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Resistance training elicited important alterations in soleus intrinsic motor neuronal excitability, likely mediated by enhanced persistent inward current (PIC) amplitude, in older adults. Estimates of PICs increased after the training period, accompanied by an enhanced ability to increase PIC amplitudes at higher contraction intensities. Our data also suggest that changes in PIC contribution to self-sustained discharging may contribute to increases in motor neuron discharge rates, maximal strength, and functional capacity in older adults after resistance training.

Objective The aim of this study was to explore expert opinion to identify the components of sprinting technique they believed to be risk factors for hamstring strain injuries (HSI). Design Mixed-method research design. Methods The Concept Systems groupwisdom™ web platform was used to analyse and collect data. Participants brainstormed, sorted and rated the components of sprinting technique to consider in a HSI prevention strategy. Results Twenty-three experts (academic/researcher, physiotherapist, strength and conditioning coaches and sprint coaches) brainstormed 66 statements that were synthesised and edited to 60 statements. Nineteen participants sorted the statements into clusters and rated them for relative importance and confidence they could be addressed in a hamstring injury prevention program. Multidimensional scaling and cluster analysis identified a 8-cluster solution modified to a 5-cluster solution by the research team: Training prescription (10 statements, mean importance: 3.79 out of 5 and mean confidence: 3.79); Neuromuscular and tendon properties (9, 3.09, 3.08); Kinematics parameters/Technical skills (27, 2.99, 2.98); Kinetics parameters (10, 2.85, 2.92); and Hip mechanics (4, 2.70, 2.63). The statement: “low exposure to maximal sprint running” located in the cluster “Training prescription” received the highest mean importance (4.55) and confidence ratings (4.42) of all statements. Conclusion The five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were: training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.

Noncontact lower limb injuries are common within the Australian Football League (AFL) and National Rugby League (NRL). Smaller (8.5 cm2) lumbar multifidus at the fifth vertebra (LM L5) and larger (8.2 cm2) quadratus lumborum (QL) cross-sectional area (CSA) have been associated with increased noncontact lower limb injury risk in AFL players. These associations have not been explored in an NRL cohort. This study will attempt to replicate previous research findings by confirming that muscle morphology is associated with noncontact lower limb injury.AFL (n = 87) and NRL (n = 151) players underwent LM L2-L5 and QL CSA ultrasound measures during preseason. Each club's medical staff reported all noncontact lower limb injuries sustained in the subsequent regular season. LM and QL CSA, age, body mass index, and noncontact lower limb injuries were analyzed using multivariable logistic regression.Seventy-two players sustained a noncontact lower limb injury in the 2020 regular season (AFL = 21, NRL = 51). The multivariable logistic regression (odds ratio (OR) = 1.36; 95% confidence interval (CI), 1.02-1.85; P = 0.038) identified AFL players with larger QL CSA at increased risk of sustaining a noncontact lower limb injury during the regular season, but no relationship was found for LM CSA and noncontact lower limb injuries in the AFL (OR = 1.01; 95% CI, 0.36-2.78; P = 0.591) or NRL (OR = 0.63; 95% CI, 0.29-1.33; P = 0.149).AFL players who sustained regular season noncontact lower limb injuries had larger QL CSA in preseason tests. No significant associations between either LM L5 CSA or LM L5 to QL ratio and regular season noncontact lower limb injuries were found.

ObjectivesThis study aimed to investigate short-interval intracortical inhibition (SICI) and muscle function in the Triceps surae of runners with mid-portion Achilles tendinopathy (AT).MethodsRunners with (n=11) and without (n=13) AT were recruited. Plantar flexor isometric peak torque and rate of torque development (RTD) were measured using an isokinetic dynamometer. Triceps surae endurance was measured as single leg heel raise (SLHR) to failure test. SICI was assessed using paired-pulse transcranial magnetic stimulation during a sustained contraction at 10% of plantar flexor isometric peak torque.ResultsTriceps surae SICI was 14.3% (95%CI: -2.1 to 26.4) higher in AT than control group (57.9%, 95%CI: 36.2, to 79.6; and 43.6% 95%CI:16.2 to 71.1; p=0.032) irrespective of the tested muscle. AT performed 16 (95%CI: 7.9 to 23.3, pPerspectiveOur data suggest greater intracortical inhibition for the Triceps surae muscles for the AT group accompanied by reduced SLHR endurance, without deficits in isometric peak torque or RTD. The increased SICI observed in the AT group could be negatively influencing Triceps surae endurance; thus, rehabilitation aiming to reduce intracortical inhibition should be considered to improve patient outcomes. Furthermore, SLHR is a useful clinical tool to assess plantar flexor function in AT patients.

Cortical mechanisms may contribute to weakness in participants with previous hamstring strain injury. This study aims to examine intra-cortical inhibition (SICI) and corticospinal excitability in previously injured participants. In this cross-sectional study, TMS was used to examine SICI, silent period, silent period: MEP ratios and area under the stimulus response curve in the biceps femoris and medial hamstrings. Comparisons were made between participants with (n = 10) and without (n = 10) previous hamstring strain injury. Motor threshold and isometric knee flexor strength were also compared between participants and the relationship between strength and SICI in control and previously injured participants was examined. Isometric knee flexor strength was lower in previously injured limbs compared with control limbs (mean difference = − 41 Nm (− 26%) [95% CI = − 80 to − 2 Nm], p = 0.04, Cohen’s d = − 1.27) and contralateral uninjured limbs (mean difference = − 23 Nm (− 17%), [95% CI = − 40 to − 6 Nm], p = 0.01, Cohen’s d = − 0.57). Previously injured limbs exhibited smaller responses to paired pulse stimulation (i.e. greater levels of SICI) in the biceps femoris compared with control limbs (mean difference = − 19%, [95% CI = − 34 to − 5%], p = 0.007, Cohen’s d = − 1.33). Isometric knee flexor strength was associated with the level of SICI recorded in the biceps femoris in previously injured participants (coefficient = 23 Nm [95% CI = 7–40 Nm], adjusted R2 = 0.31, p = 0.01). There were no differences in markers of corticospinal excitability between previously injured and control limbs (all p > 0.24, all Cohen’s d

The aim of this study was to determine the impacts of anterior cruciate ligament reconstruction (ACLR) and recent (

Background Lower limb muscle strain injury is highly prevalent in running-based sports and is considered a risk factor for recurrent injury. It is possible that differences in muscle activity and activation in previously strain-injured limbs may contribute to the elevated risk of reinjury. Objectives To systematically review available literature investigating whether muscle activity and/or activation is different in previously strain-injured muscles compared to contralateral uninjured muscles or uninjured controls. Methods A systematic review of literature in SPORTDiscus, MEDLINE Complete, CINAHL and Web of Science was conducted. Full-text English articles which compared indicators of neuromuscular function between injured and uninjured contralateral limbs or control groups in those with a history of muscle strain injury were included. Results Twelve studies were included in the review after eligibility criteria were applied. A best evidence synthesis revealed moderate to limited evidence suggesting differences in surface electromyography (sEMG) amplitude, integrated sEMG amplitude, inter-muscle sEMG ratios and voluntary activation in injured limbs, most often during eccentric contractions. Studies utilising sprinting assessments demonstrated conflicting evidence when comparing late swing phase biceps femoris sEMG amplitude between limbs with a history of hamstring strain injury and uninjured contralateral limbs. Conclusions Differences in muscle activity and activation were observed between injured and uninjured limbs across a variety of strength assessments. The evidence supporting these differences was most often moderate or limited and was generally observed during eccentric contractions. Mostly conflicting or limited evidence was found to suggest that participants with previous hamstring strain injury demonstrate no differences in muscle activity during running tasks when compared with their uninjured counterparts or contralateral limbs. Trial Registry PROSPERO (ID, CRD42019135681).

This study tested whether estimates of persistent inward currents (PICs) in the human plantar flexors would increase with the level of voluntary drive. High-density surface electromyograms were collected from soleus and gastrocnemius medialis of 21 participants (29.2 ± 2.6 yr) during ramp-shaped isometric contractions to 10%, 20%, and 30% (torque rise and decline of 2%/s and 30-s duration) of each participant's maximal torque. Motor units identified in all the contraction intensities were included in the paired-motor unit analysis to calculate delta frequency (ΔF) and estimate the PICs. ΔF is the difference in discharge rate of the control unit at the time of recruitment and derecruitment of the test unit. Increases in PICs were observed from 10% to 20% [Δ = 0.6 pulse per second (pps)

Power training has been suggested to be effective in improving strength, power, and functional capacity in older adults. However, there is still a lack of systematic investigations reporting its effectiveness for muscle hypertrophy. Thus, this study investigated the effect of power training on muscle hypertrophy and compared its magnitude with traditional moderate-velocity resistance training in older adults. A systematic search was conducted to identify clinical trials investigating the effect of power training on muscle hypertrophy (power training vs. control) and/or comparing the effect of power training versus moderate-velocity resistance training for a meta-analytical approach. Ten studies comparing power training to control conditions and 9 studies comparing power training to moderate-velocity resistance training were selected. Three studies were classified as high quality and 2 were preregistered. The meta-analysis showed that power training was superior for muscle hypertrophy compared with control condition (n = 8 studies; standardised mean difference (SMD) = 0.31; 95% confidence interval (CI) = 0.04, 0.58; p = 0.029), and resulted in similar hypertrophy compared with moderate-velocity resistance training (n = 7 studies; SMD = 0.07; 95% CI = –0.18, 0.32; p = 0.50). No significant heterogeneity was observed (p = 0.46 and 0.54, and I2 = 0% and 0%, respectively). Our data suggest that power training is effective for muscle hypertrophy in older adults, with similar effectiveness as moderate-velocity resistance training. (PROSPERO registration no.: CRD42019128951.) Novelty It is known that power training might be superior to moderate-velocity resistance training for function improvements in older adults, but there was no meta-analysis investigating its effect on muscle hypertrophy. Power training is effective to induce muscle hypertrophy in older adults to a similar extent as moderate-velocity resistance training.

Objectives To assess if swimming practice results in changes in supraspinatus tendon thickness, acromiohumeral distance, and occupational ratio in shoulders of elite swimmers with and without a history of shoulder pain. Design Case-Control study. Methods A convenience sample of fifty elite swimmers (14-22 years) were recruited for this study. Groups were defined by the presence (history of pain, N = 37) or absence (pain free, N = 63) of significant interfering shoulder pain within the previous 6 months. The current study analyzed supraspinatus tendon thickness, acromiohumeral distance, and the occupational ratio, through the use of ultrasound. Measures were taken prior to swim practice; immediately after practice; and 6 hours post-practice. Results No statistically significant difference in supraspinatus tendon thickness, acromiohumeral distance or ratio between shoulders with and without a history of pain were found at rest. Following a swimming practice, both shoulders with and without a history of pain had a significant increase in tendon thickness (0.27 & 0.17 mm; P ≤ .001 &

Background Eccentric hamstring strength seems important in reducing the odds of future hamstring injuries. While age and previous injury are well-known risk factors for future hamstring injuries, the association of age and previous hamstring injury with eccentric hamstring strength in the following season is unknown. Purpose To investigate the association of age and previous hamstring injury with preseason eccentric hamstring strength in soccer players, and to investigate the association between previous hamstring injury duration and preseason eccentric hamstring strength. Study design Descriptive, cross-sectional study. Methods A convenience sample of 284 male amateur soccer players (age 18-38 years) was included in the analyses. Self-reported information about previous season hamstring injury and its duration (three weeks or less; more than three weeks) was collected. Preseason eccentric hamstring strength was obtained during the Nordic hamstring exercise using a field-based device. Results Age had a negative association with preseason eccentric hamstring strength with 0.9% reduction per year. Players with a previous hamstring injury duration of more than three weeks (n=27) had 13% lower preseason eccentric hamstring strength compared to players without previous hamstring injury. Conclusion Older players have lower preseason eccentric hamstring strength than younger players. Players with a previous hamstring injury duration of more than three weeks have lower preseason eccentric hamstring strength than the rest of the players. These results highlight the need to monitor and address the identified weaknesses in eccentric hamstring strength in amateur soccer players, with specific emphasis on older players with a previous hamstring injury of longer duration. Level of evidence 2b.

There is a lack of definitive evidence supporting deficits in voluntary activation in participants with prior hamstring injury; moreover, it remains unknown if spinal mechanisms contribute to suspected deficits.This study aimed to determine the effect of prior hamstring strain injury on knee flexor concentric and eccentric strength, voluntary activation, surface electromyographic (sEMG) activity, and stretch and tendon reflex amplitudes.Twenty-five participants were recruited, 12 with a history of unilateral hamstring strain injury of at least moderate severity. Voluntary activation, strength, and sEMG activity were recorded during maximal eccentric and concentric knee flexor contractions at 60°·s. Stretch and tendon reflexes were also recorded at rest.Previously injured limbs exhibited lower levels of voluntary activation (mean difference = -24.1%, 95% confidence interval [CI] = -34.1% to -14.0%, P0.001), strength (mean difference vs control group = -0.37 Nm·kg, 95% CI = -0.71% to -0.03 N·m·kg, P = 0.03), and normalized sEMG (mean difference = -17%, 95% CI = -32% to -2%, P = 0.02) during maximal eccentric knee flexor contractions compared with control group. No such differences were seen in concentric contractions. Stretch reflexes (mean difference = -3.8%, 95% CI = -6.8 to -0.8, P = 0.02) and tendon reflexes (mean difference = -13%, 95% CI = -26% to 0%, P = 0.04) were also lower in previously injured compared with control biceps femoris muscles.Moderate to severe hamstring strain injury is associated with long-term deficits in voluntary activation during maximal eccentric contraction. Hamstring injury history is also associated with deficits in stretch reflex and tendon reflex amplitude.

Nervous system maladaptation is linked to the loss of maximal strength and motor control with aging. Motor unit discharge rates are a critical determinant of force production; thus, lower discharge rates could be a mechanism underpinning maximal strength and motor control losses during aging. This meta-analysis summarized the findings of studies comparing motor unit discharge rates between young and older adults, and examined the effects of the selected muscle and contraction intensity on the magnitude of discharge rate difference between these two groups. Estimates from 29 studies, across a range of muscles and contraction intensities, were combined in a multilevel meta-analysis, to investigate whether discharge rates differed between young and older adults. Motor unit discharge rates were higher in younger than older adults, with a pooled standardized mean difference (SMD) of 0.66 (95%CI= 0.29-1.04). Contraction intensity had a significant effect on the pooled SMD, with a 1% increase in intensity associated with a 0.009 (95%CI= 0.003-0.015) change in the pooled SMD. These findings suggest that reductions in motor unit discharge rates, especially at higher contraction intensities, may be an important mechanism underpinning age-related losses in maximal force production.

Persistent deficits in strength and voluntary activation have been observed in athletes with a history of hamstring strain injury. The mechanisms contributing to these deficits are poorly understood and consequently may not be appropriately addressed during rehabilitation. This study aimed to investigate the impact of intended knee flexor contraction mode (concentric, eccentric or isometric) on the rate of torque development and surface electromyography (sEMG) rise in athletes with and without a history of unilateral hamstring strain injury. The impact of the previous injury on hip extensor rate of torque development was also investigated. Previously injured limbs exhibited a slower rate of torque development (mean difference = -31%, p = 0.02, Cohen's d = 0.62) and biceps femoris rate of sEMG rise (mean difference = -181% · s

Age-related deterioration within both motor neurones and monoaminergic systems should theoretically reduce neuromodulation by weakening motor neuronal persistent inward current (PIC) strength. However, this assumption remains untested. Surface electromyographic signals were collected using two 32-channel electrode matrices placed on soleus and tibialis anterior of 25 older adults (70{+/-}4years) and 17 young adults (29{+/-}5 years) to investigate motor unit discharge behaviours. Participants performed triangular-shaped plantar and dorsiflexion contractions to 20% of maximum torque at a rise-decline rate of 2%/s of each participants maximal torque. Pairwise and composite paired-motor unit analyses were adopted to calculate delta frequency ({Delta}F) and estimate PIC amplitudes. {Delta}F has been used to differentiate between the effects of synaptic excitation and intrinsic motor neuronal properties and is assumed to be proportional to PIC amplitude. The results show that soleus and tibialis anterior motor units in older adults had lower {Delta}Fs when calculated with the pairwise (-0.99 and -1.29 pps, respectively) or composite (-1.65 and -2.26 pps, respectively) methods. Older adults motor units discharged at lower rates (-2.14 and -2.03 pps, respectively) and were recruited at lower torque levels (-1.50 and -2.06% of maximum, respectively) than young adults. These results demonstrate reduced intrinsic motor neurone excitability during low-force contractions in older adults, likely mediated by decreases in the strength of persistent inward currents. Our findings might be explained by deterioration in the motor neurones or monoaminergic systems, and could contribute to the decline in motor function during ageing; these assumptions should be explicitly tested in future investigations. KEY POINTS- The persistent inward current (PIC) is an intrinsic motor neurone excitability property responsible for amplifying excitatory synaptic input into an appropriate motor output. This study compared estimates of PICs in soleus and tibialis anterior between young and older adults. - Motor units of older adults presented lower estimates of PICs for both soleus and tibialis anterior. Older adults also presented lower motor unit discharge rates and they were recruited at lower torque levels than young adults. - These results indicate a reduced intrinsic motor neurone excitability in soleus and tibialis anterior motor units, likely mediated by decreases in the strength of persistent inward currents. - The reduced PIC strength in older adults may result from deterioration within both motor neurones and monoaminergic systems. These novel findings contribute to our understanding of the factors underpinning the declines in force production and motor function during ageing.

Background Hamstring injuries remain a major burden in football while the effective prevention exercise the Nordic Hamstring is poorly adopted, despite the added positive effects on performance. Better understanding of hamstring function during Nordic Hamstring compared to other exercises may provide better insight to the physiological adaptations of different types of hamstring curls. Purpose This cross-sectional study therefore aimed to compare the Nordic Hamstring curl with a conventional prone Leg Curl at different loads, and novel high velocity Hamstring Catches; in terms of peak normalized electromyographical activity (nEMG) and rate of electromyographic rise (RER) of Biceps Femoris long head, and angular velocity of the knee. Study design Cross-sectional study. Methods Out of 28 participants enrolled, the final sample included 23 recreationally active male participants who attended a session for determining RM (repetition maximum) to establish loading (8 and 16RM for Hamstring Catches, and 8, 16 and 24RM for Leg Curl) and to familiarize themselves with the three different exercises (Nordic Hamstring, Leg Curl and Hamstring Catch), and a testing session >4 days after during which EMG data were collected during 3 repetitions of each exercise performed in a random order. Results The Nordic Hamstring evoked higher RER (1091.8 nEMG/s) than Hamstring Catches (mean difference: 421 nEMG/s, p Conclusion The Nordic Hamstring displayed the highest level muscle activity and most explosive recruitment characteristics with early and high rate of electromyographic rise, compared to even high velocity exercises, thus providing a possible mechanism by which it may increase performance and reduce injuries. Levels of evidence 3 What is known about the subject Early phase force and muscle recruitment have been linked to both performance and hamstring-related inhibition and fatiguability. However, the potential for different hamstring exercises to elicit explosive recruitment is unknown. What this study adds to existing knowledge Early phase recruitment was higher and faster during the Nordic Hamstring exercise compared with conventional hamstring Leg Curl exercises with different loads and a high-velocity hamstring exercise. Clinical Relevance The surprisingly fast and explosive recruitment characteristics during the Nordic Hamstring exercise suggests the possibility that this exercise have the potential to improve the rate of force development and perhaps counter the effects of hamstring-related inhibition and fatigue.

This study examined the spatial patterns of hamstring and gluteal muscle activation during high-speed overground running in limbs with and without aprior hamstring strain injury. Ten active males with arecent (ST>BFLH>GMED>SM>BFSH) and may exhibit altered intramuscular hamstring activation after returning to sport from BFLH strain injury.

Hamstring strain injury (HSI) is a common and costly injury in many sports such as the various professional football codes. Most HSIs have been reported to occur during high intensity sprinting actions. This observation has led to the suggestion that a link between sprinting biomechanics and HSIs may exist. The aim of this literature review was to evaluate the available scientific evidence underpinning the potential link between sprinting biomechanics and HSIs. A structured search of the literature was completed followed by a risk of bias assessment. A total of eighteen studies were retrieved. Sixteen studies involved retrospective and/or prospective analyses, of which only three were judged to have a low risk of bias. Two other case studies captured data before and after an acute HSI. A range of biomechanical variables have been measured, including ground reaction forces, trunk and lower-limb joint angles, hip and knee joint moments and powers, hamstring muscle–tendon unit stretch, and surface electromyographic activity from various trunk and thigh muscles. Overall, current evidence was unable to provide a clear and nonconflicting perspective on the potential link between sprinting biomechanics and HSIs. Nevertheless, some interesting findings were revealed, which hopefully will stimulate future research on this topic.

Nervous system maladaptation is linked to the loss of maximal strength production and motor control with aging. Motor unit discharge rates are a critical determinant of force production; thus, lower discharge rates could be a mechanism underpinning maximal strength and motor control losses during aging. This meta-analysis summarized the findings of studies comparing motor unit discharge rates between young and older adults, and examined the effect of distinct muscles and contraction intensities on the magnitude of discharge rates difference between these two groups. Eligible studies were combined in a meta-analysis, including tested contraction intensities and muscles in different levels, to investigate whether there were differences in discharge rates between younger and older adults. Motor unit discharge rates were higher in younger adults compared to older adults, with a pooled standardized mean difference (SMD) for all studies of 0.63 (95%CI= 0.27 to 0.99). Contraction intensity had a significant effect on the pooled SMD, with a 1% increase in intensity associated with a 0.009 (95%CI= 0.003 to 0.015) change in the pooled SMD. These findings suggest that the reductions in motor unit discharge rates, especially at higher contraction intensities, may be an important mechanism underpinning age-related losses in maximal strength production.

This study tested the hypothesis that estimates of persistent inward currents (PICs) in the human plantar flexors would increase with the level of voluntary drive. Twenty-one participants volunteered for this study (29.2±2.6 years). High-density surface electromyograms were collected from soleus and gastrocnemius medialis during ramp-shaped isometric contractions to 10%, 20%, and 30% (torque rise of 2%/s and 30-s duration) of each participant’s maximal torque. Motor units identified in all the contraction intensities were included in the paired-motor unit analysis to calculate delta frequency (ΔF) and estimate the PICs. Increases in PICs were observed from 10% to 20% (Δ=0.6 pps; psoleus, and from 10% to 20% (Δ=1.2 pps; pgastrocnemius medialis. Maximal discharge rate increased for soleus and gastrocnemius medialis from 10% to 20% (respectively, Δ=1.75 pps, psoleus (r=0.64; pgastrocnemius medialis (r=0.77; p

The aims of this study were to investigate changes in selected performance measures during an off-season period, their association, and the potential role of age and previous hamstring injury in semi-professional and amateur football players. Seventy-four male players (age: 25 ± 4 years, stature: 178.0 ± 6.6 cm, body mass: 74.9 ± 8.1 kg) were assessed at the beginning and end of the off-season summer-period for sprint, change-of-direction performance and eccentric hamstring strength. Small to medium increases in sprint times were observed at 5 (d = 0.26, p = 0.057), 10 (d = 0.42, p < 0.001) and 30 m (d = 0.64, p < 0.001). Small (d = −0.23, p = 0.033) improvements were observed for COD performance, and no changes in eccentric hamstring strength (d = 0.10, p = 0.317). The changes in the outcomes were not affected by age (p = 0.449 to 0.928) or previous hamstring injury (p = 0.109 to 0.995). The impaired sprint performance was not related to changes in eccentric hamstring strength (r = −0.21 to 0.03, p = 0.213 to 0.856), instead, changes in COD performance were associated with changes in eccentric hamstring strength (r = −0.42, p = 0.008).

Objectives To compare the change in supraspinatus tendon thickness (STT) following a high volume (HV) and high intensity (HI) swimming practice in shoulders of elite swimmers. Design Cohort Study. Setting Non-clinical, state swim team training facility. Participants A convenience sample of eight non-injured state and national level swimmers from a regional swim team were recruited for this study. Main outcome measures Ultrasound measures of STT were collected in response to the two swimming practice sessions. Measures were taken prior to each swim practice; immediately after practice; 6-hours post practice and 24-hours post practice. Results A significant increase in STT resulted from both the HI and HV (p < 0.05) practice immediately post practice. For the HI practice, the STT remained significantly thicker than pre-practice measures at the 6-hour post practice test (p < 0.05) however no longer significant 24-hours post practice. The difference in the change in STT between the HI and HV practice was significantly different immediately post practice and 6-hours post practice (p < 0.05) however no longer significant 24-hour post practice. Conclusion Ultrasound measures of STT following different swimming volumes and intensities may provide information on shoulder tendon loads.

Hamstring function is influenced by a number of neural, architectural and morphological factors, and the adaptability of these characteristics has important implications for optimizing performance and reducing injury risk. High rates of maximal or near-maximal hamstring force development are required to generate peak horizontal velocities during running, and this is largely determined by the extent to which these muscles can be voluntarily activated. Greater eccentric hamstring strength also correlates with better acceleration capacity and likely improves the ability to decelerate the lower limb during the presumably injurious terminal swing phase of high-speed running. The intra- and intermuscular coordination of the hamstrings appears to influence both hamstring muscle fatiguability and the risk of muscle strain injury. Muscle volume and architectural features such as fascicle length and pennation angle also influence hamstring function, and these vary considerably between hamstring muscles, between individuals and with training status. The adaptability of these features has been explored to a significant extent in recent times, and careful exercise selection allows selective targeting of individual hamstring muscles or muscle segments and this appears to influence the pattern of chronic adaptations such as muscle hypertrophy. Short fascicles within the often-injured long head of biceps femoris may predispose athletes to strain injury but these appear to respond in a contraction-mode-specific manner; lengthening after eccentric training and shortening after concentric training of 4 or more weeks. Conventional training with eccentric and concentric phases in each repetition can also lengthen fascicles, possibly in an excursion (muscle length)-dependent manner. A large biceps femoris muscle to proximal aponeurosis width ratio has been proposed as a potential risk factor for hamstring strain injury, although this is only supported by biomechanical modelling at the time of writing. High levels of anterior pelvic tilt and lateral trunk flexion during sprint running may also predispose athletes to hamstring strain injury, although the quantity of evidence for this is small at the moment. At present, the optimal methods for altering coordination and running technique are not known. Hamstring function is influenced by a number of neural, architectural and morphological factors, and the adaptability of these characteristics has important implications for optimizing performance and reducing injury risk. High rates of maximal or near-maximal hamstring force development are required to generate peak horizontal velocities during running, and this is largely determined by the extent to which these muscles can be voluntarily activated. Greater eccentric hamstring strength also correlates with better acceleration capacity and likely improves the ability to decelerate the lower limb during the presumably injurious terminal swing phase of high-speed running. The intra- and intermuscular coordination of the hamstrings appears to influence both hamstring muscle fatiguability and the risk of muscle strain injury. Muscle volume and architectural features such as fascicle length and pennation angle also influence hamstring function, and these vary considerably between hamstring muscles, between individuals and with training status. The adaptability of these features has been explored to a significant extent in recent times, and careful exercise selection allows selective targeting of individual hamstring muscles or muscle segments and this appears to influence the pattern of chronic adaptations such as muscle hypertrophy. Short fascicles within the often-injured long head of biceps femoris may predispose athletes to strain injury but these appear to respond in a contraction-mode-specific manner; lengthening after eccentric training and shortening after concentric training of 4 or more weeks. Conventional training with eccentric and concentric phases in each repetition can also lengthen fascicles, possibly in an excursion (muscle length)-dependent manner. A large biceps femoris muscle to proximal aponeurosis width ratio has been proposed as a potential risk factor for hamstring strain injury, although this is only supported by biomechanical modelling at the time of writing. High levels of anterior pelvic tilt and lateral trunk flexion during sprint running may also predispose athletes to hamstring strain injury, although the quantity of evidence for this is small at the moment. At present, the optimal methods for altering coordination and running technique are not known.

Purpose Harvest of the semitendinosus (ST) tendon for anterior cruciate ligament reconstruction (ACLR) causes persistent hypotrophy of this muscle even after a return to sport, although it is unclear if hamstring activation patterns are altered during eccentric exercise. It was hypothesised that in comparison with contralateral control limbs, limbs with previous ACLR involving ST grafts would display (i) deficits in ST activation during maximal eccentric exercise; (ii) smaller ST muscle volumes and anatomical cross-sectional areas (ACSAs); and (iii) lower eccentric knee flexor strength. Methods Fourteen athletes who had successfully returned to sport after unilateral ACLR involving ST tendon graft were recruited. Median time since surgery was 49 months (range 12–78 months). Participants underwent functional magnetic resonance imaging (MRI) of their thighs before and after the Nordic hamstring exercise (NHE) and percentage change in transverse (T2) relaxation time was used as an index of hamstring activation. Muscle volumes and ACSAs were determined from MRI and distal ST tendons were evaluated via ultrasound. Eccentric knee flexor strength was determined during the NHE. Results Exercise-induced T2 change was lower for ST muscles in surgical than control limbs (95% CI − 3.8 to − 16.0%). Both ST muscle volume (95% CI − 57.1 to − 104.7 cm3) and ACSA (95% CI − 1.9 to − 5.0 cm2) were markedly lower in surgical limbs. Semimembranosus (95% CI 5.5–14.0 cm3) and biceps femoris short head (95% CI 0.6–11.0 cm3) volumes were slightly higher in surgical limbs. No between-limb difference in eccentric knee flexor strength was observed (95% CI 33 N to − 74 N). Conclusion ST activation is significantly lower in surgical than control limbs during eccentric knee flexor exercise 1–6 years after ACLR with ST graft. Lower levels of ST activation may partially explain this muscle’s persistent hypotrophy post ACLR and have implications for the design of more effective rehabilitation programs. Level of evidence IV.

Hamstring strain injury often results in neuromuscular performance deficits that persist beyond rehabilitation and the return to full training and competitive sport. It seems appropriate to address these deficits as a part of a sport-specific training program which primarily aims to enhance performance. Prolonged deficits in horizontal ground reaction forces in sprinting, repeat sprint performance, knee flexor eccentric strength and biceps femoris long head fascicle lengths have been observed in multiple studies of hamstring strain injury. Why such deficits persist beyond the return to sport is not known, although persistent neuromuscular inhibition of the injured muscles has been proposed. There is limited and mixed evidence for sprint running kinematic (technique) differences between previously injured and uninjured limbs or athletes, although more work in this area seems warranted. While there is some uncertainty about the optimal mix of methods for addressing the aforementioned deficits, sport-specific running programs in conjunction with continued monitoring of acceleration phase sprint performance and repeated sprint ability seem appropriate. Heavy strength training with at least some eccentrically biased exercises is also recommended to address deficits in eccentric strength and muscle fascicle lengths.

This chapter will provide the anatomical foundation for the content to come in later portions of this book. It will begin with an overview of the proximal insertion sites of the muscles that comprise the hamstring group. The proximal tendons and musculotendinous junctions (MTJs) of semimembranosus, semitendinosus and the long and short heads of biceps femoris long head will then be described, highlighting the differences in structure between each of the muscles. The distinct architectural characteristics of each muscle belly (e.g. size, fascicle orientation within and between muscles) will be outlined, followed by the structure of the distal tendons and MTJs. Finally, a summary is provided of the neurovascular supply of the hamstrings.

Background Understanding hamstring muscle activation patterns in resistance training exercises may have implications for the design of strength training and injury prevention programs. Unfortunately, surface electromyography studies have reported conflicting results regarding hamstring muscle activation patterns in women. Objectives To determine the spatial patterns of hamstring muscle activity during the 45° hip extension and Nordic hamstring exercises in women using functional magnetic resonance imaging (fMRI). Methods This was a cross-sectional study in which 6 recreationally active women with no history of lower-limb injury underwent fMRI on both thighs before and immediately after 5 sets of 6 bilateral eccentric contractions of the 45° hip extension exercise or the Nordic exercise. Using fMRI, the transverse (T2) relaxation times were measured from pre-exercise and postexercise scans, and the percentage increase in T2 was used as an index of muscle activation. Results The fMRI revealed a significantly higher biceps femoris long head-to-semitendinosus ratio during the 45° hip extension exercise than in the Nordic exercise (P = .028). The T2 increase after the 45° hip extension exercise was greater for the biceps femoris long head (P

Hamstring strain injuries are endemic in running-based sports. Given the economic and performance implications of these injuries, a significant body of research has emerged in recent years in an attempt to identify risk factors and develop or optimise injury prevention strategies. Surveys of injury prevention practices among medical and conditioning staff in elite sport suggest that many sporting clubs invest significant efforts in eccentric hamstring conditioning and lumbo-pelvic or trunk stability programmes. The purpose of this narrative review was to critically evaluate the evidence underpinning these practices. Single-exercise eccentric training interventions have proven effective in the prevention of primary and recurrent hamstring strains, when compliance is adequate. However, despite its almost universal acceptance, the authors are aware of only one, very recent, prospective risk factor study examining the effect of lumbo-pelvic motion during sprinting on hamstring injury risk. Furthermore, the interventions exploring the effect of lumbo-pelvic training on hamstring injury rates have not measured stability in any way. An improved understanding of the evidence underpinning commonly employed hamstring injury prevention practices may enable clinicians and coaches to better prioritise effective strategies in the increasingly complex environment of elite sport.

Strength training is a valuable component of hamstring strain injury prevention programmes; however, in recent years a significant body of work has emerged to suggest that the acute responses and chronic adaptations to training with different exercises are heterogeneous. Unfortunately, these research findings do not appear to have uniformly influenced clinical guidelines for exercise selection in hamstring injury prevention or rehabilitation programmes. The purpose of this review was to provide the practitioner with an evidence-base from which to prescribe strengthening exercises to mitigate the risk of hamstring injury. Several studies have established that eccentric knee flexor conditioning reduces the risk of hamstring strain injury when compliance is adequate. The benefits of this type of training are likely to be at least partly mediated by increases in biceps femoris long head fascicle length and improvements in eccentric knee flexor strength. Therefore, selecting exercises with a proven benefit on these variables should form the basis of effective injury prevention protocols. In addition, a growing body of work suggests that the patterns of hamstring muscle activation diverge significantly between different exercises. Typically, relatively higher levels of biceps femoris long head and semimembranosus activity have been observed during hip extension-oriented movements, whereas preferential semitendinosus and biceps femoris short head activation have been reported during knee flexion-oriented movements. These findings may have implications for targeting specific muscles in injury prevention programmes. An evidence-based approach to strength training for the prevention of hamstring strain injury should consider the impact of exercise selection on muscle activation, and the effect of training interventions on hamstring muscle architecture, morphology and function. Most importantly, practitioners should consider the effect of a strength training programme on known or proposed risk factors for hamstring injury.

Objectives: To examine the effect of 100 drop punt kicks on isokinetic knee flexor strength and surface electromyographic activity of bicep femoris and medial hamstrings. Design: Randomized control study. Methods: Thirty-six recreational footballers were randomly assigned to kicking or control groups. Dynamometry was conducted immediately before and after the kicking or 10 min of sitting (control). Results: Eccentric strength declined more in the kicking than the control group (p < 0.001; d = 1.60), with greater reductions in eccentric than concentric strength after kicking (p = 0.001; d = 0.92). No significant between group differences in concentric strength change were observed (p = 0.089; d = 0.60). The decline in normalized eccentric hamstring surface electromyographic activity (bicep femoris and medial hamstrings combined) was greater in the kicking than the control group (p < 0.001; d = 1.78), while changes in concentric hamstring surface electromyographic activity did not differ between groups (p = 0.863; d = 0.04). Post-kicking reductions in surface electromyographic activity were greater in eccentric than concentric actions for both bicep femoris (p = 0.008; d = 0.77) and medial hamstrings (p < 0.001; d = 1.11). In contrast, the control group exhibited smaller reductions in eccentric than concentric hamstring surface electromyographic activity for bicep femoris (p = 0.026; d = 0.64) and medial hamstrings (p = 0.032; d = 0.53). Reductions in bicep femoris surface electromyographic activity were correlated with eccentric strength decline (R = 0.645; p = 0.007). Conclusions: Reductions in knee flexor strength and hamstring surface electromyographic activity are largely limited to eccentric contractions and this should be considered when planning training loads in Australian Football.

The goal of this study was to determine whether ultrasound measures of muscle architecture can be used to infer strength and functional capacity in older adults. Thirty-six healthy older adults (aged 68.2 ± 5.3 y) undertook isokinetic dynamometry for isometric and isokinetic concentric knee extensor strength, the 6-m fast walk, timed up and go, stair climb and descent and vertical jump tests. Longitudinal brightness-mode ultrasound scans (probe frequency, 10 MHz) of the vastus lateralis, vastus intermedius, rectus femoris and gastrocnemius medialis were obtained, and muscle architecture measures (thickness, fascicle pennation angle and fascicle length) were correlated with the aforementioned strength and functional measures. Quadriceps thickness was a significant (p

Reliable measures of muscle strength and functional capacity in older adults are essential. The aim of this study was to determine whether coefficients of variation (CVs) of individuals obtained at the first session can infer repeatability of performance in a subsequent session. Forty-eight healthy older adults (mean age 68.6 ± 6.1 years; age range 60–80 years) completed two assessment sessions, and on each occasion undertook: dynamometry for isometric and isokinetic quadriceps strength, 6 meter fast walk (6MFWT), timed up and go (TUG), stair climb and descent, and vertical jump. Significant linear relationships were observed between CVs in session 1 and the percentage difference between sessions 1 and 2 for torque at 60, 120, 240 and 360°/s, 6MFWT, TUG, stair climb, and stair descent. The results of this study could be used to establish criteria for determining an acceptably reliable performance in strength and functional tests.

Reduced levels of functional capacity in older adults are related to lower quality of life, frailty, and sarcopenia, and can increase risk of falling, fractures and hospitalisation. Resistance training is an effective method to attenuate age-related functional declines. Based on the findings that muscle power and explosive strength are strongly associated with functional performance in older adults, it has been suggested that fast-intended-velocity resistance training may elicit greater improvements in functional capacity when compared to moderate-velocity resistance training. However, currently, there is no high-quality systematic review and meta-analysis supporting this assertion. The present study compared the magnitude of functional capacity improvements following resistance training performed with fast-intentional velocity versus moderate velocity. Pubmed, Scopus, and Web of Science databases were searched from inception to January 2019. The following eligibility criteria for selecting studies was adopted: Participants aged ≥60 years; resistance training based intervention for lower limbs performed solely with slow to moderate concentric velocity (≥2 s for each concentric phase) or solely with the intention of maximising velocity (i.e., as fast as possible); and at least one functional test for lower limbs, with pre- and post-intervention measurements. When studies employed multiple functional tests, a single (pooled) standardised mean difference was calculated and presented as combined functional capacity. In addition, functional tests were grouped accordingly to their specificity for the sub-groups meta-analyses. Fifteen studies were selected (high quality, n = 3; and pre-registered, n = 2). The results presented heterogeneity and small-studies publication bias, leading to a biased advantage for fast-intended-velocity resistance training (95%CI = 0.18, 0.65; I 2 = 45%). Short physical performance battery indicated an advantage for fast-intended-velocity resistance training (95%CI = 0.10, 0.94; I 2 = 0%). There was no difference for timed up and go (95%CI = −0.07, 0.94; I 2 = 48%), 30-s chair stand (95%CI = −0.24, 1.39; I 2 = 71%), 5-times chair stand (95%CI = −1.63, 1.27; I 2 = 57%) stair climb (95%CI = −1.89, 2.81; I 2 = 0%), short walk (95%CI = −0.99, 0.96; I 2 = 21%) and long walk (95%CI = −0.59, 1.00; I 2 = 0%). These results suggest that there is inconclusive evidence to support the superiority of fast-intended-velocity resistance training to improve functional capacity when compared to moderate-velocity resistance training. These results may have been influenced by the lack of high-quality and pre-registered studies, high heterogeneity, and small-studies publication bias. PROSPERO registration number: CRD42019122251

Objectives To investigate whether five-weeks of concentric (CON) or eccentric (ECC) hamstring strength training have different effects on recovery from sprint running, eccentric strength and architecture of the biceps femoris long head (BFLH). Design Cohort study. Methods Thirty males (age, 22.8 ± 4.1 y; height, 180.1 ± 6.4 cm; weight, 85.2 ± 14.6 kg) were allocated into either a CON or ECC group, both performing nine sessions of resistance training. Prior to and immediately after the five-week intervention, each participant’s BFLH fascicle length (FL), pennation angle (PA), muscle thickness (MT), peak isometric KF torque and Nordic eccentric strength were assessed. Post-intervention, participants performed two timed sprint sessions (10 × 80 m) 48 h apart. Blood samples and passive KF torques were collected before, immediately after, 24 h and 48 h after the first sprint session. Results After five-weeks of strength-training, fascicles lengthened in the ECC (p < 0.001; d = 2.0) and shortened in the CON group (p < 0.001; d = 0.92), while PA decreased for the ECC (p = 0.001; d = 0.52) and increased in the CON group (p < 0.001; d = 1.69). Nordic eccentric strength improved in both ECC (p < 0.001; d = 1.49) and CON (p < 0.001; d = 0.95) groups. No between-group differences were observed in peak isometric strength (p = 0.480), passive KF torques (p = 0.807), sprint performance decrements between sprint sessions (p = 0.317) and creatine kinase (p = 0.818). Conclusions Despite inducing significant differences in BFLH muscle architecture, there were no significant between group differences in sprint performance decrements across two sprint sessions.

There has been significant interest in understanding population sedentary behaviour in recent years and how this impacts on children’s and adult’s health. This chapter provides an overview of key topics within sedentary behaviour research. The chapter discusses the development of the definition of sedentary behaviour and how this definition has been used historically. Common measures for assessing sedentary behaviour are presented, including subjective self-report measures and objective monitors. Given the range of contexts in which sedentary behaviour can occur, the chapter also provides an overview of settings that have been the target of sedentary behaviour research and interventions. Associations between sedentary behaviour and health in children and adults are discussed. The chapter finishes with two case studies that provide key considerations for the development of future interventions that target sedentary behaviour.

Background: This study examined relationships between adiposity, physical functioning, and physical activity. Methods: Obese (N = 107) and healthy-weight (N = 132) children aged 10-13 years underwent assessments of percent body fat (%BF, dual energy X-ray absorptiometry); knee extensor strength (KE, isokinetic dynamometry); cardiorespiratory fitness (CRF, peak oxygen uptake by cycle ergometry); physical health-related quality of life (HRQOL); and worst pain intensity and walking capacity [six-minute walk (6MWT)]. Structural equation modelling was used to assess relationships between variables. Results: Moderate relationships were observed between %BF and (1) 6MWT, (2) KE strength corrected for mass, and (3) CRF relative to mass (r -0.36 to -0.69, p ≤ 0.007). Weak relationships were found between %BF and physical HRQOL (r -0.27, p = 0.008); CRF relative to mass and physical HRQOL (r -0.24, p = 0.003); physical activity and 6MWT (r 0.17, p = 0.004). Squared multiple correlations showed that 29.6% variance in physical HRQOL was explained by %BF, pain, and CRF relative to mass; while 28.0% variance in 6MWT was explained by %BF and physical activity. Conclusions: It appears that children with a higher body fat percentage have poorer KE strength, CRF, and overall physical functioning. Reducing percent fat appears to be the best target to improve functioning. However, a combined approach to intervention, targeting reductions in body fat percentage, reductions in pain, and improvements in physical activity and CRF may assist physical functioning. Refereed/Peer-reviewed

Background: The architectural characteristics of muscle (fascicle length, pennation angle muscle thickness) respond to varying forms of stimuli ( eg, training, immobilisation and injury ). Architectural changes following injury are thought to occur in response to the restricted range of motion experienced during rehabilitation and the associated neuromuscular inhibition. However, it is unknown if these differences exist prior to injury, and had a role in injury occuring ( prospectively ), or if they occur in response to the incident itself ( retrospectively ). Considering that the structure of a muscle will influence how it functions, it is of interest to understand how these architectural variations may alter how a muscle acts with reference to the force-length and force-velocity relationships. Objectives: Our narrative review provides an overview of muscle architectural adaptations to training and injury. Specifically, we (1) describe the methods used to measure muscle architecture; (2) detail the impact that architectural alterations following training interventions, immobilisation and injury have on force production and (3) present a hypothesis on how neuromuscular inhibition could cause maladaptations to muscle architecture following injury.

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This study aimed to determine: (a) the spatial patterns of hamstring activation during the Nordic hamstring exercise (NHE); (b) whether previously injured hamstrings display activation deficits during the NHE; and (c) whether previously injured hamstrings exhibit altered cross-sectional area (CSA). Ten healthy, recreationally active men with a history of unilateral hamstring strain injury underwent functional magnetic resonance imaging of their thighs before and after six sets of 10 repetitions of the NHE. Transverse (T2) relaxation times of all hamstring muscles [biceps femoris long head (BFlh); biceps femoris short head (BFsh); semitendinosus (ST); semimembranosus (SM)] were measured at rest and immediately after the NHE and CSA was measured at rest. For the uninjured limb, the ST's percentage increase in T2 with exercise was 16.8%, 15.8%, and 20.2% greater than the increases exhibited by the BFlh, BFsh, and SM, respectively (P

Purpose: This study aimed (i) to determine the reliability of two-dimensional ultrasonography for the assessment of biceps femoris long head (BFlh) architectural characteristics and (ii) to determine whether limbs with a history of strain injury in the BFlh display different architecture and eccentric strength compared to uninjured limbs. Methods: This case–control study (control [n = 20], injured group [n = 16], males) assessed the BFlh architecture at rest and during graded isometric contractions using two-dimensional ultrasonography. The control group were assessed three times (>24 h apart) to determine reliability. Previously injured individuals were evaluated once. Results: The assessment of BFlh architecture was highly reliable (intraclass correlations >0.90). Fascicle length (P < 0.001; d range = 0.67–1.34) and fascicle length relative to muscle thickness (P < 0.001; d range = 0.58–0.85) of the previously injured BFlh were significantly less than the contralateral uninjured BFlh at all intensities. Pennation angle of the previously injured BFlh was significantly greater (P < 0.001; d range = 0.62–0.88) than the contralateral uninjured BFlh at all intensities. Eccentric strength in the previously injured limb was significantly lower than that in the contralateral limb (−15.4%; −52.5 N, 95% confidence interval = −76.2 to −28.4; P < 0.001, d = 0.56). Conclusions: These data indicate that two-dimensional ultrasonography is reliable for assessing BFlh architecture at rest and during graded isometric contractions. Fascicle length, fascicle length relative to muscle thickness, and pennation angle are significantly different in previously injured BFlh compared to an uninjured contralateral BFlh. Eccentric strength of the previously injured limb is also significantly lower than that of the uninjured contralateral limb. These findings have implications for rehabilitation and injury prevention practices, which should consider altered architectural characteristics.

Background: Few studies have examined acute injuries in track and field in both elite and subelite athletes. Purpose: To observe the absolute number and relative rates of injury in track and field athletes across a wide range of competition levels and ages during 3 years of the Penn Relays Carnival to assist with future medical coverage planning and injury prevention strategies. Study Design: Descriptive epidemiology study. Methods: Over a 3-year period, all injuries treated by the medical staff were recorded on a standardized injury report form. Absolute number of injuries and relative injury rates (number of injuries per 1000 competing athletes) were determined and odds ratios (ORs) of injury rates were calculated between sexes, competition levels, and events. Injuries were also broken down into major or minor medical or orthopaedic injuries. Results: Throughout the study period, 48,473 competing athletes participated in the Penn Relays Carnival, and 436 injuries were sustained. For medical coverage purposes, the relative rate of injury subtypes was greatest for minor orthopaedic injuries (5.71 injuries per 1000 participants), followed by minor medical injuries (3.42 injuries per 1000 participants), major medical injuries (0.69 injuries per 1000 participants), and major orthopaedic injuries (0.18 injuries per 1000 participants). College/elite athletes displayed the lowest relative injury rate (7.99 injuries per 1000 participants), which was significantly less than that of high school (9.87 injuries per 1000 participants) and masters athletes (16.33 injuries per 1000 participants). Male athletes displayed a greater likelihood of having a minor orthopaedic injury compared with female athletes (OR, 1.36 [95% CI, 1.06-1.75]; χ2 = 5.73; P = .017) but were less likely to sustain a major medical injury (OR, 0.33 [95% CI, 0.15-0.75]; χ2 = 7.75; P = .005). Of the 3 most heavily participated in events, the 4 × 400-m relay displayed the greatest relative injury rate (13.6 injuries per 1000 participants) compared with the 4 × 100-m and 4 × 200-m relays. Conclusion: Medical coverage teams for future large-scale track and field events need to plan for at least 2 major orthopaedic and 7 major medical injuries per 10,000 participants. Male track and field athletes, particularly masters male athletes, are at greater risk of injury compared with other sexes and competition levels.