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Deficits in the ankle plantarflexor muscles, such as weakness and contracture, occur commonly in conditions such as cerebral palsy, stroke, muscular dystrophy, Charcot-Marie-Tooth disease, and sarcopenia. While these deficits likely contribute to observed gait pathologies, determining cause-effect relationships is difficult due to the often co-occurring biomechanical and neural deficits. To elucidate the effects of weakness and contracture, we systematically introduced isolated deficits into a musculoskeletal model and generated simulations of walking to predict gait adaptations due to these deficits. We trained a planar model containing 9 degrees of freedom and 18 musculotendon actuators to walk using a custom optimization framework through which we imposed simple objectives, such as minimizing cost of transport while avoiding falling and injury, and maintaining head stability. We first generated gaits at prescribed speeds between 0.50 m/s and 2.00 m/s that reproduced experimentally observed kinematic, kinetic, and metabolic trends for walking. We then generated a gait at self-selected walking speed; quantitative comparisons between our simulation and experimental data for joint angles, joint moments, and ground reaction forces showed root-mean-squared errors of less than 1.6 standard deviations and normalized cross-correlations above 0.8 except for knee joint moment trajectories. Finally, we applied mild, moderate, and severe levels of muscle weakness or contracture to either the soleus (SOL) or gastrocnemius (GAS) or both of these major plantarflexors (PF) and retrained the model to walk at a self-selected speed. The model was robust to all deficits, finding a stable gait in all cases. Severe PF weakness caused the model to adopt a slower, "heel-walking" gait. Severe contracture of only SOL or both PF yielded similar results: the model adopted a "toe-walking" gait with excessive hip and knee flexion during stance. These results highlight how plantarflexor weakness and contracture may contribute to observed gait patterns. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the concurrent validity of two different inertial measurement units for measuring spatiotemporal parameters during running on a treadmill, by comparing data with a high-speed video analysis (VA) at 1,000 Hz. Forty-nine endurance runners performed a running protocol on a treadmill at comfortable velocity (i.e., 3.25 ± 0.36 m.s-1). Those wearable devices (i.e., Stryd™ and RunScribe™ systems) were compared to a high-speed VA, as a reference system for measuring spatiotemporal parameters (i.e. contact time [CT], flight time [FT], step frequency [SF] and step length [SL]) during running at comfortable velocity. The pairwise comparison revealed that the Stryd™ system underestimated CT (5.2%, p < 0.001) and overestimated FT (15.1%, p < 0.001) compared to the VA; whereas the RunScribe™ system underestimated CT (2.3%, p = 0.009). No significant differences were observed in SF and SL between the wearable devices and VA. The intra class correlation coefficient (ICC) revealed an almost perfect association between both systems and high-speed VA (ICC > 0.81). The Bland-Altman plots revealed heteroscedasticity of error (r2 = 0.166) for the CT from the Stryd™ system, whereas no heteroscedasticity of error (r2 < 0.1) was revealed in the rest of parameters. In conclusion, the results obtained suggest that both foot pods are valid tools for measuring spatiotemporal parameters during running on a treadmill at comfortable velocity. If the limits of agreement of both systems are considered in respect to high-speed VA, the RunScribe™ seems to be a more accurate system for measuring temporal parameters and SL than the Stryd™ system. [ABSTRACT FROM AUTHOR]

Background: To analyze the goodness of fit of the load-velocity relationship in a machine-based, single-joint exercise performed both in a bilateral and unilateral manner, as well as to study its accuracy to estimate one repetition maximum (1-RM). Methods: Fifteen resistance trained males performed an incremental test in the bilateral and unilateral leg extension exercise up to the 1-RM in two separate occasions. Mean vertical velocity of the weight plates in the leg extension machine was measured for every repetition using a smartphone application (My Lift). Results: Linear regression analyses showed a high goodness of fit (R2 > 0.93) and small standard errors of estimate (SEE < 5%1-RM) both in the bilateral and unilateral leg extension when individual load-velocity regressions for each participant were computed. Unilateral load-velocity relationships showed significant differences in the intercept of the regression line with the Y-axis and the velocity at each percentage of the 1-RM (Cohen’s d > 1.0, p< 0.05). Finally, non-significant differences were observed between actual and estimated 1-RM from the load-velocity relationships (r = 0.88.0–96, Cohen’s d < 0.2, p> 0.05). Conclusions: This proof of concept highlights that computing load-velocity relationships in a machine-based, single-joint, angular exercise can be appropriately performed by measuring the mean vertical velocity of the weight plates. These results could help strength and conditioning researchers and coaches who wish to analyze load-velocity relationship in other common machine-based exercises. [ABSTRACT FROM AUTHOR]

Practitioners of strength and conditioning are increasingly using vibration and unstable environments to enhance training effects. However, little evidence has been found comparing the use of suspension devices and vibratory platforms used in the Bulgarian squat. The purpose of this cross-sectional study was to examine the effect of suspension devices (TRX®), unstable surfaces (BOSU®), and vibration plates on muscle activity and force during the Bulgarian squat. Twenty physically active male students (age = 24.40 ± 3.63 years) performed a set of five repetitions of Bulgarian squats, suspended lunges, suspended lunges-BOSU, suspended lunges-Vibro30, and suspended lunges-Vibro40 (vibration 30 Hz or 40 Hz and 4 mm of amplitude). A randomized within-subject design was used to compare leg muscle activity, vertical ground reaction forces, and force exerted on the strap across the five exercises. Results showed no significant differences in muscle activity between the Bulgarian squat and suspended lunge (p = 0.109, d = 2.84). However, the suspended lunge significantly decreased muscle activation compared to the suspended lunge-BOSU (p = 0.012, d = 0.47), suspended lunge-Vibro30 (p = 0.001, d = 1.26), and suspended lunge-Vibro40 (p = 0.000, d = 1.51). Likewise, the Bulgarian squat achieved lower activity than the suspended lunge-Vibro40 (p = 0.010, d = 0.96). The force on the strap significantly decreased in the suspended lunge-BOSU compared to the suspended lunge-Vibro30 (p = 0.009, d = 0.56). The suspended lunge achieved higher front leg force production than the Bulgarian squat (p = 0.006, d = 0.48). In conclusion, leaning the rear leg on a suspension device does not provoke an increase in the activation of the front leg during the Bulgarian squat but increases the vertical ground reaction forces. Thus, the use of unstable surfaces or vibration plates for the front leg increased muscular activity when performing a suspended lunge. [ABSTRACT FROM AUTHOR]

This study aimed to measure muscle activity and motion kinematics during chair-based exercises under submerged and non-submerged conditions. Twelve healthy men performed chair-based standing and sitting movements. Surface electrodes were attached at the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris, rectus abdominis, and erector spinae. The ankle, knee, and hip joint angles and forward inclination angle of the trunk segment in the sagittal plane were calculated. The mean muscle activities during both movements in the submerged condition for the entire motion were lower than those in the non-submerged condition except in the tibialis anterior and biceps femoris during the sitting movement (in the standing exercise, rectus femoris: 14.1% and 5.2%; and erector spinae: 18.3% and 13.6% in non-submerged and submerged conditions, respectively; and in the sitting exercise, rectus femoris: 12.1% and 4.5% and erector spinae: 12.9% and 9.9% in the non-submerged and submerged conditions, respectively). However, the integrated muscle activity in submerged conditions was similar or higher to that in non-submerged conditions during both movements, except for the rectus femoris. This was mainly due to the increased duration of motion (44.3% and 39.9% longer for standing and sitting exercises in submerged conditions, respectively, compared with non-submerged conditions). The hip joint flexion at the beginning and end of movement and forward inclination angles of the trunk segment at the beginning of the movement in the submerged condition were larger than those in the non-submerged condition during both movements (hip: 126.1° and 111.5° at the beginning, 182.3° and 178.4° at the end and trunk: 2.7° and 17.4° at the beginning in non-submerged and submerged conditions for the standing exercise, respectively; hip: 182.4° and 178.0° at the beginning, 125.9° and 111.1° at the end and trunk: 2.2° and 16.9° at the end in non-submerged and submerged conditions for the sitting exercise, respectively). Reduced or similar muscle activity but similar or higher muscular effort was observed in the submerged condition for all the muscles except the rectus femoris, with the upper body inclined forward. These findings could have beneficial implications for the prescription of exercise and rehabilitation regimens. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyse the relationship between several parameters of neuromuscular performance with dynamic postural control using a Bayesian Network Classifiers (BN) based analysis. Methods: The y-balance test (measure of dynamic postural control), isokinetic (concentric and eccentric) knee flexion and extension strength, isometric hip abduction and adduction strength, lower extremity joint range of motion (ROM) and core stability were assessed in 44 elite male futsal players. A feature selection process was carried out before building a BN (using the Tabu search algorithm) for each leg. The BN models built were used to make belief updating processes to study the individual and concurrent contributions of the selected parameters of neuromuscular performance on dynamic postural control. Results: The BNs generated using the selected features by the algorithms correlation attribute evaluator and chi squared reported the highest evaluation criteria (area under the receiver operating characteristic curve [AUC]) for the dominant (AUC = 0.899) and non-dominant (AUC = 0.879) legs, respectively. Conclusions: The BNs demonstrated that performance achieved in the y-balance test appears to be widely influenced by hip and knee flexion and ankle dorsiflexion ROM measures in the sagittal plane, as well as by measures of static but mainly dynamic core stability in the frontal plane. Therefore, training interventions aimed at improving or maintaining dynamic postural control in elite male futsal players should include, among other things, exercises that produce ROM scores equal or higher than 127° of hip flexion, 132.5° of knee flexion as well as 34° and 30.5° of ankle dorsiflexion with the knee flexed and extended, respectively. Likewise, these training interventions should also include exercises to maintain or improve both the static and dynamic (medial-lateral plane) core stability so that futsal players can achieve medial radial error values lower than 6.69 and 8.79 mm, respectively. [ABSTRACT FROM AUTHOR]

The robustness of motor outputs to muscle dysfunction has been investigated using musculoskeletal modeling, but with conflicting results owing to differences in model complexity and motor tasks. Our objective was to systematically study how the number of kinematic degrees of freedom, and the number of independent muscle actuators alter the robustness of motor output to muscle dysfunction. We took a detailed musculoskeletal model of the human leg and systematically varied the model complexity to create six models with either 3 or 7 kinematic degrees of freedom and either 14, 26, or 43 muscle actuators. We tested the redundancy of each model by quantifying the reduction in sagittal plane feasible force set area when a single muscle was removed. The robustness of feasible force set area to the loss of any single muscle, i.e. general single muscle loss increased with the number of independent muscles and decreased with the number of kinematic degrees of freedom, with the robust area varying from 1% and 52% of the intact feasible force set area. The maximum sensitivity of the feasible force set to the loss of any single muscle varied from 75% to 26% of the intact feasible force set area as the number of muscles increased. Additionally, the ranges of feasible muscle activation for maximum force production were largely unconstrained in many cases, indicating ample musculoskeletal redundancy even for maximal forces. We propose that ratio of muscles to kinematic degrees of freedom can be used as a rule of thumb for estimating musculoskeletal redundancy in both simulated and real biomechanical systems. [ABSTRACT FROM AUTHOR]

This article addresses the study of crack behavior elicited on axial fatigue in specimens joined by butt weld made of steel ASTM A36 by using fracture mechanics and simulation software of finite elements (Ansys APDL, Franc3D). The computational model was initially to define the geometry model by using CAD software. Specimens with Weld Reinforcement of 2 mm and 3mm were simulated. Subsequently, the type of element for the mesh, the information inclusion concerning material mechanical properties and load conditions were selected. By using Franc3D software, the crack propagation phenomenon is analyzed, and its growth parameters have been established. In this way, it is possible to calculate the magnitude of stress intensity factor (SIF) along the crack front. It is concluded that the stress located in the weld toe is maximized proportionately to the size of the weld reinforcement due to the concentration effect of geometric stress. In addition, it is observed that the propagation rate obtained from Paris law has a similar behavior for the studied weld reinforcements; the latter as there were short cracks. [ABSTRACT FROM AUTHOR]

Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571–1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience. [ABSTRACT FROM AUTHOR]

Gait variability is a sensitive metric for assessing functional deficits in individuals with mobility impairments. To correctly represent the temporal evolution of gait kinematics, nonlinear measures require extended and uninterrupted time series. In this study, we present and validate a novel algorithm for concatenating multiple time-series in order to allow the nonlinear analysis of gait data from standard and unrestricted overground walking protocols. The full-body gait patterns of twenty healthy subjects were captured during five walking trials (at least 5 minutes) on a treadmill under different weight perturbation conditions. The collected time series were cut into multiple shorter time series of varying lengths and subsequently concatenated using a novel algorithm that identifies similar poses in successive time series in order to determine an optimal concatenation time point. After alignment of the datasets, the approach then concatenated the data to provide a smooth transition. Nonlinear measures to assess stability (Largest Lyapunov Exponent, LyE) and regularity (Sample Entropy, SE) were calculated in order to quantify the efficacy of the concatenation approach using intra-class correlation coefficients, standard error of measurement and paired effect sizes. Our results indicate overall good agreement between the full uninterrupted and the concatenated time series for LyE. However, SE was more sensitive to the proposed concatenation algorithm and might lead to false interpretation of physiological gait signals. This approach opens perspectives for analysis of dynamic stability of gait data from physiological overground walking protocols, but also the re-processing and estimation of nonlinear metrics from previously collected datasets. [ABSTRACT FROM AUTHOR]

Purpose: To test the accuracy, validity, reliability and sensitivity of an alternative method for the measure of TMS-assessed voluntary activation (VATMS) in the knee extensors. Methods: Ten healthy males (24 ± 5 years) completed a neuromuscular assessment protocol before and after a fatiguing isometric exercise: two sets of five contractions (50%, 62.5%, 75%, 87.5%, 100% Maximal Voluntary Contraction; MVC) with superimposed TMS-evoked twitches for calculation of VATMS using either the first 5 stimulations (1x5C) or all 10 (2x5C). This was performed on two separate occasions (between-day reliability). Accuracy and validity were compared with a routinely used protocol [i.e. 50%, 75%, and 100% of MVC (1x3C) performed three times (3x3C)]. Results: 95% confidence interval for estimated resting twitch, a key determinant of VATMS, was similar between 1x5C, 2x5C, and 3x3C but improved by six-fold when compared to 1x3C (P<0.05). In a fresh state, potentiated twitch force was unchanged following 1x5C but decreased following 2x5C (P<0.05). A recovery was found post-exercise but was smaller for 1x5C compared to 2x5C (P<0.05), with no difference between the latter two (P>0.05). Absolute reliability was strong enough for both 1x5C and 2x5C to depict a true detectable change in the sample's VATMS following the fatiguing exercise (TEM < 3% at rest, <9% post-exercise) but 2x5C was marginally more sensitive to individual's changes from baseline. Conclusion: Both 1x5C and 2x5C provide reliable measures of VATMS. However, 1x5C may hold stronger internal validity. Both protocols allow detection of 'true' changes in sample's means but not individual scores following a fatiguing isometric exercise. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the feasibility of intraosseous (i.o.) contrast media injection (CMI) for emergency computed tomography (CT) of severe trauma and the associated image quality compared to intravenous (i.v.) CMI. Materials and methods: The authors retrospectively analysed objective (contrast-to-noise ratio (CNR)) and subjective (4-point Likert scale) image quality of CTs after i.o. (n = 4, mean age (y) 57.0±11.0) versus i.v. (n = 20, mean age (y) 58.8±4.4) CMI. All patients underwent a native head CT scan, a cerebral CT angiography (CTA) and CTA of the supra-aortic vasculature as well as a chest and abdominal CT scan in the venous phase; one patient with an i.o. access additionally received a CTA of the lower limbs. Electronic patient records have been reviewed to determine i.o. access related complications. Results: Both groups were consistent in age, heart rate, scan parameters including the flow rate of the contrast agent, resulting in comparable radiation dose levels. The image noise and CNR had no significant difference between the two groups. Scoring the delineation of the main vessels after i.o. CMI showed no significant difference to the i.v. group. There were no CT or i.o. access related complications observed. Conclusion: The i.o. access is a safe and suitable alternative for emergency CMI in CT. Using established protocols good to very good image quality can be achieved, comparable to i.v. CMI. We show for the first time, that i.o. CMI is also feasible for CTA imaging of the head and neck region as well as of pelvic and leg vessels. [ABSTRACT FROM AUTHOR]

A stable walking pattern is presumably essential to avoid falls. Stability of walking is most accurately determined by the short-term local dynamic stability (maximum Lyapunov exponent) of the body centre of mass. In many studies related to fall risk, however, variability of step width is considered to be indicative of the stability of the centre of mass during walking. However, other footfall parameters, in particular variability of stride time, have also been associated with increased risk for falling. Therefore, the aim of this study was to investigate the association between short-term local dynamic stability of the body centre of mass and different measures of footfall variability. Twenty subjects performed unperturbed walking trials on a treadmill and under increased (addition of 40% body weight) and decreased (harness system) demands to stabilise the body centre of mass. Association between stability of the centre of mass and footfall parameters was established using a structural equation model. Walking with additional body weight lead to greater instability of the centre of mass and increased stride time variability, however had no effect on step width variability. Supported walking in the harness system did not increase centre of mass stability further, however, led to a significant decrease of step width and increase in stride time variability. A structural equation model could only predict 8% of the variance of the centre of mass stability after variability of step width, stride time and stride length were included. A model which included only step width variability as exogenous variable, failed to predict centre of mass stability. Because of the failure to predict centre of mass stability in this study, it appears, that the stability of the centre of mass is controlled by more complex interaction of sagittal and frontal plane temporal and spatial footfall parameters, than those observed by standard variability measures. Anyway, this study does not support the application of step width variability as indicator for medio-lateral stability of the centre of mass during walking. [ABSTRACT FROM AUTHOR]

Although several studies have examined the effects of performing resistance training with different percentages of one-repetition maximum (1-RM), little is known of the neuromuscular effects and kinematics of lifting low to heavy loads with maximal movement velocity. The aim of this study is to compare muscle activation and kinematics in free-weight back squats with different loads. Thirteen resistance-training males (aged 24.2 ± 2.0 years, body mass 81.5 ± 9.1 kg, height 1.78 ± 0.06 m) with 6 ± 3 years of resistance-training experience conducted squats with 30%–100% of 1-RM. Barbell kinematics and electromyographic (EMG) activity of the vastus lateralis, vastus medialis, rectus femoris, semitendinosus, biceps femoris, and gluteus maximus were measured in the upward phase of each load. With increasing loads, the barbell velocity decreased, the upward phase duration increased, and the peak velocity occurred later. The muscle activation in all muscles increased with increasing loads but was not linear. In general, similar muscle activation in the prime movers was observed for loads between 40% and 60% of 1-RM and between 70% and 90% of 1-RM, with 100% of 1-RM being superior to the other loads when the loads were lifted at maximal intended velocity. However, the timing of maximal muscle activations was not affected by the different loadings for the quadriceps, but the timing was sequential and independent of loading (rectus femoris before vastus medial before vastus lateral). Maximal activation in the gluteus and semitendinosus increased with increasing loads. This means that for muscle activation, maximal lifting velocity may compensate for increased loads, which may allow resistance-trained athletes and individuals in rehabilitation to avoid heavy loads but still get the same muscle activation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the reliability of isometric peak force (IPF) in a novel “long-length” 90°Hip:20°Knee (90:20) strength test and to compare the simulated soccer match induced fatigue-recovery profile of IPF in this test with that of an isometric 90°Hip:90°Knee (90:90) position test. Methods: Twenty semi-professional soccer players volunteered for the study of which 14 participated in the first part of the study which assessed 90:20 reliability (age = 21.3 ± 2.5 years, height = 1.79 ± 0.07 m, body mass = 73.2 ± 8.8 kg), while 17 completed the second part of the study evaluating fatigue-recovery (age 21.2±2.4 yrs., height = 180 ± 0.09 m, body mass 73.8 ± 8.9 kg). We evaluated the inter-session reliability of IPF in two 90:20 test protocols (hands on the wall (HW); and hands on chest (HC)) both performed on two occasions, 7 days apart. We then assessed 90:20 (HC) and 90:90 IPF immediately before (PRE) and after (POST) after a simulated soccer match protocol (BEAST90mod) and 48 (+48 h) and 72 hours (+72 h) later. Results: Part one: the 90:20 showed moderate to high overall reliability (CV’s of 7.3% to 11.0%) across test positions and limbs. CV’s were lower in the HW than HC in the dominant (7.3% vs 11.0%) but the opposite happened in the non-dominant limb where CV’s were higher in the HW than HC (9.7% vs 7.3%). Based on these results, the HC position was used in part two of the study. Part two: 90:20 and 90:90 IPF was significantly lower POST compared to PRE BEAST90mod across all testing positions (p<0.001). IPF was significantly lower at +48 h compared to PRE in the 90:20 in both limbs (Dominant: p<0.01,Non-dominant: p≤0.05), but not in the 90:90. At +72 h, IPF was not significantly different from PRE in either test. Conclusions: Simple to implement posterior IPF tests can help to define recovery from competition and training load in football and, potentially, in other multiple sprint athletes. Testing posterior chain IPF in a more knee extended 90:20 position may provide greater sensitivity to fatigue at 48 h post simulated competition than testing in the 90:90 position, but also may require greater degree of familiarization due to more functional testing position. [ABSTRACT FROM AUTHOR]

Habitual loading and resistance training (RT) can lead to changes in muscle and tendon morphology as well as in its mechanical properties which can be measured by Shear Wave Elastography (SWE) technique. The objective of this study was to analyze the Vastus Lateralis (VL) and patellar tendon (PT) mechanical properties adaptations to an 8-week RT protocol using SWE. We submitted 15 untrained health young men to an 8-week RT directed for knee extensor mechanism. VL and PT shear modulus (μ) were assessed pre and post intervention with SWE. PT thickness (PTT), VL muscle thickness (VL MT) and knee extension torque (KT) were also measure pre and post intervention to ensure the RT efficiency. Significant increases were observed in VL MT and KT (pre = 2.40 ± 0.40 cm and post = 2.63 ± 0.35 cm, p = 0.0111, and pre = 294.66 ± 73.98 Nm and post = 338.93 ± 76.39 Nm, p = 0.005, respectively). The 8-week RT was also effective in promoting VL μ adaptations (pre = 4.87 ± 1.38 kPa and post = 9.08.12 ± 1.86 kPa, p = 0.0105), but not in significantly affecting PT μ (pre = 78.85 ± 7.37 kPa and post = 66.41 ± 7.25 kPa, p = 0.1287) nor PTT (baseline = 0.364 ± 0.053 cm and post = 0.368 ± 0.046 cm, p = 0.71). The present study showed that an 8-week resistance training protocol was effective in adapting VL μ but not PT μ. Further investigation should be conducted with special attention to longer interventions, to possible PT differential individual responsiveness and to the muscle-tendon resting state tension environment. [ABSTRACT FROM AUTHOR]

Posterolateral corner (PLC) structures of the knee joint comprise complex anatomical soft tissues that support static and dynamic functional movements of the knee. Most previous studies analyzed posterolateral stability in vitro under static loading conditions. This study aimed to evaluate the contributions of the lateral (fibular) collateral ligament (LCL), popliteofibular ligament (PFL), and popliteus tendon (PT) to cruciate ligament forces under simulated dynamic loading conditions by using selective individual resection. We combined medical imaging and motion capture of healthy subjects (four males and one female) to develop subject-specific knee models that simulated the 12 degrees of freedom of tibiofemoral and patellofemoral joint behaviors. These computational models were validated by comparing electromyographic (EMG) data with muscle activation data and were based on previous experimental studies. A rigid multi-body dynamics simulation using a lower extremity musculoskeletal model was performed to incorporate intact and selective resection of ligaments, based on a novel force-dependent kinematics method, during gait (walking) and squatting. Deficiency of the PLC structures resulted in increased loading on the posterior cruciate ligament and anterior cruciate ligament. Among PLC structures, the PT is the most influential on cruciate ligament forces under dynamic loading conditions. [ABSTRACT FROM AUTHOR]

In this study we investigated the relationships between muscle-tendon parameters and average/peak values of velocity, force and power in sprint running focusing on the acceleration phase. Eighteen male sprinters (100 m PB: 10.66±0.51 s) participated to the study. Instantaneous values of horizontal velocity (v) were recorded by means of a radar and instantaneous values of force (F) and power (P) were calculated based on these data. Muscle thickness, fascicle length and pennation angle of knee extensors and plantar flexors, as well as Achilles tendon length and CSA, were measured by means of ultrasonography. In the first 20 m of the sprint average and peak speed were 6.31±0.59 and 8.88±0.98 m·s-1, respectively; force was highest at the start of the sprint (Fpeak = 10.02±1.43 N·kg-1) and power peaked about 1 s after the start (26.64±5.99 W·kg-1). Muscle-tendon parameters showed stronger correlations with peak values of power (R range: 0.81–0.92), force (R range: 0.56–0.84) and speed (R range: 0.53–0.85) than with average values of velocity over the 20 m distance (R range: 0.41–0.61) (R <0.47 = NS; R >0.71 = P < .001). These data underline that the influence of muscle tendon parameters on sprint performance could be better appreciated when peak values of power can be calculated rather than by considering the simple measure of average velocity (e.g. distance/time). [ABSTRACT FROM AUTHOR]

Aims: To summarize the best available evidence on the effectiveness of physical counterpressure manoeuvers (PCM) for vasovagal syncope management compared to a control intervention. Control interventions included either a PCM, no intervention, or other interventions feasible in a lay setting. Methods: A systematic literature search (March 21st 2018) was performed in the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase. PCM were subdivided into 1) PCM decreasing orthostatic load (PCMOL), 2) PCM shortening the hydrostatic column between heart and brain (PCMHC), 3) PCM using mechanical compression of the veins (PCMMC). The primary outcome was syncope, secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR). When possible, a random effects meta-analysis was performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for dichotomous outcomes, and mean differences (MD) or standardized mean differences (SMD) were calculated for continuous outcomes. Heterogeneity was assessed by means of the I2 statistic. The total body of evidence was evaluated by means of the GRADE methodology. Results: Eleven trials involving 688 people with vasovagal syncope were included. Risk of bias was high in all included studies. The total body of evidence (GRADE) was considered to be low or very low. PCM were found to improve syncope as compared to control (OR: 0.52, 95% CI [0.33;0.81], p = 0.004). Similarly, before-and-after studies without a control group showed a significant reduction in syncope following PCM (OR: 0.01, 95%CI [0.00;0.01], p<0.001). No studies investigated PCMOL. PCMHC increased SBP, DBP, MAP, SV, and CO, and decreased HR. PCMMC increased SBP, DBP, and MAP. Conclusion: PCM may reduce syncope and increase SBP, DBP, and MAP. The effects on other outcomes are less clear. Additional high-quality studies are needed. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms. Methods: VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz). Results: The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4–308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04–3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25–6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (≤ 10 yrs.) T1DM patients compared to age- and gender-matched control subjects. Conclusions: Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Integrated exercises that mimic daily tasks are generally preferred for improving performance and the later stages of rehabilitation, but it is unknown whether integrated core exercises are better than isolated core exercises at improving muscle activation for hypertrophy. The aim of the study was to compare the electromyographic (EMG) activity in rectus abdominis, oblique externus, and erector spinae while performing three conditions of integrated core exercises (lunges) with three isolated core exercises (prone bridge, side bridge and back extension). The three conditions of lunges were: on a stable surface, unstable surface and with external resistance to the trunk using an elastic band. The external resistance was measured with a force cell and peaked at 75N. After one familiarization session, all exercises were performed in one experimental session in randomized order. The isolated core exercises were performed in 20 seconds and the time performing the five repetitions with lunges was matched (20 seconds). Significantly greater peak normalized EMG activity were observed in the isolated core exercises compared to the three integrated core exercises (P<0.001) with two exceptions. For the oblique externus, the isolated core exercise was only greater than the stable lunge. Lunges with elastic bands only demonstrated greater peak erector spinae activation compared the other lunge conditions. Comparing the mean EMG activity between the isolated and three integrated exercises, greater muscle activations were observed performing the isolated exercises (P<0.001). Unstable lunges did not increase the peak or mean core muscle activations. In conclusion, mean and peak EMG activity performing the isolated exercises were in general greater than the three condition of lunges. Based on these results, we recommend using isolated core exercises when the primary goal is to improve muscle activation and elicit hypertrophy, but integrated exercises once adequate initial hypertrophy is achieved. [ABSTRACT FROM AUTHOR]

By definition, perception is a multisensory process that unfolds in time as a complex sequence of exploratory activities of the organism. In such a system perception and action are integrated, and multiple energy arrays are available simultaneously. Perception of affordances interweaves sensory and motor activities into meaningful behavior given task constraints. The present contribution offers insight into the manner in which perception and action usher the organism through competent functional apprehension of its surroundings. We propose that the tensegrity structure of the body, manifested via multifractality of exploratory bodily movements informs perception of affordances. The affordance of stand-on-ability of ground surfaces served as the experimental paradigm. Observers viewed a surface set to a discrete angle and attempted to match it haptically with a continuously adjustable surface occluded by a curtain, or felt an occluded surface set to a discrete angle then matched it visually with a continuously adjustable visible surface. The complex intertwining of perception and action was demonstrated by the interactions of multifractality of postural sway with multiple energy arrays, responses, and changing geometric task demands. [ABSTRACT FROM AUTHOR]

Flywheel iso-inertial training has been shown to positively affect muscular strength and sports performance (e.g. agility). However, implementing such eccentrically-biased training during a microcycle needs to be carefully planned due to its purported effects on the neuromuscular system that can last for hours/days post-exercise. This study aimed at using tensiomyography to verify the effects of different inertias during the hip extension exercise on the contractile function of biceps femoris and semitendinosus muscles of the dominant leg for up to 72 hours post-exercise. Thirty participants (24.4 ± 3.4 years) were divided into 0.075 or 0.1 kg·m2 inertia groups and a control group. Magnitude-based analysis was used for the comparisons. Several tensiomyography parameters were changed after both intensities of flywheel exercise (in most cases indicating a decrement in muscle stiffness), whereas most between-group differences suggested that in the semitendinosus muscle, the higher inertia (0.1 kg·m2) influenced the muscle stiffness parameters more (e.g. Dm = maximal radial displacement) while in the biceps femoris, the greater effect was caused by the lower inertia (0.075 kg·m2) (e.g. Tc = contraction time). Most changes in contractile properties of the investigated muscles occur within 24 hours post-exercise, but can persist for up to 72 hours. However, higher inertia (0.1 kg·m2) influenced the stiffness of the semitendinosus muscle more, while in the biceps femoris, the greater effect was caused by the lower inertia (0.075 kg·m2). These findings should be considered by practitioners when prescribing flywheel iso-inertial training. [ABSTRACT FROM AUTHOR]

Background: The observational cohort study investigated whether the flexor muscles peak torque (PT) angle shifting towards extension observed in the involved knee in patients after anterior cruciate ligament reconstruction (ACLR) using semitendinosus and gracilis tendon (STGR) autograft is associated with the postoperative physiotherapy supervision duration. Methods: From 230 ACL-reconstructed males, we identified patients after ACLR utilizing STGR autograft and divided them into those who completed supervised physiotherapy <6 months (Group I; n = 77) and those who completed supervised physiotherapy ≥6 months (Group II; n = 66). The mean follow-up time was 6.84 ± 1.47 months. The ACL-reconstructed patients were compared to 98 controls (Group III). Bilateral knee flexor muscle PT measurements were performed. The relative PT at 180°/s (RPT), PT angle at 180°/s, and range of motion at 180°/s were analysed. The RPT limb symmetry index (LSI) was calculated. Tests for dependent samples, one-way analysis of variance, post hoc test, and linear Pearson’s correlation coefficient (r) calculations were performed. Results: The shift towards extension was noted when comparing the ACL-reconstructed limb to the uninvolved limb (Group I, p ≤ 0.001; Group II, p ≤ 0.001) and to Group III (p ≤ 0.001), but it was not correlated with physiotherapy supervision duration (r = -0.037, p = 0.662). In ACL-reconstructed patients, there was a moderate association of supervision duration and knee flexor LSI (r = 0.587, p < 0.001). Conclusions: The ACL-reconstructed knee flexors PT angle shift towards extension was observed regardless of the duration of postoperative physiotherapy supervision. However, the analysis revealed that the duration of supervised physiotherapy positively influenced the RPT and LSI in patients after the ACLR. [ABSTRACT FROM AUTHOR]

Annotation of foot-contact and foot-off events is the initial step in post-processing for most quantitative gait analysis workflows. If clean force plate strikes are present, the events can be automatically detected. Otherwise, annotation of gait events is performed manually, since reliable automatic tools are not available. Automatic annotation methods have been proposed for normal gait, but are usually based on heuristics of the coordinates and velocities of motion capture markers placed on the feet. These heuristics do not generalize to pathological gait due to greater variability in kinematics and anatomy of patients, as well as the presence of assistive devices. In this paper, we use a data-driven approach to predict foot-contact and foot-off events from kinematic and marker time series in children with normal and pathological gait. Through analysis of 9092 gait cycle measurements we build a predictive model using Long Short-Term Memory (LSTM) artificial neural networks. The best-performing model identifies foot-contact and foot-off events with an average error of 10 and 13 milliseconds respectively, outperforming popular heuristic-based approaches. We conclude that the accuracy of our approach is sufficient for most clinical and research applications in the pediatric population. Moreover, the LSTM architecture enables real-time predictions, enabling applications for real-time control of active assistive devices, orthoses, or prostheses. We provide the model, usage examples, and the training code in an open-source package. [ABSTRACT FROM AUTHOR]

There are many adult studies reporting static stretch (SS)-induced deficits and dynamic stretch (DS) performance improvements shortly after the intervention. However, there is only a single study examining stretch-induced performance changes with youth at 24 hours’ post-stretch. The objective of this study was to examine physiological responses of young trained athletes at 24-hours after experiencing SS or DS protocols. Eight young male, elite handball players (age: 16.1±5.1 years) were tested prior to-, 3-minutes and 24-hours following the three conditions (DS, SS, Control) in a randomized and counterbalanced order. Similar volumes of SS (2 repetitions of 75s for each leg) and DS (5 repetitions of 30s for each leg) involved one stretch each for the quadriceps and hamstrings. Tests included (i) two 4s maximal voluntary isometric contractions (MVC) at 60° of knee flexion with 2-min rest, (ii) two maximal isokinetic contractions each at 60°/sec and 300°/sec with 1-min rest, and (iii) two drop jumps with 30-sec rest. To simulate a full warm-up, dynamic activity including 5 minutes of aerobic cycling (70 rpm; 1 kilopond), 4 submaximal isometric contractions and 4 drop jumps were instituted before the pre-tests and following the interventions. Two-way repeated measures ANOVAs revealed that 1) both the SS and control conditions exhibited knee extensor 60°.s-1 (SS:-10.3%; p = 0.04, Control: -8.7%; p = 0.07) and 300°.s-1 (SS: -12.9%; p = 0.005, Control: -16.3%; p = 0.02) isokinetic deficits at post-test, 2) DS impaired knee flexor 60°.s-1 isokinetic work and power-related measures at post-test (Work: -10.1%; p = 0.0006; Power: -19.1%; p = 0.08) and at 24-hours’ post-test (Work: 9.9%; p = 0.023; Power: -9.6%; p = 0.01), 3) DS (12.07% and 10.47%) and SS (13.7% and 14.6%) enhanced knee flexor 300°.s-1 isokinetic force and power-related measures compared to control. In conclusion, testing-induced knee extensor isokinetic impairments were counterbalanced by DS, however the hip flexion DS could have produced minor muscle damage for at least 24-hours decreasing knee flexor forces and power at 60°.s-1. [ABSTRACT FROM AUTHOR]

The physical and biochemical factors related to cervical disc degeneration (CDD), which is involved in several spinal disorders, remain uncertain. We investigated associations between CDD and muscle strength in a general Japanese population. We used mid-sagittal-plane MRIs to assess CDD in 344 subjects recruited from participants in our community health-check project, and measured body mass index (BMI), skeletal muscle index (SMI), and muscle strength in the neck, trunk, hands, and legs. CDD was scored based on the prevalence and severity of intravertebral disc degeneration. Spearman correlation coefficients were used to evaluate whether the SMI or muscle-strength values were correlated with the disc degenerative score. Stepwise multiple linear regression analyses were then conducted with the CDD score as the dependent variable, and age, sex, BMI, and muscle strength as independent variables, for each gender. These analyses used the muscle-strength parameters that were found to be correlated with the CDD scores in the single correlation analyses. The CDD scores were similar in men and women. Men had significantly more muscle strength in the neck, trunk, hands, and legs. There was a significant negative corelation between the CDD score and the trunk strength in both sexes, handgrip in men, and leg strength in women in the single-variable correlation analysis. Including age and the limb- or trunk-muscle strength comprehensively, multiple linear regression analyses showed that age was the strongest factor that was independently associated with CDD in both sexes, and that the effects were attenuated by limb and trunk muscle strength. [ABSTRACT FROM AUTHOR]

With an emphasis on ballistic movements, an accurately anticipated neural control is an essential prerequisite to deliver a motor response coincidentally with the event of ground contact. This study investigated how previous knowledge of the ground condition affects proactive and reactive motor control in drop jumps (DJ). Thereby, human anticipatory capacity of muscle activation was investigated regarding neuromuscular activation, joint kinematics and peak forces associated with DJ performance. In 18 subjects, the effect of knowledge of two different surface conditions during DJs was evaluated. Peak force, ground-contact-time (GCT), rate of force development (RFD) and jump height were assessed. Electromyographic (EMG) activities of the m. soleus (SOL) and gastrocnemius medialis (GM) were assessed for 150ms before (PRE) and during ground contact (GC) for the short-, medium-, and long-latency responses. Ankle and knee joint kinematics were recorded in the sagittal plane.In the unknown conditions peak force, RFD and jump height declined, GCT was prolonged, proactive EMG activity (PRE) in SOL and GM was diminished (P<0.05). During GC, a decline in EMG activity in the unknown condition was manifested for SOL and GM for the SLR, MLR and LLR (P<0.05). Ankle and knee joint deflections during GC were increased in the unknown vs. known condition (P<0.05). Peak force, RFD and jump height were positively correlated to GM-EMG in PRE, SLR, MLR and LLR (P<0.05). Results revealed that proactive and reactive modulations in muscle activity prior and during GC are interrelated to the force-time characteristics and height of the jumps. The unknown condition revealed a comparable neuromuscular activity during pre-activation for both conditions, followed by an inhibition in the subsequent phase after touch down. These findings underline that anticipation is a determining factor influencing timing and adjustment of motor responses to accomplish ballistic movements regarding precision and performance. [ABSTRACT FROM AUTHOR]

Variable, external resistance is proposed to increasingly augment the muscular stress throughout a dynamic movement. However, it is uncertain how different levels of variable resistance affect the activation in the deadlift. The aim of the study was to compare the electromyographic activity of the gluteus maximus, biceps femoris, semitendinosus, vastus lateralis and erector spinae muscles during the barbell deadlift with free weights (FW) alone, with two (FW-2EB), and four elastic bands (FW-4EB) to deload some of the constant external resistance. Fifteen resistance-trained men participated in a cross-over design where resistance loadings were matched using two-repetition maximum loadings in the three different conditions. For the whole movement, both repetitions were analyzed. For the phase-specific analysis, the last repetition was divided into six parts, i.e. the lower, middle and upper phase in both the ascending and descending phase of the movement. The mean deloading contributions from FW-2EB and FW-4EB were 21% and 41%, respectively. In FW-4EB, the erector spinae was activated more in the whole movement (8%, ES = 0.31, p = 0.002) compared to FW-2EB. There was also a tendency towards higher activation in FW-4EB versus FW for the whole movement (5%, ES = 0.18, p = 0.072). There were no significant differences between the conditions in any of the other phases or muscles (p = 0.106–0.926). In summary, a high contribution from variable, external resistance seems to activate the back extensors more than a low contribution. [ABSTRACT FROM AUTHOR]

Aging is associated with a higher risk of falls, and an impaired ability to recover balance after a postural perturbation is an important contributing factor. In turn, this impaired recovery ability likely stems from age-related decrements in lower limb strength. The purpose of this study was to investigate the effects of age-related strength loss on non-stepping balance recovery capability after a perturbation while standing, without constraining movements to the ankle as in prior reports. Two experiments were conducted. In the first, five young adults (ages 20–30) and six community-dwelling older adults (ages 70–80) recovered their balance, without stepping, from a backward displacement of a support surface. Balance recovery capability was quantified as the maximal backward platform displacement that a subject could withstand without stepping. The maximal platform displacement was 27% smaller among the older group (11.8±2.1 cm) vs. the young group (16.2±2.6 cm). In the second experiment, forward dynamic simulations of a two-segment, rigid-body model were used to investigate the effects of manipulating strength in the hip extensors/flexors and ankle plantar flexors/dorsiflexors. In these, typical age-related reductions in strength were included. The model predicted lower maximal platform displacements with age-related reductions only in plantar flexion and hip flexion strength. These findings support the previously reported age-related loss of balance recovery ability, and an important role for plantar flexor strength in this ability. [ABSTRACT FROM AUTHOR]

Human ageing is accompanied by a progressive decline in leg-extensor power (LEP). LEP is typically measured with specialized and expensive equipment, which limits the large-scale applicability. Previously, sensor-based trunk kinematics have been used to estimate the vertical power required to elevate the body’s center of mass during functional tests, but the link with LEP and age remains to be investigated. Therefore, we investigated whether a body-fixed sensor-based analysis of power during stair ascent (SA) and sit-to-stand (STS) is positively related to LEP and whether its ability to detect age-related declines is similar. In addition, the effect of load during SA and STS was investigated. 98 adults (20–70 years) performed a leg press to assess LEP, SA and 5-repetition STS tests. In SA and STS, two conditions were tested: unloaded and loaded (+10% body mass). An inertial measurement unit was used to analyze (sub)-durations and vertical power. SA and STS power were more related to LEP than duration parameters (i.e. 0.80–0.81 for power and -0.41 –-0.66 for duration parameters, p < 0.05). The average annual age-related percent change was higher in SA power (-1.38%) than in LEP (-0.86%) and STS power (-0.38%) (p < 0.05). Age explained 29% in SA power (p < 0.001), as opposed to 14% in LEP (p < 0.001) and a non-significant 2% in STS power (p = 0.102). The addition of 10% load did not influence the age-related decline of SA and STS power nor the relationship with LEP. These results demonstrate the potential of SA tests to detect age-related deterioration in neuromuscular function. SA seems more sensitive to detect age-related changes than LEP, probably because of the additional balance component and plantar- and dorsiflexor activity. On the contrary, STS is less sensitive to age-related changes because of a ceiling effect in well-functioning adults. [ABSTRACT FROM AUTHOR]

Patellofemoral pain (PFP) is one of the most common overuse injuries of the knee. Previous research has found that individuals with PFP exhibit differences in peak hip kinematics; however, differences in peak knee kinematics, where the pain originates, are difficult to elucidate. To better understand the mechanism behind PFP, we sought to characterize differences in knee gait kinematic waveform patterns in individuals with PFP compared to healthy individuals using fast Fourier transform (FFT). Sixteen control and sixteen individuals with PFP participated in a fast walk protocol. FFT was used to decompose the sagittal, frontal and transverse plane knee gait waveforms into sinusoidal signals. A two-way ANOVA and Bonferroni post hoc analysis compared group, limb and interaction effects on sagittal, frontal and transverse amplitude, frequency and phase components between control and PFP individuals gait waveforms. Differences in frequency and phase values were found in the sagittal and frontal plane knee waveforms between the control and PFP groups. The signal-to-noise ratio also reported significant differences between the PFP and control limbs in the sagittal (p<0.01) and frontal planes (p = 0.04). The findings indicate that differences in gait patterns in the individuals with PFP were not the result of amplitude differences, but differences attributed to temporal changes in gait patterns detected by the frequency and phase metrics. These changes suggest that individuals with PFP adopted a more deliberate, stiffer gait and exhibit altered joint coordination. And the FFT technique could serve as a fast, quantifiable tool for clinicians to detect PFP. [ABSTRACT FROM AUTHOR]

During whole body vibrations, the total contact force in knee and hip joints consists of a static component plus the vibration-induced dynamic component. In two different cohorts, these forces were measured with instrumented joint implants at different vibration frequencies and amplitudes. For three standing positions on two platforms, the dynamic forces were compared to the static forces, and the total forces were related to the peak forces during walking. A biomechanical model served for estimating muscle force increases from contact force increases. The median static forces were 122% to 168% (knee), resp. 93% to 141% (hip), of the body weight. The same accelerations produced higher dynamic forces for alternating than for parallel foot movements. The dynamic forces individually differed much between 5.3% to 27.5% of the static forces in the same positions. On the Powerplate, they were even close to zero in some subjects. The total forces were always below 79% of the forces during walking. The dynamic forces did not rise proportionally to platform accelerations. During stance (Galileo, 25 Hz, 2 mm), the damping of dynamic forces was only 8% between foot and knee but 54% between knee and hip. The estimated rises in muscle forces due to the vibrations were in the same ranges as the contact force increases. These rises were much smaller than the vibration-induced EMG increases, reported for the same platform accelerations. These small muscle force increases, along with the observation that the peak contact and muscle forces during vibrations remained far below those during walking, indicate that dynamic muscle force amplitudes cannot be the reason for positive effects of whole body vibrations on muscles, bone remodelling or arthritic joints. Positive effects of vibrations must be caused by factors other than raised forces amplitudes. [ABSTRACT FROM AUTHOR]

Although core stability (CS) training is largely used to enhance motor performance and prevent musculoskeletal injuries, the lack of methods to quantify CS training intensity hinders the design of CS programs and the comparison and generalization of their effects. The aim of this study was to analyze the reliability of accelerometers integrated into smartphones to quantify the intensity of several CS isometric exercises. Additionally, this study analyzed to what extent the pelvic acceleration data represent the local stability of the core structures or the whole-body postural control. Twenty-three male and female physically-active individuals performed two testing-sessions spaced one week apart, each consisting of two 6-second trials of five variations of frontal bridge, back bridge, lateral bridge and bird-dog exercises. In order to assess load intensity based on the postural control challenge of CS exercises, a smartphone accelerometer and two force platforms were used to measure the mean pelvic linear acceleration and the mean velocity of the centre of pressure displacement, respectively. Reliability was assessed through the intra-class correlation coefficient (ICC3,1) and the standard error of measurement (SEM). In addition, Pearson coefficient was used to analyze the correlation between parameters. The reliability analysis showed that most CS exercise variations obtained moderate-to-high reliability scores for pelvic acceleration (0.71

Cluster sets allow for velocity and power output maintenance, but the literature routinely uses highly fatiguing traditional set protocols. Although such studies have merit, others suggest fatigue should be avoided when training to improve power output, making those cluster set studies less practical. Therefore, the purpose of this study was to compare these set structures when truncating sets using a power-based threshold. Nine males (23.4 ± 0.6 yr) with various sport backgrounds performed 6 sets of back squats with individualized loads that elicited the greatest mean power (MPmax) output (112.7 ± 12.1% of body mass). Each set during the traditional set (TS) protocol included as many repetitions as possible until two consecutive repetitions dropped below 90% MPmax, which was followed by 120 s inter-set rest. The design was identical for cluster sets (CS) but with an additional 20 s intra-set rest after every 2 repetitions. The number of repetitions performed, mean velocity, and mean power output, were analyzed using 2(protocol)*6(set) repeated measures ANOVA. The number of repetitions during CS (51.8 ± 14.4) was greater than TS (31.9 ± 3.7) (p = 0.001), but the average velocity (CS = 0.711 ± 0.069, TS = 0.716 ± 0.081 m·s-1; p = 0.732) and power output (CS = 630.3 ± 59.8, TS = 636.0 ± 84.3 W; p = 0.629) of those repetitions were similar. These data indicate that CS are a viable option for increasing training volume during contemporary training where sets are ended when repetitions drop below velocity or power thresholds. [ABSTRACT FROM AUTHOR]

Freezing, an episodic movement breakdown that goes from disrupted gait patterns to complete arrest, is a disabling symptom in Parkinson’s disease. Several efforts have been made to objectively identify freezing episodes (FEs), although a standardized methodology to discriminate freezing from normal movement is lacking. Novel mathematical approaches that provide information in the temporal and frequency domains, such as the continuous wavelet transform, have demonstrated promising results detecting freezing, although still with limited effectiveness. We aimed to determine whether a computerized algorithm using the continuous wavelet transform based on baseline (i.e. no movement) rather than on amplitude decrease is more effective detecting freezing. Twenty-six individuals with Parkinson’s disease performed two trials of a repetitive stepping-in-place task while they were filmed by a video camera and tracked by a motion capture system. The number of FEs and their total duration were determined from a visual inspection of the videos and from three different computed algorithms. Differences in the number and total duration of the FEs between the video inspection and each of the three methods were obtained. The accuracy to identify the time of occurrence of a FE by each method was also calculated. A significant effect of Method was found for the number (p = 0.016) and total duration (p = 0.013) of the FEs, with the method based on baseline being the closest one to the values reported from the videos. Moreover, the same method was the most accurate in detecting the time of occurrence, and the one reaching the highest sensitivity (88.2%). Findings suggest that threshold detection methods based on baseline and movement amplitude decreases capture different characteristics of Parkinsonian gait, with the first one being more effective at detecting FEs. Moreover, robust approaches that consider both time and frequency characteristics are more sensitive in identifying freezing. [ABSTRACT FROM AUTHOR]

Advancements in wearable technology have facilitated performance monitoring in a number of sports. Figure skating may also benefit from this technology, but the inherent movements present some unique challenges. The purpose of this study was to evaluate the feasibility of using an inertial measurement unit (IMU) to monitor three aspects of figure skating jumping performance: jump count, jump height, and rotation speed. Seven competitive figure skaters, outfitted with a waist-mounted IMU, performed a total of 59 isolated multi-revolution jumps and their competition routines, which consisted of 41 multi-revolution jumps along with spins, footwork, and other skills. The isolated jumps were used to develop a jump identification algorithm, which was tested on the competition routines. Four algorithms to estimate jump height from flight time were then evaluated using calibrated video as a gold standard. The identification algorithm counted 39 of the 41 program jumps correctly, with one false positive. Flight time and jump height errors under 7% and 15% respectively were found using a peak-to-peak scaling algorithm. Rotation speeds up to 1,500°/s were noted, with peak speeds occurring just over halfway between takeoff and landing. Overall, jump monitoring via IMUs may be an efficient aid for figure skaters training multi-revolution jumps. [ABSTRACT FROM AUTHOR]

Truck pulling is one of the common manual materials handling tasks which contribute to musculoskeletal disorders. The maximum endurance time (MET) for two-handed truck pulling tasks has been rarely discussed in the literature. The objectives of this study were to explore the development of muscular fatigue when performing two-handed pulling task and to establish models to predict the MET. A simulated pallet truck pulling experiment was conducted. Sixteen healthy adults including eight females and eight males participated. The participants pulled a handle simulating that of a pallet truck using two hands until they could not pull any longer under two postures. The forces applied for females and males were 139.65 N and 170.03 N, respectively. The maximum voluntary contractions (MVC) of the pulling strength both before and after the simulated pull were measured. After each trial, both the MET and subjective ratings of muscular fatigue on body segments were recorded. The results showed that posture significantly affected MVC of pull both before and after the trial. It was found that foot/shank of the front leg had higher subjective ratings of muscular fatigue than the other body segments. The MET equations employing both power and logarithmic functions were developed to predict the MET of the two-handed pulling tasks. Predictive models established in this study may be used to assess the MET for two-handed pulling tasks. [ABSTRACT FROM AUTHOR]

The influence of age on spinal muscle activation patterns and its relation to kinematics is poorly understood. We aimed at understanding age-related changes to spine and trunk muscle activity in addition to spinal and lower limb kinematics during treadmill walking under various conditions. An observational study was conducted evaluating asymptomatic young (n = 10; 3F, 7M; 26.3±2.5yrs) and older (n = 9; 3F, 6M; 67.1±4.2yrs) adults’ treadmill walking at 2km/h and 4km/h, each at 0, 1, 5, and 10% inclination. Unilateral (right side) electromyography (EMG) was recorded from deep and superficial multifidus (intramuscular) and erector spinae and abdominal obliques (surface); trunk and leg kinematics were also measured. Muscle activity was characterised by peak amplitude and duration of activity, and the time-point of peak amplitude in the gait cycle (0–100%). Peak activation in older adults was lower for the superficial multifidus (p<0.0001) and higher for the thoracolumbar (p<0.001) and lumbar erector spinae (p<0.01). The duration of activation was longer in older adults for all muscles (p<0.05) except the superficial multifidus, and longer during faster walking for all participants. The time-point of peak amplitude in the gait cycle was earlier in older participants for the external obliques (p<0.05). Walking speed appeared to influence muscle activity more than inclination. Older adults used less spine, trunk and lower limb motion, except at the ankle. Age-related differences within multifidus and between paravertebral and trunk muscles were inconsistent. Walking at 4km/h at 5–10% inclination may specifically target the lumbar paravertebral muscles. [ABSTRACT FROM AUTHOR]

Musculoskeletal injuries (MSI) in the military reduce soldier capability and impose substantial costs. Characterizing biomechanical surrogates of MSI during commonly performed military tasks (e.g., load carriage) is necessary for evaluating the effectiveness of possible interventions to reduce MSI risk. This study determined the effects of body-borne load distribution, load magnitude, and walking speed on tibiofemoral contact forces. Twenty-one Australian Army Reserve soldiers completed a treadmill walking protocol in an unloaded condition and wearing four armor types (standard-issue and three prototypes) with two load configurations (15 and 30 kg) for a total of 8 armor x load ensembles. In each ensemble, participants completed a 5-minute warm-up, and then walked for 10 minutes at both moderate (1.53 m⋅s-1) and fast (1.81 m⋅s-1) speeds. During treadmill walking, three-dimensional kinematics, ground reaction forces, and muscle activity from nine lower-limb muscles were collected in the final minute of each speed. These data were used as inputs into a neuromusculoskeletal model, which estimated medial, lateral and total tibiofemoral contact forces. Repeated measures analyses of variance revealed no differences for any variables between armor types, but peak medial compartment contact forces increased when progressing from moderate to fast walking and with increased load (p<0.001). Acute exposure to load carriage increased estimated tibiofemoral contact forces 10.1 and 19.9% with 15 and 30kg of carried load, respectively, compared to unloaded walking. These results suggest that soldiers carrying loads in excess of 15 kg for prolonged periods could be at greater risk of knee MSI than those with less exposure. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this work is the design, implementation and evaluation of a mechanically flexible receive-only coil array for magnetic resonance imaging (MRI) at 3 T that can be applied to various target organs and provides high parallel imaging performance. Methods: A 23-channel array was designed based on a rigid-flex printed circuit board (PCB). The flexible multi-layer part contains the copper traces forming the coil elements. The rigid part of the PCB houses the solder joints and lumped elements. The coil housing consists of rigid caps mounted above the rigid parts. Adhesive PTFE sheets cover all flexible parts. The developed array was tested on the bench as well as in phantom and in vivo MRI experiments employing parallel imaging acceleration factors up to six. Results: Efficient mutual decoupling between receive elements and detuning between receive array and body coil was achieved. An increased signal-to-noise ratio in comparison to commercial reference coils is demonstrated, especially in regions close to the developed array and for high parallel imaging acceleration factors. Exemplary in vivo images of head, ankle, knee, shoulder and hand are presented. Conclusion: Based on high sensitivity close to the array and low g-factors, this flexible coil is well suited for studies of occipital and temporal cortex, as well as musculoskeletal targets like knee, ankle, elbow and wrist. [ABSTRACT FROM AUTHOR]

This study aimed to assess the effect of acute exposure to moderate altitude on kinematic variables of the ippon-seoi-nage and on the mechanical outputs of the countermovement jump (CMJ). Thirteen elite male judokas from the Spanish Judo Training Centre in Valencia (age: 21.54 ± 2.15 years) participated in the study. All of them performed an incremental CMJ test and an ippon-seoi-nage technique test before (N) and after the ascent to a moderate altitude of 2320 m above the sea level (H). A linear velocity transducer was attached to the bar to assess the mechanical outputs of each loaded CMJ at different percentages of their own body weight (25, 50, 75 and 100%). A wearable sensor was used to assess the kinematic variables (times, accelerations and angular velocities) transferred to a dummy during the technique test. The kinematic variables showed great individual reliability (CV = 8.46% in N; CV = 8.37% in H), which contrasted with low reliability observed when the whole group was considered. The smallest important CV ratio (>1.15) showed that H caused changes in the reliability of the kinematic variables, with some variables becoming more reliable and others losing the reliability they had in N. H also caused small increments in peak velocity across all loads tested in the CMJ (+3.67%; P<0.05). In contrast, no changes in the kinematic variables were verified. In addition, there was no association between leg extension capability and the acceleration (r = -0.16 ± 0.19 in N; r = -0.24 ± 0.19 in H) or angular velocity (r = -0.19 ± 0.24 in N; r = -0.30 ± 0.26 in H) of the ippon-seoi-nage, nor was acute exposure to H found to affect this association (P>0.05). Differences between individual and within-groups CV confirm the individual adaptations that each judoka makes during this technique. Additionally, the CV ratio shows a change in the space-time pattern of the technique in H. Therefore, it would be necessary to include an adaptation period to adapt the technique after the ascent in altitude. Further studies are needed to confirm the relationship and transference from the velocity gains in CMJ during altitude training. [ABSTRACT FROM AUTHOR]

Background: Clinical management of children and youth with cerebral palsy (CP) is increasingly supported by computerized gait analysis. Methods have been developed to reduce the complexity of interpreting biomechanical data and quantify meaningful movement patterns. However, few methods are inclusive of multiple joints and planes of motion, and consider the entire duration of gait phases; potentially limiting insight into this heterogeneous pathology. The objective of this study was to assess the implementation of k-means clustering to determine clusters of participants with CP based on multi-joint gait kinematics. Methods: Barefoot walking kinematics were analyzed for a historical cohort (2007–2015) of 37 male and female children and youth with spastic diplegic CP [male n = 21; female n = 16; median age = 12 (range 5–25) years; Gross Motor Function Classification System Level I n = 17 and Level II n = 20]. Mean stance phase hip (sagittal, coronal, transverse), knee (sagittal), and ankle (sagittal) kinematics were time (101 data points), mean and range normalized. Normalized kinematics data vectors (505 data points) for all participants were then combined in a single data matrix M (37x505 data points). K-means clustering was conducted 10 times for all data in M (2–5 seeds, 50 repetitions). Cluster quality was assessed using the mean Silhouette value () and cluster repeatability. The mean kinematic patterns of each cluster were explored with respect to a dataset of normally developing (ND) children using Statistical Parametric Mapping (SPM, alpha 0.05). Differences in potentially confounding variables (age, height, weight, walking speed) between clusters (C) were assessed individually in SPSS (IBM, USA) using Kruskal-Wallis H tests (alpha 0.05). Results: Four clusters (n1 = 5, n2 = 12, n3 = 12, n4 = 8) provided the largest possible data separation based on high cluster repeatability (96.8% across 10 repetitions) and comparatively greater cluster quality [ (SD), 0.275 (0.152)]. Participant data with low cluster quality values displayed a tendency toward lower cluster allocation repeatability. Distinct kinematic differences between clusters and ND data were observable. Specifically, C1 displayed a unique continuous hip abduction and external rotation pattern. In contrast, participants in C2 moved from hip adduction (loading response) to abduction (mid to terminal stance) and featured a unique ankle plantarflexor pattern during pre-swing. C3 was characterized by gait deviations in the sagittal plane of the hip, knee and ankle only. C4 displayed evidence for the most substantial hip and knee extension, and ankle plantarflexion deficit from midstance to pre-swing. Discussion: K-means clustering enabled the determination of up to four kinematic clusters of individuals with spastic diplegic CP using multi-joint angles without a priori data reduction. A cluster boundary effect was demonstrated by the Silhouette value, where data with values approaching zero were more likely to change cluster allocation. Exploratory analyses using SPM revealed significant differences across joints and between clusters indicating the formation of clinically meaningful clusters. Further work is needed to determine the effects of including further topographical classifications of CP, additional biomechanical data, and the sensitivity to clinical interventions to assess the potential for informing clinical decision-making. [ABSTRACT FROM AUTHOR]

The pendulum test is a sensitive clinical assessment of spasticity where the lower leg is dropped from the horizontal position and features of limb motion are recorded. Three key kinematic features are associated with the degree of severity of spasticity in children with cerebral palsy: decreased initial limb excursion, reduced number of limb oscillations, and a non-vertical resting limb angle. While spasticity is attributed to increased velocity-dependent resistance to motion, prior models simulating increased sensorimotor feedback of muscle velocity fail to explain the key pendulum test kinematic outcomes in spastic individuals. Here we hypothesized that increased muscle tone, causing a transient increase in muscle force, i.e. short-range stiffness, could account for reduced first swing excursion and non-vertical resting limb angle. We further hypothesized that hyperreflexia modeled based on muscle fiber force, and not velocity, feedback would be necessary to reduce the number of oscillations because of its interaction with transiently increased muscle force due to short-range stiffness. We simulated the lower leg as a torque-driven single-link pendulum. Muscle tone was modeled as a constant baseline joint torque, short-range stiffness torque was dependent on the level of muscle tone, and delayed sensory feedback torque to simulate reflex activity was based on either muscle velocity or force. Muscle tone and transient short-range stiffness were necessary to simulate decreased initial swing excursion and non-vertical resting leg angle. Moreover, the reduction in the number of oscillations was best reproduced by simulating stretch reflex activity in terms of force, and not velocity, feedback. Varying only baseline muscle torque and reflex gain, we simulated a range of pendulum test kinematics observed across different levels of spasticity. Our model lends insight into physiological mechanisms of spasticity whose contributions can vary on an individual-specific basis, and potentially across different neurological disorders that manifest spasticity as a symptom. [ABSTRACT FROM AUTHOR]

The present study aimed at investigating whether the neuromuscular system behaves differently (in terms of force and muscle activity generation) as a function of the task being performed (i.e. maximal voluntary efforts vs stair negotiation) and the presence of patellofemoral pain (PFP) and possible influences of pain intensity. Thirty-eight women with (n = 19) and without PFP (n = 19) had their knee strength (extension joint torque) measured during maximal voluntary isometric contractions (MVIC) and electromyography (EMG) data recorded during both MVIC and stair ascent tasks, which were performed before and after a loading protocol designed to exacerbate pain symptoms. Women with PFP displayed lower levels of vastus medialis (p = 0.002) and vastus lateralis (p = 0.032) EMG activation during MVIC assessments. Conversely, the PFP group showed higher levels of vastus medialis muscle activity during stair climbing (p = 0.007), which happened exclusively after the loading protocol. Similarly, women with PFP displayed lower knee extensor torque only during the MVIC tests performed after the loading protocol, which was moderately correlated with the increase in self-reported pain (p = 0.041, r = 0.37), whereas the changes in EMG activity during stair ascent were not correlated with changes in pain intensity (p = 0.215, r = 0.12). These results suggest that, in comparison to pain-free controls, women with PFP display lower levels of quadriceps EMG activation during maximal contractions, but higher activation during dynamic tasks (stair ascent). In addition, the moderate association between the decrease in knee extensor torque and increase in self-reported pain indicates that care should be taken by clinicians during quadriceps strength evaluation in women with PFP, as misleading outcomes may emerge if the intensity of knee pain is not considered during screening. Additionally, rehabilitation strategies should focus on both restoring neuromuscular control and increasing muscle strength. [ABSTRACT FROM AUTHOR]

Inverse dynamics is a technique in which measured kinematics and, possibly, external forces are used to calculate net joint torques in a rigid body linked segment model. However, kinematics and forces are usually not consistent due to incorrect modelling assumptions and measurement errors. This is commonly resolved by introducing ‘residual forces and torques’ which compensate for this problem, but do not exist in reality. In this study a constrained optimization algorithm is proposed that finds the kinematics that are mechanically consistent with measured external forces and mimic the measured kinematics as closely as possible. The algorithm was tested on datasets containing planar kinematics and ground reaction forces obtained during human walking at three velocities (0.8 m/s, 1.25 and 1.8 m/s). Before optimization, the residual force and torque were calculated for a typical example. Both showed substantial values, indicating the necessity of developing a mechanically consistent algorithm. The proposed optimization algorithm converged to a solution in which the residual forces and torques were zero, without changing the ground reaction forces and with only minor changes to the measured kinematics. When using a rigid body approach, our algorithm ensures a consistent description of forces and kinematics, thereby improving the validity of calculated net joint torque and power values. [ABSTRACT FROM AUTHOR]

Musculoskeletal models represent a powerful tool to gain knowledge on the internal forces acting at the joint level in a non-invasive way. However, these models can present some errors associated with the level of detail in their geometrical representation. For this reason, a thorough validation is necessary to prove the reliability of their predictions. This study documents the development of a generic musculoskeletal model and proposes a working logic and simulation techniques for identifying specific model features in need of refinement; as well as providing a quantitative validation for the prediction of hip contact forces (HCF). The model, implemented in the AnyBody Modeling System and based on the cadaveric dataset TLEM 2.0, was scaled to match the anthropometry of a patient fitted with an instrumented hip implant and to reproduce gait kinematics based on motion capture data. The relative contribution of individual muscle elements to the HCF and joint moments was analyzed to identify critical geometries, which were then compared to muscle magnetic resonance imaging (MRI) scans and, in case of inconsistencies, were modified to better match the volumetric scans. The predicted HCF showed good agreement with the overall trend and timing of the measured HCF from the instrumented prosthesis. The average root mean square error (RMSE), calculated for the total HCF was found to be 0.298*BW. Refining the geometries of the muscles thus identified reduced RMSE on HCF magnitudes by 17% (from 0.359*BW to 0.298*BW) over the whole gait cycle. The detailed study of individual muscle contributions to the HCF succeeded in identifying muscles with incorrect anatomy, which would have been difficult to intuitively identify otherwise. Despite a certain residual over-prediction of the final hip contact forces in the stance phase, a satisfactory level of geometrical accuracy of muscle paths has been achieved with the refinement of this model. [ABSTRACT FROM AUTHOR]

Lower extremity powered exoskeletons (LEPE) are an emerging technology that assists people with lower-limb paralysis. LEPE for people with complete spinal cord injury walk at very slow speeds, below 0.5m/s. For the able-bodied population, very slow walking uses different neuromuscular, locomotor, postural, and dynamic balance control. Speed dependent kinetic and kinematic regression equations in the literature could be used for very slow walking LEPE trajectory scaling; however, kinematic and kinetic information at walking speeds below 0.5 m/s is lacking. Scaling LEPE trajectories using current reference equations may be inaccurate because these equations were produced from faster than real-world LEPE walking speeds. An improved understanding of how able-bodied people biomechanically adapt to very slow walking will provide LEPE developers with more accurate models to predict and scale LEPE gait trajectories. Full body motion capture data were collected from 30 healthy adults while walking on an instrumented self-paced treadmill, within a CAREN-Extended virtual reality environment. Kinematic and kinetic data were collected for 0.2 m/s—0.8 m/s, and self-selected walking speed. Thirty-three common sagittal kinematic and kinetic gait parameters were identified from motion capture data and inverse dynamics. Gait parameter relationships to walking speed, cadence, and stride length were determined with linear and quadratic (second and third order) regression. For parameters with a non-linear relationship with speed, cadence, or stride-length, linear regressions were used to determine if a consistent inflection occurred for faster and slower walking speeds. Group mean equations were applied to each participant’s data to determine the best performing equations for calculating important peak sagittal kinematic and kinetic gait parameters. Quadratic models based on walking speed had the strongest correlations with sagittal kinematic and kinetic gait parameters, with kinetic parameters having the better results. The lack of a consistent inflection point indicated that the kinematic and kinetic gait strategies did not change at very slow gait speeds. This research showed stronger associations with speed and gait parameters then previous studies, and provided more accurate regression equations for gait parameters at very slow walking speeds that can be used for LEPE joint trajectory development. [ABSTRACT FROM AUTHOR]

Many Service members and Veterans with lower-limb amputations have the potential for high function and the desire to resume physically demanding occupations that require them to carry heavy loads (e.g., military service, firefighters, farmers, ranchers, construction workers). However, it is currently unclear which prosthetic feet best accommodate heavy load carriage while also providing good overall function and mobility during unweighted activities. The main objective of this study was to investigate the ability of currently available prosthetic ankle-foot systems to accommodate weighted walking by examining the mechanical characteristics (i.e., forefoot stiffness) and dynamic function (i.e., rocker radius, effective foot length ratio, and late-stance energy return) of prosthetic feet designed for high activity users. Load versus deflection curves were obtained for nine prosthetic ankle-foot systems using a servohydraulic test frame and load cell. Effective roll-over shape characteristics and late-stance energy return measures were then obtained using quantitative gait analysis for three users with unilateral, transtibial amputation. Results from mechanical and dynamic testing showed that although forefoot stiffness varied across the nine feet investigated in this study, changes measured in roll-over shape radius and effective foot length ratio were relatively small in response to weighted walking. At the same time, prosthetic feet with more compliant forefoot keel structures appeared to provide more late-stance energy return compared to feet with stiffer forefoot keel structures. These results suggest that prosthetic ankle-foot systems with compliant forefoot keel structures may better accommodate weighted walking by reducing the metabolic cost of physically demanding activities. However, to more fully understand the biomechanical and functional implications of these results, other factors, such as the residual-limb strength of the user and the overall stiffness profile of the prosthetic foot, should also be considered. [ABSTRACT FROM AUTHOR]

The use of physical tests to profile physical capabilities, and provide training direction to athletes is common practice. Likewise, in professional team sports, notational analysis codes the key contributions of each player during competition. Limited studies have however investigated relationships between physical capabilities and key performance indicators (KPIs) of rugby union match-play. Elite professional players, categorised as forwards (n = 15) or backs (n = 14), from an international rugby union squad (n = 29) undertook assessments of isometric mid-thigh pull (IMTP), bilateral and unilateral countermovement jumps (CMJ) and drop jumps (DJ; from 40 and 20 cm, respectively), and assessment of acceleration (10 m), a 5 m weighted sled drive, and a Yo-Yo intermittent recovery test level 1 (Yo-Yo IRTL1). Game statistics of the same players from 92 matches (~23 matches per player) during the 2014–15 season were analysed for effort and performance-based metrics. For forwards, Yo-Yo IRTL1 correlated significantly with; number of tackles made (r = 0.717), first three players at a ruck in both attack (r = 0.568) and defence (r = 0.581), number of effective rucks (r = 0.630), total possessions (r = 0.522), passes made (r = 0.651), percentage of carries over the gainline (r = 0.610), effective ruck success (r = 0.600), tackle success (r = 0.540), and the number of turnovers made (r = 0.518). Drop jump performance in forwards was associated with; the number of clean breaks (r = 0.558), dominant collisions (r = 0.589), and offloads (r = 0.594). For backs, the sled-drive test correlated with; number of carries (r = -0.751), first three players at an attacking ruck (r = -0.613), effective attacking rucks (r = -0.584), number of dominant collisions (r = -0.792) and offloads (r = -0.814). Likewise, for backs, IMTP peak force was related to; the number of possessions (r = 0.793), passes made (r = 0.792), effective attacking ruck percentage (r = 0.628), and the number of offloads (r = 0.621) whilst relative peak force correlated with; the percentage of carries over the gainline (r = 0.533), percent tackle success (r = 0.603) and effective attacking ruck percentage (r = 0.584). Regression analyses highlighted that only a small number of variables (i.e., carries, tackles, attacking and defensive first three at ruck) returned practically achievable changes (<20%) in physical qualities. In spite of this, and while leaving scope identification of further physical and/or performance predictors, greater strength, power and intermittent running performance were positively related to match-derived KPIs during competition. This may provide a basis for better integrating the strategies used by physical and technical performance-focused coaching staff to improve key performance indicators, and thus match performance, of rugby union players. [ABSTRACT FROM AUTHOR]