure to be here in Australia. Many of you know the “Blue Wiggle” Anthony Field, and it’s interesting that you’re coming to a medical conference and you’re hearing a doctor talk about anti-aging medicine and the application of bare-foot running and that was certainly the exact same thing that the client said, when I recommended barefoot running and barefoot training to him back in 2004. What happened was this individual had chronic pain, chronic fatigue, fibromyalgia, which obviously was misdiagnosed, and he had clinical depression. To learn more about Dr. Stoxen’s other Lecture he gave entitled, ‘The Inflammation-Depression Connection at The 6th Annual A5M Conference In Anti-Aging & Aesthetic Medicine, click here I’m talking about the ‘Wiggles’ by the way and they were only in Chicago for approximately 48 hours, and we had a limited amount of time to try to fix this chronic condition that Anthony had for 25 years. What I did was what he called “the pain exorcism” which was a 15-hour-straight treatment broken up between, shows. Basically this was a grueling release of the human spring mechanism, and the flushing of the inflammatory chemicals with various therapies that was, extremely aggressive. - See more at: http://teamdoctorsblog.com/2013/03/lecture-video-and-power-point-notes-for-walk-and-run-for-life-through-lever-mechanisms-or-spring-mechanisms-melbourne-australia-august-19-2012/#sthash.oT1pIjK6.dpuf
The use of stretching in the training programs of recrea-
tional and competitive athletes has been historically common-
place. The role of stretching in enhancing athletic performance
has been debated (49). The purpose of this review was to
examine the literature regarding the effect of stretching on
performance, without regard to any of the other purported
effects of stretching, including improvements in joint range
of motion, muscle length, or recovery from or susceptibility
to injury.
Training the vertical jump to head the ball in soccer Fernando Farias
IN MODERN SOCCER, HEADING
THE BALL IS BOTH AN OFFENSIVE
TOOL USED TO SCORE GOALS
AND A DEFENSIVE MEASURE
AGAINST OPPOSING TEAMS. PRO-
FICIENCY IN HEADING THE BALL
REQUIRES PROPER TECHNIQUE IN
CONJUNCTION WITH AN EFFEC-
TIVE VERTICAL JUMP. THE AIM OF
THIS ARTICLE IS TO ADDRESS THE
FACTORS INVOLVED IN VERTICAL
JUMP PERFORMANCE AND HOW
THEY RELATE SPECIFICALLY TO
HEADING THE BALL
John Orchard
Adjunct Associate Professor, Sydney Medical School, University of Sydney.
-
Hamstrings are most susceptible to injury during the late stance phase of sprinting
Downhill Running as an Eccentric Exercise and its effect of Muscle Strength a...3050999
This presentation summarizes research on downhill running as an eccentric exercise and its effects on muscle strength and damage. Downhill running places high eccentric loads on the muscles of the legs. Several studies were reviewed that showed downhill running decreases muscle power and strength, increases markers of muscle damage, and is associated with delayed onset muscle soreness. Practical applications for training and further research areas were also discussed.
Is self myofascial release an effective preexercise and recovery strategy?Fernando Farias
Sports participation in youth is on the rise (35). In addi-
tion, paradigms in preventive health care are shifting focus
to the benefits of exercise in the aging population, leading
to exercise prescriptions for a previously sedentary group
(14,23,36). As more individuals become active, the number
of exercise-related injuries and conditions such as delayed-
onset muscle soreness (DOMS) is likely increasing (10).
DOMS can limit physical activity or result in pain that de-
ters individuals from continuing their exercise regimen (10).
Whether the athlete is young or old, novice or elite, regular
and/or strenuous exercise can result in DOMS and forma-
tion of fibrous tissue adhesions, leading to decreased range
of motion (ROM) (4,10,15).
Delayed-Onset Muscle Soreness Alters the Response to Postural PerturbationsNosrat hedayatpour
The purpose of this study was to assess the EMG activity
of knee muscles during destabilizing perturbations performed
before, immediately after, and 24 and 48 h after eccentric
exercise.
Neuromuscular plasticity in quadriceps functions in response to trainingMuscleTech Network
Neuromuscular plasticity in quadriceps functions in response to training and how this might affect sprinting ability and kicking performance
Per Aagaard
8th MuscleTech Network Workshop
Return to play in rectus femoris muscle injuries. Our experience with profess...MuscleTech Network
This document outlines a 4-step in-field return-to-play process for professional football players recovering from rectus femoris muscle injuries. The 4 steps progress from running circuits in dry sand, to circuits with a ball in dry sand, to uphill/downhill running, and finally specific football skills circuits. Each step aims to gradually increase difficulty, coordination, strength and sport-specific movements while monitoring pain and GPS data. The process is tailored to each player and aims to return them to full training and play in an optimal way according to their symptoms and injury severity.
Anterior Cruciate Ligament Injury: Identification of Risk Factors and Prevent...Fernando Farias
Injury to the anterior cruciate ligament (ACL) is common and affects
young individuals, particularly girls, who are active in sports that involve
jumping, pivoting, as well as change of direction. ACL injury is associ-
ated with potential long-term complications including reduction in ac-
tivity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors
have been identified, which include anatomic variations, neuromuscular
deficits, biomechanical abnormalities, playing environment, and hormonal
status. Multicomponent prevention programs have been shown to be ef-
fective in reducing the incidence of this injury in both girls and boys. Pro-
grams should include a combination of strengthening, stretching, aerobic
conditioning, plyometrics, proprioceptive and balance training, as well as
education and feedback regarding body mechanics and proper landing
pattern. Preventive programs should be implemented at least 6 wk prior to
competition, followed by a maintenance program during the season.
STRETCHING IS A COMMONLY
PRESCRIBED EXERCISE ACTIVITY
THAT HAS BEEN APPLIED TO
WARM-UP, INCREASING RANGE OF
MOTION (ROM), AND RECOVERY
FROM TRAINING. THE PRACTI-
TIONER SHOULD UNDERSTAND
THE EFFECTS OF STRETCHING
EXERCISE AND THE INHERENT DIF-
FERENCES BETWEEN TYPES OF
STRETCHING EXERCISES AND
ACTIVITIES DESIGNED TO
ENHANCE "LOOSENESS" AND
FREEDOM OF MOTION. STRETCH-
ING TO ENHANCE ROM MAY BE
CONTRAINDICATED WHEN
APPLIED TO RECOVERY ACTIVITIES.
STRETCHING FOR RECOVERY
SHOULD BE PAIN-FREE MOTION
WITHIN THE CONSTRAINTS OF
MAXIMUM ROM OF A JOINT.
Clinical relevance of foam rolling on hip extension angle in a functional lun...Jennifer Bushell
This document contains 7 queries from editors for the authors to address in a manuscript on the clinical relevance of foam rolling on hip extension angle in a functional lunge position. The queries request clarification on keywords, heading levels, subject details, citations, references, and city/publisher information. The authors are asked to check and amend these sections as needed to adhere to journal style.
This document contains assessment findings and proposed training program for a 25-year old client with anterior pelvic tilt, leg length discrepancy, foot hyperpronation, and limited range of motion. Static and functional assessments identified impairments including excessive foot pronation, weak gluteal muscles, and anterior pelvic tilt. The proposed training focuses on self-myofascial release, static stretching, isolated strengthening, and integration exercises for the feet, hips, and core to address imbalances and improve posture. Regular participation in the program was limited by the client's work commitments.
Is Postexercise muscle soreness a valid indicator of muscular adaptations?Fernando Farias
DELAYED ONSET MUSCLE SORE- NESS (DOMS) IS A COMMON SIDE EFFECT OF PHYSICAL ACTIVITY, PARTICULARLY OF A VIGOROUS NATURE. MANY EXERCISERS WHO REGULARLY PERFORM RESISTANCE TRAINING CONSIDER DOMS TO BE ONE OF THE BEST INDICATORS OF TRAINING EFFECTIVENESS, WITH SOME RELYING UPON THIS SOURCE AS A PRIMARY GAUGE. THIS ARTICLE DISCUSSES THE RELEVANCE OF USING DOMS TO ASSESS WORKOUT QUALITY.
1) The study examined electromyographic (EMG) activity in the anterior, middle, and posterior subdivisions of gluteus medius (GM) muscle during three weight-bearing exercises: wall squat, pelvic drop, and wall press.
2) The results showed significant differences in activation levels between the three GM subdivisions and between the three exercises.
3) The wall press produced the highest activation overall and was most effective at activating the posterior GM subdivision, which typically displays higher activation than the other two subdivisions.
Flywheel training in football for injury prevention and performanceJari Puustinen
The document discusses using flywheel training for injury prevention and performance in football. It describes how flywheels can provide eccentric overload training through the entire range of motion compared to free weights. A 10-week training program for junior elite soccer players using flywheels twice per week reduced muscle injury rates and improved jumping and sprinting abilities. For in-season training, a weekly 25-minute high-intensity session incorporating flywheels improved change of direction ability in football players.
Nikos Malliaropoulos - Rehabilitation of hamstring injuries MuscleTech Network
Nikos Malliaropoulos
Director of the Athletics National Sports Medicine Centre Thessaloniki Greece. Consultant SEM Physician Barts and The London Clinical Senior Lecturer QMUL CSEM.
-
The rehabilitation of Hamstring injuries - Can we be more injury specific?
(6th MuscleTech Network Workshop)
14th October, Barcelona
Anthony Shield - is nmi a risk factor for hamstring strain injury MuscleTech Network
Anthony Shield
Senior lecturer, School of Exercise and Nutrition Science Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Australia.
-
Is neuromuscular inhibition a risk factor for hamstring strain?
This study aimed to determine which exercises best activate the gluteus medius and superior portion of the gluteus maximus muscles while minimizing activation of the tensor fascia lata muscle. Researchers used fine-wire electromyography to measure muscle activity in the gluteus medius, gluteus maximus, and tensor fascia lata muscles during 11 different exercises in 20 healthy subjects. They found that the clam exercise, sidestepping, unilateral bridging, and quadruped hip extension activated the gluteal muscles significantly more than the tensor fascia lata muscle.
This document discusses the rehabilitation process for quadriceps muscle injuries from initial injury through return to play. It begins by covering injury classification and the muscle architecture of the quadriceps. It then discusses muscle mechanics in running and kicking sports. Rehabilitation stages are outlined from early isometric exercises to advanced functional training mimicking sports movements. A case study is presented of an athlete who suffered multiple quadriceps injuries and underwent a rehabilitation process focused on hypertrophy, tendon elasticity and returning to high intensity running.
Rehabilitation of rectus Femoris Injuries. Experience at Sevilla FC
José Conde And Adolfo Muñoz
8th MuscleTech Network Workshop
Tuesday 4th October, 2016
Interventions for prevention and rehabilitation of hamstring injuriesReza Rahimi-Moghaddam
Hamstring strains are common injuries among athletes with a high re-injury rate. Most injuries occur during sprints and involve the biceps femoris muscle. There are many modifiable risk factors that prevention programs should address, such as a history of injury, preseason strength imbalances, and lack of eccentric hamstring exercises like the Nordic hamstring. Rehabilitation aims to return athletes to prior performance levels safely in the shortest time while avoiding reinjury, as the first month after return is highest risk. Multi-factorial programs are needed that consider injury severity, core stability, flexibility, and subjective readiness instead of just pain levels.
Os resultados atuais indicaram que a ocorrência de lesões de isquiotibiais podem estar associadas a uma mudança hierárquica na distribuição da atividade metabólica dentro do complexo muscular do isquiotibial após o trabalho excêntrico em que o Semitendinoso provavelmente deveria tomar a parte principal, seguido pelo BÍceps Femural e Semimembranoso. Quando o BF aumenta sua contribuição e é ativado em uma extensão proporcionalmente maior, o risco de sofrer uma lesão do isquiotibial pode aumentar substancialmente.
This document discusses core stability, core strength, and their relationship to athletic performance. It begins by defining key terms like performance, core stability, and core strength. It then explores the functional anatomy of the core and different types of core training. The document reviews evidence that core training provides benefits in rehabilitation by reducing lower back injuries, but evidence of performance enhancement in sports is less clear. Specifically, some studies found improvements in core stability and strength from training but ambiguous results on actual sports performance. The relationship between core stability, functional movement, and different performance tests is also examined but results suggest only weak to moderate correlations. While core and functional training are important for injury prevention, the evidence does not strongly support them as the primary focus for performance
Adding stiffness to the foot through shoes and insoles during walking:
1. Decreased the amount of energy dissipated by the foot and increased the gear ratio of the foot-ankle complex.
2. Increased soleus muscle peak force production and decreased soleus fascicle shortening speed, altering the muscle's force-velocity behavior.
3. Despite changes to soleus muscle mechanics, increased whole-body metabolic cost, likely due to the added force demand placed on the plantar flexor muscles.
Healy and harrison et al. 2014 drop jump emg gluteoFábio Lanferdini
The document summarizes a study that examined the effects of a unilateral gluteal activation protocol on single leg drop jump performance. The study found:
1) Significant differences in contact time, peak ground reaction force, and flight time between the baseline day and when the gluteal exercises were performed, but no difference between the exercise day and a third baseline day, suggesting the improvements were due to practice not the exercises.
2) Using a typical error analysis to examine individual responses, there was no discernible pattern of enhancement or fatigue for any participant from the gluteal exercises.
3) In conclusion, the gluteal activation protocol did not acutely improve single leg drop jump performance beyond potential learning effects
Downhill Running as an Eccentric Exercise and its effect of Muscle Strength a...3050999
This presentation summarizes research on downhill running as an eccentric exercise and its effects on muscle strength and damage. Downhill running places high eccentric loads on the muscles of the legs. Several studies were reviewed that showed downhill running decreases muscle power and strength, increases markers of muscle damage, and is associated with delayed onset muscle soreness. Practical applications for training and further research areas were also discussed.
Is self myofascial release an effective preexercise and recovery strategy?Fernando Farias
Sports participation in youth is on the rise (35). In addi-
tion, paradigms in preventive health care are shifting focus
to the benefits of exercise in the aging population, leading
to exercise prescriptions for a previously sedentary group
(14,23,36). As more individuals become active, the number
of exercise-related injuries and conditions such as delayed-
onset muscle soreness (DOMS) is likely increasing (10).
DOMS can limit physical activity or result in pain that de-
ters individuals from continuing their exercise regimen (10).
Whether the athlete is young or old, novice or elite, regular
and/or strenuous exercise can result in DOMS and forma-
tion of fibrous tissue adhesions, leading to decreased range
of motion (ROM) (4,10,15).
Delayed-Onset Muscle Soreness Alters the Response to Postural PerturbationsNosrat hedayatpour
The purpose of this study was to assess the EMG activity
of knee muscles during destabilizing perturbations performed
before, immediately after, and 24 and 48 h after eccentric
exercise.
Neuromuscular plasticity in quadriceps functions in response to trainingMuscleTech Network
Neuromuscular plasticity in quadriceps functions in response to training and how this might affect sprinting ability and kicking performance
Per Aagaard
8th MuscleTech Network Workshop
Return to play in rectus femoris muscle injuries. Our experience with profess...MuscleTech Network
This document outlines a 4-step in-field return-to-play process for professional football players recovering from rectus femoris muscle injuries. The 4 steps progress from running circuits in dry sand, to circuits with a ball in dry sand, to uphill/downhill running, and finally specific football skills circuits. Each step aims to gradually increase difficulty, coordination, strength and sport-specific movements while monitoring pain and GPS data. The process is tailored to each player and aims to return them to full training and play in an optimal way according to their symptoms and injury severity.
Anterior Cruciate Ligament Injury: Identification of Risk Factors and Prevent...Fernando Farias
Injury to the anterior cruciate ligament (ACL) is common and affects
young individuals, particularly girls, who are active in sports that involve
jumping, pivoting, as well as change of direction. ACL injury is associ-
ated with potential long-term complications including reduction in ac-
tivity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors
have been identified, which include anatomic variations, neuromuscular
deficits, biomechanical abnormalities, playing environment, and hormonal
status. Multicomponent prevention programs have been shown to be ef-
fective in reducing the incidence of this injury in both girls and boys. Pro-
grams should include a combination of strengthening, stretching, aerobic
conditioning, plyometrics, proprioceptive and balance training, as well as
education and feedback regarding body mechanics and proper landing
pattern. Preventive programs should be implemented at least 6 wk prior to
competition, followed by a maintenance program during the season.
STRETCHING IS A COMMONLY
PRESCRIBED EXERCISE ACTIVITY
THAT HAS BEEN APPLIED TO
WARM-UP, INCREASING RANGE OF
MOTION (ROM), AND RECOVERY
FROM TRAINING. THE PRACTI-
TIONER SHOULD UNDERSTAND
THE EFFECTS OF STRETCHING
EXERCISE AND THE INHERENT DIF-
FERENCES BETWEEN TYPES OF
STRETCHING EXERCISES AND
ACTIVITIES DESIGNED TO
ENHANCE "LOOSENESS" AND
FREEDOM OF MOTION. STRETCH-
ING TO ENHANCE ROM MAY BE
CONTRAINDICATED WHEN
APPLIED TO RECOVERY ACTIVITIES.
STRETCHING FOR RECOVERY
SHOULD BE PAIN-FREE MOTION
WITHIN THE CONSTRAINTS OF
MAXIMUM ROM OF A JOINT.
Clinical relevance of foam rolling on hip extension angle in a functional lun...Jennifer Bushell
This document contains 7 queries from editors for the authors to address in a manuscript on the clinical relevance of foam rolling on hip extension angle in a functional lunge position. The queries request clarification on keywords, heading levels, subject details, citations, references, and city/publisher information. The authors are asked to check and amend these sections as needed to adhere to journal style.
This document contains assessment findings and proposed training program for a 25-year old client with anterior pelvic tilt, leg length discrepancy, foot hyperpronation, and limited range of motion. Static and functional assessments identified impairments including excessive foot pronation, weak gluteal muscles, and anterior pelvic tilt. The proposed training focuses on self-myofascial release, static stretching, isolated strengthening, and integration exercises for the feet, hips, and core to address imbalances and improve posture. Regular participation in the program was limited by the client's work commitments.
Is Postexercise muscle soreness a valid indicator of muscular adaptations?Fernando Farias
DELAYED ONSET MUSCLE SORE- NESS (DOMS) IS A COMMON SIDE EFFECT OF PHYSICAL ACTIVITY, PARTICULARLY OF A VIGOROUS NATURE. MANY EXERCISERS WHO REGULARLY PERFORM RESISTANCE TRAINING CONSIDER DOMS TO BE ONE OF THE BEST INDICATORS OF TRAINING EFFECTIVENESS, WITH SOME RELYING UPON THIS SOURCE AS A PRIMARY GAUGE. THIS ARTICLE DISCUSSES THE RELEVANCE OF USING DOMS TO ASSESS WORKOUT QUALITY.
1) The study examined electromyographic (EMG) activity in the anterior, middle, and posterior subdivisions of gluteus medius (GM) muscle during three weight-bearing exercises: wall squat, pelvic drop, and wall press.
2) The results showed significant differences in activation levels between the three GM subdivisions and between the three exercises.
3) The wall press produced the highest activation overall and was most effective at activating the posterior GM subdivision, which typically displays higher activation than the other two subdivisions.
Flywheel training in football for injury prevention and performanceJari Puustinen
The document discusses using flywheel training for injury prevention and performance in football. It describes how flywheels can provide eccentric overload training through the entire range of motion compared to free weights. A 10-week training program for junior elite soccer players using flywheels twice per week reduced muscle injury rates and improved jumping and sprinting abilities. For in-season training, a weekly 25-minute high-intensity session incorporating flywheels improved change of direction ability in football players.
Nikos Malliaropoulos - Rehabilitation of hamstring injuries MuscleTech Network
Nikos Malliaropoulos
Director of the Athletics National Sports Medicine Centre Thessaloniki Greece. Consultant SEM Physician Barts and The London Clinical Senior Lecturer QMUL CSEM.
-
The rehabilitation of Hamstring injuries - Can we be more injury specific?
(6th MuscleTech Network Workshop)
14th October, Barcelona
Anthony Shield - is nmi a risk factor for hamstring strain injury MuscleTech Network
Anthony Shield
Senior lecturer, School of Exercise and Nutrition Science Institute of Health and Biomedical Innovation Queensland University of Technology, Brisbane, Australia.
-
Is neuromuscular inhibition a risk factor for hamstring strain?
This study aimed to determine which exercises best activate the gluteus medius and superior portion of the gluteus maximus muscles while minimizing activation of the tensor fascia lata muscle. Researchers used fine-wire electromyography to measure muscle activity in the gluteus medius, gluteus maximus, and tensor fascia lata muscles during 11 different exercises in 20 healthy subjects. They found that the clam exercise, sidestepping, unilateral bridging, and quadruped hip extension activated the gluteal muscles significantly more than the tensor fascia lata muscle.
This document discusses the rehabilitation process for quadriceps muscle injuries from initial injury through return to play. It begins by covering injury classification and the muscle architecture of the quadriceps. It then discusses muscle mechanics in running and kicking sports. Rehabilitation stages are outlined from early isometric exercises to advanced functional training mimicking sports movements. A case study is presented of an athlete who suffered multiple quadriceps injuries and underwent a rehabilitation process focused on hypertrophy, tendon elasticity and returning to high intensity running.
Rehabilitation of rectus Femoris Injuries. Experience at Sevilla FC
José Conde And Adolfo Muñoz
8th MuscleTech Network Workshop
Tuesday 4th October, 2016
Interventions for prevention and rehabilitation of hamstring injuriesReza Rahimi-Moghaddam
Hamstring strains are common injuries among athletes with a high re-injury rate. Most injuries occur during sprints and involve the biceps femoris muscle. There are many modifiable risk factors that prevention programs should address, such as a history of injury, preseason strength imbalances, and lack of eccentric hamstring exercises like the Nordic hamstring. Rehabilitation aims to return athletes to prior performance levels safely in the shortest time while avoiding reinjury, as the first month after return is highest risk. Multi-factorial programs are needed that consider injury severity, core stability, flexibility, and subjective readiness instead of just pain levels.
Os resultados atuais indicaram que a ocorrência de lesões de isquiotibiais podem estar associadas a uma mudança hierárquica na distribuição da atividade metabólica dentro do complexo muscular do isquiotibial após o trabalho excêntrico em que o Semitendinoso provavelmente deveria tomar a parte principal, seguido pelo BÍceps Femural e Semimembranoso. Quando o BF aumenta sua contribuição e é ativado em uma extensão proporcionalmente maior, o risco de sofrer uma lesão do isquiotibial pode aumentar substancialmente.
This document discusses core stability, core strength, and their relationship to athletic performance. It begins by defining key terms like performance, core stability, and core strength. It then explores the functional anatomy of the core and different types of core training. The document reviews evidence that core training provides benefits in rehabilitation by reducing lower back injuries, but evidence of performance enhancement in sports is less clear. Specifically, some studies found improvements in core stability and strength from training but ambiguous results on actual sports performance. The relationship between core stability, functional movement, and different performance tests is also examined but results suggest only weak to moderate correlations. While core and functional training are important for injury prevention, the evidence does not strongly support them as the primary focus for performance
Adding stiffness to the foot through shoes and insoles during walking:
1. Decreased the amount of energy dissipated by the foot and increased the gear ratio of the foot-ankle complex.
2. Increased soleus muscle peak force production and decreased soleus fascicle shortening speed, altering the muscle's force-velocity behavior.
3. Despite changes to soleus muscle mechanics, increased whole-body metabolic cost, likely due to the added force demand placed on the plantar flexor muscles.
Healy and harrison et al. 2014 drop jump emg gluteoFábio Lanferdini
The document summarizes a study that examined the effects of a unilateral gluteal activation protocol on single leg drop jump performance. The study found:
1) Significant differences in contact time, peak ground reaction force, and flight time between the baseline day and when the gluteal exercises were performed, but no difference between the exercise day and a third baseline day, suggesting the improvements were due to practice not the exercises.
2) Using a typical error analysis to examine individual responses, there was no discernible pattern of enhancement or fatigue for any participant from the gluteal exercises.
3) In conclusion, the gluteal activation protocol did not acutely improve single leg drop jump performance beyond potential learning effects
- The study examined the effects of gastrocnemius (calf muscle) fatigue on ankle joint kinetics during the squat jump in 5 trained male basketball players.
- Participants performed squat jumps before and after a calf raise protocol to induce gastrocnemius fatigue. Kinematic and kinetic data of the foot segment was analyzed.
- Results showed no significant difference in foot segment power between pre- and post-fatigue jumps, indicating that bi-articular muscle fatigue did not reduce segmental kinetics.
- The conclusion is that the gastrocnemius acts to transfer energy between segments rather than generate work, so its fatigue did not decrease ankle joint power during the squat jump.
This document summarizes a study that used biomechanical simulations to evaluate how different modes of applying functional resistance training during walking affect gait biomechanics and muscle activation patterns. The study investigated five common modes of functional resistance training: ankle weights, ankle elastic bands, a viscous hip/knee device, pelvis weights, and a constant backwards pelvis force. Simulations were run applying each mode at resistance levels of 30, 60, and 90 Newtons. The results showed that the different modes differentially affected joint moments, powers, and muscle activations during specific phases of gait. Understanding these effects is important for selecting the appropriate resistance training mode for different rehabilitation needs.
Biomechanics is the study of how forces affect living organisms during movement. It uses concepts from physics like mechanics, kinematics, and kinetics to understand human motion. Biomechanists study biomechanics to improve athletic performance and prevent injuries by understanding how forces impact the body during different activities. They analyze both the description of movement through kinematics and the causes of motion through kinetics.
This study aimed to compare quadriceps muscle activation and perceived exertion during the leg press and Smith machine squat exercises. The researchers measured muscle activation via EMG and perceived exertion ratings in athletes performing each exercise across a range of loads. They developed predictive equations to determine equivalent loads between exercises that produce the same muscle activation and perceived exertion. The muscle activation equation was less accurate due to individual variability, while the perceived exertion equation was more accurate as it reflects the overall exertion of each exercise rather than specific muscles. These equations provide a new tool to convert loads between exercises over a training period.
An Integrated Musculoskeletal-Finite-Element Model to Evaluate Effects of Loa...Chun Phoebe Xu
This study developed an integrated musculoskeletal and finite element modeling framework to evaluate the effects of load carriage on tibial biomechanics during walking. The framework included:
1. A musculoskeletal model driven by motion capture and ground reaction force data from a subject walking with different load carriage amounts. This was used to calculate time-varying joint reaction forces.
2. A finite element model of the tibia generated using mesh morphing and mapping techniques, along with spatially varying material properties derived from CT imaging of a reference subject.
3. Physiologically realistic loading conditions for the finite element model, defined by the joint reaction forces calculated in the musculoskeletal model.
The framework assessed how load carriage affected joint reaction forces, tib
This study investigated the preparation phase of the seated double poling cycle in sledge hockey through biomechanical analysis. A solid-static prototype representing an adult male was used with motion capture and force plates to measure kinematics and kinetics. Results showed peak impact forces occurred before 5 milliseconds post contact. Forces were greatest when preparation began slightly below the horizon. Data provides baseline measures to understand preparation phase importance and insights to improve sledge hockey performance and shoulder joint health.
Biomechanics of dental implants/dental implant courses by Indian dental academyIndian dental academy
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Mechanics of the human hamstring muscles during sprintingFernando Farias
As peak musculotendon
force and strain for BF
LH
, ST, and SM occurred around the same time during terminal swing, it is suggested that this period in the
stride cycle may be when the biarticular hamstrings are at greatest injury risk. On this basis, hamstring injury prevention or rehabilitation
programs should preferentially target strengthening exercises that involve eccentric contractions performed with high loads at longer
musculotendon lengths.
This document discusses biomechanics as it relates to implantology. It defines key biomechanical concepts such as force, stress, strain and their relationships. Forces on dental implants can come from biting or parafunctional habits and are made up of compressive, tensile and shear components. The magnitude of stress on implants is determined by the applied force and the cross-sectional area over which it is distributed. Maintaining low stress levels is important for long-term implant success and minimizing risk of failure. Biting forces on natural teeth can range from 100-2400 Newtons and impact loads present additional risk. Biomechanical principles guide optimal implant design and placement to ensure forces are properly dissipated.
Dynamic Model of Hip and Ankle Joints Loading during Working with a Motorized...J. Agricultural Machinery
The main objective of this paper is to develop a seven-link dynamic model of the operator’s body while working with a motorized backpack sprayer. This model includes the coordinates of the sprayer relative to the body, the rotational inertia of the sprayer, the muscle moments acting on the joints, and a kinematic coupling that keeps the body balanced between the two legs. The constraint functions were determined and the non-linear differential equations of motion were derived using Lagrangian equations. The results show that undesirable fluctuations in the ankle force are noticeable at the beginning and end of a swing phase. Therefore, injuries to the ankle joint are more likely due to vibrations. The effects of engine speed and sprayer mass on the hip and ankle joint forces were then investigated. It is found that the engine speed and sprayer mass have significant effects on the hip and ankle forces and can be used as effective control parameters. The results of the analysis also show that increasing the engine speed increases the frequency of the hip joint force. However, no significant effects on the frequency of the ankle joint force are observed. The results of this study may provide researchers with insight into estimating the allowable working hours with the motorized backpack sprayers, prosthesis design, and load calculations of hip implants in the future.
Efeito do Alongamento Estático Agudo no Máximo Desempenho MuscularFernando Farias
This systematic review examined 106 studies on the effect of acute static stretching on maximal muscle performance. The main findings were:
1) Stretch durations of 30 seconds or less had no detrimental effect on performance, with a pooled estimate of a 1.1% reduction.
2) Stretch durations of 30-45 seconds also showed no significant performance effects, with a pooled estimate of a 1.9% reduction.
3) There was strong evidence that stretch durations of 60 seconds or more were likely to significantly reduce performance, in a sigmoidal dose-response relationship between stretch duration and performance decrements.
4) Performance task, contraction mode, or muscle group did not influence the dose-response relationship between
This document summarizes a seminar on mechanical concepts in orthodontics given by Dr. Sandhya Anand under the guidance of Prof. Ashima Valiathan. It discusses key concepts including scalars and vectors, resultants and components of orthodontic force systems, centers of resistance, moments of force, and couples. Understanding these basic mechanical principles is important for optimizing tooth movement, anchorage control, and designing new orthodontic appliances.
A Study on 3D Finite Element Analysis of Anterior Cruciate Ligament Behavior ...ijsrd.com
The present study deals with the force and stress distribution within the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) in response to an anterior tibial load with the knee at full extension was calculated using a validated three dimensional finite element model (FEM) of a human ACL. The interaction between the AM and PL bundles, as well as the contact and friction caused by the ACL wrapping around the bone during knee motion, were included in the model. The AM and PL bundles of the ACL were simulated as incompressible homogeneous and isotropic hyperelastic materials. The validated FEM was then used to calculate the force and stress distribution within the ACL under an anterior tibial load at full extension. The AM and PL bundles shared the force, and the stress distribution was non-uniform within both bundles with the highest stress localized near the femoral insertion site. The contact and friction caused by the ACL wrapping around the bone during knee motion played the role of transferring the force from the ACL to the bone, and had a direct effect on the force and stress distribution of the ACL. This validated model will enable the analysis of force and stress distribution in the ACL in response to more complex loading conditions and has the potential to help design improved surgical procedures following ACL injuries.
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This document provides an overview of key concepts in biomechanics including mechanics, kinesiology, physiotherapy, and their applications. It defines biomechanics, human kinetics, kinesiology, and physiotherapy. It also outlines 9 principles of biomechanics related to movement and projectiles. Finally, it discusses applications of biomechanics to areas like prosthetics, exercise/sports, gait/locomotion, and orthopedics/rehabilitation.
1) The study examined jumping and landing symmetry in 15 female gymnasts between levels 4-6.
2) Significant asymmetry was found in the gymnasts' jumping and landing performance, with the "high" leg experiencing significantly higher forces than the "low" leg.
3) Most gymnasts showed over 10% asymmetry according to clinical standards, suggesting increased injury risk, with some over 20% asymmetry.
Functional appliances /certified fixed orthodontic courses by Indian dental...Indian dental academy
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Correlation between conventional clinical tests and a new movement assessment...Stavros Litsos
Correlation between conventional clinical tests and a new movement assessment battery - Bachelor thesis
Despite the complexity of movements performed in sports, physical examination is today done by conventional tests that evaluate joints and muscles individually (e.g. Smith press test, Figure1). Our study used a new movement assessment battery of 20 reach tests, which incorporates the complexity and diversity of natural human movements, taking into consideration that joints are interdependent in a movement and that the planes and sequences of a movement change during its performance. The purpose of this study was to determine whether or not there is a correlation between conventional mobility tests and the new assessment battery.
Similar to The role of impact forces and foot pronation (20)
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. ROLE OF IMPACT FORCES AND FOOT PRONATION 3
• To synthesize the current knowledge about actual ef- TABLE 1. Summary of the results for external and internal
fects of impact forces forces and loading rates for heel–toe running14–17,19,20
• To synthesize the current understanding of factors as- Variable External Internal
sociated with foot and leg movement during running
• To propose new paradigms for the understanding of Maximal force Soft ≈ hard Soft ≈ hard
the effect of impact forces and movement control dur- Barefoot ≈ shod Barefoot ≈ shod
Impact ≈ active Impact active
ing heel–toe running. Maximal loading rate Soft hard Soft ≈ hard
Barefoot shod Barefoot ≈ shod
IMPACT FORCES
≈, about the same; , much smaller than.
Impact forces in heel–toe running (Figure 1) are forces
resulting from the collision of the heel with the ground,
reaching their maximum (the impact peak) earlier than study12 did not show a significant difference of short-
50 ms after first contact.10,12 The association of impact term running injuries between subjects with high-, me-
forces with musculoskeletal injuries were typically either dium-, and low-impact force peaks (Figure 2). Surpris-
circumstantial in nature7 or derived from experiments ingly, subjects with a high loading rate in the vertical
using animal models.13 However, many results of run- ground reaction force had significantly fewer running-
ning impact-related research studies were unexpected related injuries than subjects with a low loading rate.12,28
and did not support the concept of impact forces as one Furthermore, in certain cases, selected shock-
prime reason for the onset of running injuries. absorbing insoles reduced the general frequency of inju-
Unexpected results were found in biomechanical stud- ries.29,30 However, shock-absorbing insoles were not ef-
ies as summarized in Table 1. For instance, it was found fective in reducing the incidence of stress fractures in
that external impact force peaks were not14,15 or only military recruits for which they were originally de-
minimally16 influenced by changes in the hardness of signed.29,31 The use of a viscoelastic heel pad was pro-
running shoe midsoles. Similarly, internal impact force
peaks in structures of the lower extremities were only
minimally and not systematically influenced by running
shoe midsoles.17,18 However, the magnitude of vertical
impact force peaks varied substantially (up to 100%) for
different running velocities.19,20 Results from model cal-
culations showed that the magnitude of joint contact
forces in the lower extremities are substantially smaller
(three to five times smaller) during the impact than dur-
ing the active phase of running.18,21–23 Based on these
model calculations, it was speculated that normal impact
forces occurring during physical activities such as run-
ning might not be a major factor in the development of
injuries in running.23
Unexpected epidemiological results indicated that run-
ners did not show a higher incidence of osteoarthritis
than nonrunners.24–27 Running on hard surfaces did not
result in an increase of running injuries if compared with
running on softer surfaces.5 Results of a prospective
FIG. 2. Relationship between the vertical impact force peak (Fzi),
the maximal vertical loading rate (Gzi), and the frequency of run-
ning-related injuries. The graphs are based on a reanalysis of
data from 131 subjects.28 Their impact forces were assessed at
FIG. 1. Illustration of an impact force (mean and SE) in vertical the beginning of the study. A sport medicine physician docu-
direction for ten trials of one subject running at a speed of 4 m/s. mented injury occurrences.
Clin J Sport Med, Vol. 11, No. 1, 2001
3. 4 B. M. NIGG
posed to be effective in reducing the symptoms of Achil- Excessive impact forces may produce damage to the hu-
les tendinitis in an athletic population,32 however, epi- man musculoskeletal system. There is a window of load-
demiological evidence for the effectiveness of this ing in which biologic tissues react positively to the ap-
strategy has not been provided. These unsystematic epi- plied impact loads. Based on the current knowledge, it is
demiological results for the effect of shock-absorbing speculated by the author that impact loading for bone,
insoles suggest that shock absorption might not be the cartilage, and soft tissue structures falls within the ac-
primary reason for the development of these studied in- ceptable window for moderate and intensive running. It
juries. is further speculated that impact loading for bone may
Biological reactions to impact loading have been stud- sometimes fall outside the acceptable window for inten-
ied extensively for cartilage and bone. Impact stimuli sive running with too-short recovery periods. However,
have been shown to improve bone integrity. The increase the knowledge based on these speculations is limited.
in bone mass could be explained to 68 to 81% by the The summary of biomechanical and epidemiological
loading rate applied.33 Impact activities such as gymnas- results indicates that the concept of “impact forces” as a
tics, basketball, running, or dancing typically produce an major source for running injuries is not well understood,
increase in skeletal mass, while athletes involved in low and that the paradigm of “cushioning” to reduce the fre-
impact activities such as swimming often have a low quency or type of running injuries should be reconsid-
bone density.34,35,37 Results from measurements with ered.
young female gymnasts showed an increased vertebral
bone integrity compared with a moderately active control
group.36 Premenopausal women exposed over a 2-year Further Biomechanical Considerations
period to an intensive impact exercise protocol showed a The experimental results indicate that each runner
4% increase in bone mineral density compared with a adapts to changes in shoes or surfaces. The impact forces
1.5% decrease for the nonimpact control group.38 Results acting on the human foot and leg can be influenced by
from in vivo experiments showed that the controlled re- changing the foot and leg geometry, ankle and knee joint
peated application of a force with a 1 Hz signal fre- stiffness, and/or the coupling between the soft and rigid
quency could not maintain bone mass over an 8-week structures of the leg,46,47 The response of the locomotor
period while the same procedure with a 15 Hz signal system may well be a combination of the three strategies.
frequency stimulated substantial new bone formation.39 The strategies of foot/leg geometry and joint stiffness
If the vertical ground reaction impact forces are simpli- have been discussed earlier.48 However, the strategy of
fied as sinusoidal waveforms, their frequency content is changing the coupling between the soft and rigid struc-
generally between 10–20 Hz. These results suggest, tures of the runners leg, the strategy of muscle tuning,
therefore, that impact loading has, in general, a positive has only recently been proposed.12
effect on the development and maintenance of bone, The muscle tuning concept suggests that the impact
stimulating a greater osteogenic response than nonimpact forces during heel strike should be considered as an input
loading. signal, characterized by amplitude and frequency. This
The results for cartilage are more difficult to synthe- impact force signal could produce bone vibrations at
size. Some studies showed negative effects of “impact high frequencies and soft tissue vibrations of the human
loading” on cartilage. However, in some cases, the forces leg (e.g., triceps surae, quadriceps, or hamstrings
applied were active instead of impact forces. Sometimes, muscles) at frequencies that might concur with the fre-
the stresses applied were much higher than those expe- quencies of the input signal. Thus soft tissue vibrations
rienced in an athlete’s knee during running, and/or used are of particular interest in this context because reso-
loading regimens were often rather severe.13,40–43 Fur- nance effects could occur. Such soft tissue vibrations
thermore, assuming that cartilage adapts to the stresses would cost energy, would not be comfortable, and are
acting on it, it would be reasonable to expect different typically very short and heavily damped during running
effects of this impulsive loading regimen in the rabbit, a for muscular soft tissues. Thus, it is proposed that the
fairly sedentary animal, than in humans, who have had muscles attempt to avoid vibrations of the soft tissue by
many years to adapt to running-related loading.44 Experi- using a tuning strategy. The concept proposes that
mental results from studies with no methodological con- muscles would be preactivated to create a damped vi-
cern by the author show nonconsistent results for carti- brating system. If this assumption were correct, one
lage. High loading rates showed an increase of cartilage would expect a change in the electromyographic (EMG)
damage in impact experiments, compared with low load- signal.
ing rates.43,45 However, high performance female gym- Results from pilot studies in our laboratory seem to
nasts showed an increase in strength of the intervertebral support this speculation.12,49 Muscle activity was quan-
discs, compared with a paralleled group of moderately tified for selected muscles using EMG sensors. Three
active females.36 Thus the results of these studies are not subjects were asked to run on three surfaces with dis-
conclusive when explaining the possible effects of im- tinctly different hardness: concrete, a normal synthetic
pact loading on cartilage. track surface, and a soft synthetic warm-up surface. The
Based on these research results, one cannot conclude measured EMG signal was analyzed with respect to its
that impact forces are an important factor in the devel- power spectral density and its frequency content. The
opment of chronic and/or acute running-related injuries. results of this pilot study showed a systematic change in
Clin J Sport Med, Vol. 11, No. 1, 2001
4. ROLE OF IMPACT FORCES AND FOOT PRONATION 5
the power spectral density and in the median frequency
for all three subjects (Figure 3).
Since this preactivation requires energy, one would
expect that different shoe sole or surface material prop-
erties would require different amounts of work when
performing a specific task such as running. Such a result
has been theoretically predicted with an arbitrarily de-
fined biomechanical model in which the mechanical
properties of the shoe–surface interface were systemati-
cally varied.50 The results for one set of system charac-
teristics (Figure 4) suggested that soft and viscous ma-
terials require less work than hard and elastic ones for
this specific set of characteristics.
Furthermore, one would expect that the required en-
ergy in a specific shoe situation would be subject specific
since the necessary vibration damping would depend on
the characteristics of the input signal and on the vibration FIG. 4. Work required per step cycle for systematically varied
characteristics of each soft “tissue package” (e.g., ham- spring and damping constants.50 The springs and dampers rep-
strings) of a subject. Pilot results from initial experimen- resent the mechanical properties of the sport surface/shoe.
tal work support this line of thought. Ten subjects were
exposed to treadmill running with VO2 quantification
• The muscle tuning occurs shortly before the next con-
(measurements on four different days) in two different
tact with the ground.
shoe conditions. The shoes were identical except in the
• The cost function for this muscle reaction is to mini-
material of the heel. One shoe had an elastic heel mate-
mize soft tissue vibration.
rial, the other a viscous heel material. The results (Figure
• Based on the input signal and the subject-specific
5) indicate that the required work is subject and shoe
characteristics, muscle tuning can be low or high.
specific and that the differences could be as high as 5%.
• Thus muscle tuning might affects fatigue, comfort,
Thus, the different “feeling” while running on soft or
work, and performance.
hard surfaces or shoes may be associated with changes in
muscle activities and related changes in the soft tissue Thus, impact forces during normal physical activity are
vibrations, both influenced by the impact input. not important because of potential injuries but rather be-
cause they affect fatigue, comfort, work and perfor-
A Proposed New Concept/Paradigm for Impact mance. Thus, it is proposed that muscle tuning is the
Forces: Muscle Tuning dominant response of the human locomotor system to
Based on the above considerations, a new concept/ impact loading. The theoretical and experimental evi-
paradigm for impact forces during running is proposed: dence for the proposed model is certainly not sufficient.
• Impact forces are an input signal into the human body.
• This signal produces a reaction of the muscles
(muscle tuning).
FIG. 3. Power spectral density of electromyographic signals FIG. 5. Oxygen consumption (mean values from 4 trials at dif-
measured while running on three different surfaces, hard (con- ferent days) for 10 subjects, running in shoes with different heel
crete), medium (standard synthetic track), and soft (synthetic material. Left: VO2 values for the viscous heel. Right: VO2 val-
warm-up track) for one specific subject. Data from a pilot study in ues for the elastic heel. Results from pilot measurements in the
the Human Performance Laboratory.20,49 Human Performance Laboratory.
Clin J Sport Med, Vol. 11, No. 1, 2001
5. 6 B. M. NIGG
However, further research should be used to solidify or
reject the proposed new paradigm.
MOVEMENT CONTROL
Running-related injuries have often been associated
with the static or dynamic malalignment of the skeleton.
Excessive foot varus or valgus positions have been spec-
ulated to create high loading situations and for repeated
loading cycles overuse injuries. Additionally, excessive
foot eversion and/or tibial rotation movements have been
proposed to increase the chance of overuse syndromes
such as patellofemoral pain syndromes, shin splints,
Achilles tendinitis, plantar fasciitis, and stress frac- FIG. 7. Injury frequency as a function of leg eversion during
tures.2,6,7 Thus the proper alignment of the skeleton has heel–toe running. Rearranged and reanalyzed results from a pre-
been proposed as being one of the most important func- vious prospective study28 of runners over a 6-month period.
tions of running shoes, shoe inserts, and orthotics. It has
been proposed that overuse injuries due to excessive foot
and leg movement, specifically due to excessive foot Soft, semirigid, and rigid orthotics built to reduce foot/
eversion, could be reduced with special shoes, shoe in- leg eversion and/or tibial rotation were studied by vari-
serts, or orthotics by correcting, aligning, or limiting the ous groups. Movement corrections produced by such in-
skeletal movement of foot and leg. The postulated effects terventions were maximally between 2–4°.54–58 The re-
of such interventions were documented in clinical studies sults of these studies showed generally small and
with the treatment and rehabilitation as the variables of nonconsistent reductions in foot and leg movement am-
interest, and in biomechanical studies with the changes in plitudes for the tested interventions. Nevertheless these
foot and leg movement as the variables of interest. The results were used to imply that shoe inserts or orthotics
results of these studies are critically discussed and sum- change (align) the skeletal movement or position.
marized in the next few paragraphs. However there are several experimental results, which
The support of the medial foot arch has often been suggest that the concept of “aligning the skeleton” with
proposed as one of the most important correction strat- shoes and shoe inserts/orthotics should be reconsidered.
egies for foot eversion/pronation. Some studies deter- First, in an epidemiological study, the lower extremity
mined the effect of the positioning of such a medial arch alignment was suggested not to be a major risk factor for
support. Clinically two strategies were proposed,51 a sup- running injuries based on alignment measurements59 on
port under the arch of the foot (anterior support) and a a group of runners enrolling in a marathon training pro-
support under the sustentaculum tali (posterior support). gram. Second, results from a prospective study in our
A medial arch support positioned from posterior to an- laboratory, with 131 runners and an average running dis-
terior (Figure 6) showed a mean reduction of about 4–5° tance of 30 km per week, showed that foot and ankle
for the initial shoe/leg eversion (eversion velocity) if joint alignment and movement did not act as a predictor
compared with the condition with no medial support. for an increase in running injuries over a 6-month period
However, no significant changes between medial support (Figure 7).
and no support were found for the total foot eversion.52,53 Third, results from a study using 12 subjects and 5
inserts with identical shape but different materials
showed typically small, nonsystematic changes in foot
and leg alignment and movement.60 Inserts produced for
some subject–insert combinations a reduction in foot and
leg movement, for others a reduction in foot movement
and an increase in leg movement, and for a third group an
increase in foot movement and a decrease in leg move-
ment. The results of this study indicate that use of an
insert/orthotic is subject specific. Additionally they show
that the functioning of a “good” insert/orthotic is not well
understood.
Fourth, results from studies with bone pins in the cal-
caneus, the tibia, and the femur showed only small, non-
systematic effects of shoes or inserts on the kinematics of
these bones during running.63 Even more surprising, the
differences in the skeletal movement between barefoot,
FIG. 6. Initial and total shoe eversion and foot eversion for heel–
toe running without and with a medial support. The position of the
shoes, and shoes with inserts were small and nonsystem-
medial support was systematically changed from posterior, under atic. The results of this study suggest that the locomotor
the sustentaculum tali, to anterior, under the arch of the foot.52 system does not react to interventions with shoes, inserts,
Clin J Sport Med, Vol. 11, No. 1, 2001
6. ROLE OF IMPACT FORCES AND FOOT PRONATION 7
or orthotics by changing the skeletal movement pattern. • The plantar surface of the foot with its mechanorecep-
These experimental results do not provide any evidence tors senses the force–input signal.
for the claim that shoes, inserts, or orthotics align the • The signal information is transferred to the central
skeleton. Based on the results of the bone pin study for nervous system, which provides a dynamic response
shoes and shoe inserts63 one may even challenge the idea based on the subject-specific conditions.
that a major function of shoes, shoe inserts, or orthotics • The subject performs the movement for the task at
consists in aligning the skeleton. hand.
The previous paragraphs provided evidence contrary
to the traditional concept that shoes, inserts, and orthotics The first three steps are situation dependent and can be
align the skeleton. The skeleton seems to change its path influenced by the selection of the movement task, the
of movement for a given task only minimally when ex- shoe, and the insert or orthotic. The last three steps are
posed to an intervention (shoe, insert, or orthotic). One subject dependent. The sensitivity for the mechanical
could argue (and support this argument with evidence) signals, the potentially wobbling soft tissue masses, and
that—for a given task—the locomotor system chooses a the cost functions for the movement selection may be
strategy to keep the skeletal movement in a constant different for each subject–shoe-insert condition. This line
path. A similar “minimal resistance movement path” has of reasoning could explain the small and nonconsistent
been discussed earlier for joint movement.62 The neuro- changes in foot and tibia movement between barefoot,
muscular system is programed to avoid any deviation shoes, and shoes with inserts63 and the highly subject-
from this path. Thus, appropriate muscles will be acti- specific differences in oxygen consumption when run-
vated if any intervention tries to produce a different skel- ning with viscous or elastic heels (Figure 5). However,
etal movement. An optimal shoe, insert, or orthotic the experimental results and the theoretical consideration
would minimize additional (not task related) muscle illustrate that the knowledge of the subject-specific char-
work. Consequently, shoes, inserts, and orthotics would acteristics and the appropriate insert strategies are im-
affect muscle work, which should affect fatigue, comfort, portant pieces of information for a podiatrist or orthotist
and work/performance. Thus if comfort is an indicator when preparing an insert or orthosis for an athlete or a
for muscle activity, wearing comfortable shoes should patient.
require lower oxygen consumption than wearing uncom- A Proposed New Concept/Paradigm for Foot
fortable shoes. Pilot evidence for these effects has been Pronation and Movement Control
quantified. For instance, oxygen consumption measure- Based on current state-of-the-art knowledge, a new
ments for 10 subjects running in a most and a least com- concept/paradigm for foot pronation is proposed:
fortable shoe (chosen out of five shoes provided) showed
a significant difference, with more oxygen needed for • Forces acting on the foot during the stance phase act as
running in the least comfortable shoe (Figure 8). an input signal.
Thus, the behavior of a subject in a given situation • The locomotor system reacts to these forces by adapt-
(movement task and footwear) is determined by a set of ing the muscle activity.
factors: A force signal acts as an input variable on the • The cost function used in this adaptation process is to
shoe. maintain a preferred joint movement path for a given
movement task (e.g., running).
• The shoe sole acts as a first filter for the force input • If an intervention supports the preferred movement
signal. path, muscle activity can be reduced. If an intervention
• The insert or orthotic acts as a second filter for the counteracts the preferred movement path, muscle ac-
force input signal. tivity must be increased. An optimal shoe, insert, or
orthotic reduces muscle activity.
• Thus shoes, inserts, and orthotics affect general
muscle activity and, therefore, fatigue, comfort, work,
and performance.
Thus, “movement control” during the stance phase is not
important to align the skeleton but rather because strat-
egies to control movement change muscle activity during
the stance phase. This change in muscle activity (that is
not related to the actual movement task) might affect
fatigue, comfort, work, and performance.
However, the presented concept/paradigm for the
function of shoes, inserts, and orthotics needs more evi-
dence and stronger evidence to support or reject it.
SYNTHESIS
FIG. 8. Mean and standard deviation for VO2 results for 10 sub-
jects when running in the least and most comfortable shoe se- The two aspects of running biomechanics, “impact”
lected out of 5 commercially available running shoes. and “movement control,” have been discussed, and a
Clin J Sport Med, Vol. 11, No. 1, 2001
7. 8 B. M. NIGG
new way of thinking about them has been introduced. 17. Morlock M. A Generalized Three-Dimensional Six-Segment Model
The proposed solution suggests that the locomotor sys- of the Ankle and the Foot. PhD Thesis. The University of Calgary,
Calgary, Alberta, Canada, 1990.
tem use a similar strategy in both situations, “impact” 18. Cole GK, Nigg BM, Fick GH, et al. Internal loading of the foot and
and “movement control”. In both cases the locomotor ankle during impact in running. J Appl Biomech 1995;11:25–46.
system keeps the general kinematic and kinetic situation 19. Hamill J, Bates BT, Knutzen KM, et al. Variations in ground
similar for a given task. To deal with impact forces, the reaction force parameters at different running speeds. Hum Mov
Sci 1983;2:47–56.
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vibrations. This strategy affects the muscle activation velocity and midsole hardness on external impact forces in heel-toe
before ground contact. To deal with shoes, inserts, and running. J Biomech 1987;20:951–959.
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22. Harrison RN, Lees A, McCullagh PJJ, et al. A bioengineering
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24. Lane NE, Bloch DA, Jones HH, et al. Long-distance running, bone
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27. Konradsen L, Berg-Hansen EM, Söndergaard L. Long distance
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29. Schwellnus MP, Jordaan G, Noakes TD. Prevention of common
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