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This study continues to delineate muscle biology differences between lower and higher responders to resistance training and is unique in that a female population was interrogated. As has been reported in prior studies, increases in satellite cell numbers are related to positive responses to resistance training. Satellite cell responsivity, rather than changes in muscle ribosome content per milligrams of tissue, may be a more important factor in delineating resistance-training responses in women.

Several subtypes of metaphyseal chondrodysplasia exist, of which the Schmid type is the most common. Characteristics include short limbed dwarfism, coxa vara, genu vara, and waddling gait. Skull, spine, and upper extremity involvement is minimal and often nonexistent. The primary defect involves a mutation affecting the metaphyseal portion of the growth plate, while the epiphysis is normal. A large single lineage family with metaphyseal chondrodysplasia, Schmid type (MCDS) was investigated. A genetic pedigree of 135 members of this family showed autosomal dominant inheritance between all 42 affected members. The large sample size allowed for the characterization of a broad range of features present in cases of MCDS. The majority of affected patients exhibited coxa vara with an average neck/shaft angle of 105 degrees. Despite coxa vara, premature osteoarthritis of the hip is not a feature of MCDS. Genu varum is the most prevalent knee disorder in this group, but greater than 30% of patients may exhibit genu valgum. This manuscript highlights MCDS background information, differential diagnoses, treatment options, and prognosis to aid in clinical decision-making.

To determine the cellular composition of a product created with peripheral blood harvested after systemic mobilization with filgrastim and processed with one point-of-care blood concentrating system, i.e., a platelet-rich plasma (PRP) system. The second purpose was to compare mobilized platelet-rich plasma (M-PRP) with a concentrated bone marrow aspirate (cBMA) and a PRP created from the same subjects with the same PRP system.Ten healthy volunteer subjects were recruited for collection and analysis of 3 tissue sources: non-treated peripheral blood, bone marrow aspirate, and filgrastim-mobilized peripheral blood, involving 4 doses of weight-based filgrastim. One point-of-care blood and bone marrow concentrating system was used to create 3 products: PRP, cBMA, and M-PRP. Automated hematologic analysis was performed on all products to quantify total red blood cells, white blood cells (WBCs), monocyte, platelet, and hematopoietic progenitor cell (HPC) concentrations. Flow cytometry was used to determine hematopoietic and mesenchymal progenitor cell populations. Lastly, concentrates were cultured and fibroblast colony-forming units (CFU-F) and morphology of adherent cells were evaluated.M-PRP contained a greater concentration of WBC (mean difference = 53.2 k/μL; P.0001), monocytes (mean difference = 8.3 k/μL; P = .002), and a trend toward a greater concentration of HPC (mean difference = 200.5 /μL; P = .060) when compared with PRP. M-PRP contained a greater concentration of monocytes (mean difference = 5.5 k/μL; P = .017) and a trend toward a greater concentration of platelets (mean difference = 348 k/μL; P = .051) and HPC (mean difference = 193.4 /μL; P = .068) when compared with cBMA. M-PRP had a similar concentration of platelets to PRP (mean difference = 110 k/μL; P = .051) and PRP had a greater concentration than cBMA (mean difference = 458 k/μL; P = .003). cBMA remained the only product capable of producing CFU-Fs (446 ± 247 /mL) as neither the M-PRP nor PRP produced CFU-Fs. M-PRP produced colonies consistent with WBC.M-PRP, produced with filgrastim mobilized blood and a proprietary PRP system, contained more total WBCs, monocytes, platelets, and HPCs than cBMA and more WBCs, monocytes, and HPCs than PRP.Filgrastim mobilized PRP may be an alternative to cBMA for use as a point-of-care product for orthopaedic treatments.

We examined if resistance training affected muscle NAD+ and NADH concentrations as well as nicotinamide phosphoribosyltransferase (NAMPT) protein levels and sirtuin (SIRT) activity markers in middle-aged, untrained (MA) individuals. MA participants (59±4 years old; n=16) completed 10 weeks of full-body resistance training (2 d/wk). Body composition, knee extensor strength, and vastus lateralis muscle biopsies were obtained prior to training (Pre) and 72 hours following the last training bout (Post). Data from trained college-aged men (22±3 years old, training age: 6±2 years old; n=15) were also obtained for comparative purposes. Muscle NAD+ (+127%, p0.10). Interestingly, muscle citrate synthase activity levels (i.e., mitochondrial density) increased in MA participants from Pre to Post (+183%, p

Protein supplementation is a commonly employed strategy to enhance resistance training adaptations. However, little research to date has examined if peanut protein supplementation is effective in this regard. Thus, we sought to determine if peanut protein supplementation (PP, 75 total g/d of powder providing 30 g/d protein, &gt, 9.2 g/d essential amino acids, ~315 kcal/d) affected resistance training adaptations in college-aged adults. Forty-seven college-aged adults (n = 34 females, n = 13 males) with minimal prior training experience were randomly assigned to a PP group (n = 18 females, n = 5 males) or a non-supplement group (CTL, n = 16 females, n = 8 males) (ClinicalTrials.gov trial registration NCT04707963, registered 13 January 2021). Body composition and strength variables were obtained prior to the intervention (PRE). Participants then completed 10 weeks of full-body resistance training (twice weekly) and PP participants consumed their supplement daily. POST measures were obtained 72 h following the last training bout and were identical to PRE testing measures. Muscle biopsies were also obtained at PRE, 24 h following the first exercise bout, and at POST. The first two biopsy time points were used to determine myofibrillar protein synthesis (MyoPS) rates in response to a naïve training bout with or without PP, and the PRE and POST biopsies were used to determine muscle fiber adaptations in females only. Dependent variables were analyzed in males and females separately using two-way (supplement × time) repeated measures ANOVAs, unless otherwise stated. The 24-h integrated MyoPS response to the first naïve training bout was similar between PP and CTL participants (dependent samples t-test p = 0.759 for females, p = 0.912 for males). For males, the only significant supplement × time interactions were for DXA-derived fat mass (interaction p = 0.034) and knee extensor peak torque (interaction p = 0.010), these variables significantly increased in the CTL group (p &lt, 0.05), but not the PP group. For females, no significant supplement × time interactions existed, although interactions for whole body lean tissue mass (p = 0.088) and vastus lateralis thickness (p = 0.099) approached significance and magnitude increases in these characteristics favored the PP versus CTL group. In summary, this is the second study to determine the effects of PP supplementation on resistance training adaptations. While PP supplementation did not significantly enhance training adaptations, the aforementioned trends in females, the limited n-size in males, and this being the second PP supplementation study warrant more research to determine if different PP dosing strategies are more effective than the current approach.

Resistance training increases muscle fiber hypertrophy, but the morphological adaptations that occur within muscle fibers remain largely unresolved. Fifteen males with minimal training experience (24±4years, 23.9±3.1kg/m2 body mass index) performed 10weeks of conventional, full-body resistance training (2× weekly). Body composition, the radiological density of the vastus lateralis muscle using peripheral quantitative computed tomography (pQCT), and vastus lateralis muscle biopsies were obtained 1week prior to and 72h following the last training bout. Quantification of myofibril and mitochondrial areas in type I (positive for MyHC I) and II (positive for MyHC IIa/IIx) fibers was performed using immunohistochemistry (IHC) techniques. Relative myosin heavy chain and actin protein abundances per wet muscle weight as well as citrate synthase (CS) activity assays were also obtained on tissue lysates. Training increased whole-body lean mass, mid-thigh muscle cross-sectional area, mean and type II fiber cross-sectional areas (fCSA), and maximal strength values for leg press, bench press, and deadlift (pp=0.018), albeit CS activity levels remained unaltered with training suggesting a discordance between these assays. Interestingly, although pQCT-derived muscle density increased with training (p=0.036), suggestive of myofibril packing, a positive association existed between training-induced changes in this metric and changes in mean fiber myofibril area (r=0.600, p=0.018). To summarize, our data imply that shorter-term resistance training promotes a proportional expansion of the area occupied by myofibrils and a disproportional expansion of the area occupied by mitochondria in type I and II fibers. Additionally, IHC and biochemical techniques should be viewed independently from one another given the lack of agreement between the variables assessed herein. Finally, the pQCT may be a viable tool to non-invasively track morphological changes (specifically myofibril density) in muscle tissue.

Military foot marches account for 17–22% of Army musculoskeletal injuries (MSI), with low back pain (LBP) being a common complaint. Core-exercise and whole-body vibration (WBV) have been shown to decrease LBP in patients with chronic low back MSI. This study investigated if WBV and/or core-exercise influenced LBP or posture associated with a military ruck march. A randomized control trial with three groups: (1) WBV and core-exercise (WBVEx), (2) core-exercise alone (Ex), and (3) control evaluated the effects of core-exercise and WBV on LBP during/after a two 8 K foot marches with a 35 lb rucksack. The intervention groups completed three weeks of core-exercise training with/without WBV. Outcome measurements included visual analog scale (VAS), algometer, posture and electromyography (EMG). LBP, pressure threshold, and posture were elevated throughout the foot march regardless of group. LBP remained elevated for 48 h post foot march (p = 0.044). WBVEx and Ex did not have a significant effect on LBP. WBVEx and Ex both decreased muscle sensitivity and increased trunk flexion (p &lt, 0.001) during the second foot march (FM2). The 8 K foot marches significantly increased LBP. Core-exercise training with/without WBV decreases low back muscle sensitivity. WBV and core-exercise increases trunk flexion which may help improve performance and may influence LBP.

Introduction The purpose of the present study was to investigate core exercise training and whole-body vibration (WBV) as a training method to improve performance and recovery from an 8-km military foot march in novice trainees. Materials and Methods A 3 × 5 repeated measures randomized control trial was used to evaluate the effects of core exercise training and WBV on performance and recovery from an 8-km foot march. Thirty-nine participants were randomized into three groups: core exercise (Ex), WBV with core exercise (WBVEx), and control. Each participant completed two 8-km foot marches (FM1 and FM2) with a 35 pound rucksack, separated by 4 weeks. Participants in the Ex and WBVEx groups completed 3 weeks of core exercise training, three times per week in between FM1 and FM2. Performance time, creatine kinase (CK), and interleukin-6 (IL-6) were measured. The Auburn University Institutional Review Board approved all aspects of this study (protocol number: 19-211 MR 1907). Results Performance time (P Conclusions Core exercise training with or without WBV improved 8-km foot march performance time by 5-6 minutes. The improvements are likely because of an increase in trunk stability. Additionally, this study showed that completing two identical foot marches a month apart increases performance and improves recovery.

Articular cartilage injury is an unfortunate, common occurrence in the football athlete due to the demands and nature of the sport. Injury can manifest as a new cartilage lesion, as the result of an acute traumatic event, a symptomatic aggravation of a pre-existing asymptomatic chronic cartilage lesion, or a symptomatic exacerbation of a pre-existing asymptomatic chronic lesion. When presented with symptoms of cartilage injury in season, thoroughly assess the exact extent and nature of the cartilage injury, determine what other collateral factors/injuries are associated with the cartilage lesion, and begin an initial management to treat the inflammatory response. Most cartilage injuries can be initially and definitively treated with a nonoperative regimen. Rehabilitation regimens, bracing, injection therapies, and surgery, all have their place in a full treatment algorithm. The art for the clinician is appropriately managing the injury, while maximizing the athlete’s potential with the long-term health of the athlete at the pinnacle of the treatment decision-making.

The primary aims of the study were (1) to examine kinematics and kinetics of those pitching with and without lower extremity pain in collegiate softball pitchers, and (2) to determine if there was an association between the lower extremity pain and lower extremity kinematics, trunk kinematics, and shoulder kinetics in collegiate softball pitchers. Thirty-seven NCAA Division I female collegiate softball pitchers (19.8±1.3 yrs,173.7±7.7 cm, 79.0±12.4 kg) participated. Participants were divided into two groups, those who were currently experiencing lower extremity pain and those who were not. Participants threw three rise ball pitches. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. Mann-Whitney U tests revealed no significant kinematic or kinetic differences between pitchers with and without lower extremity pain. Additionally, there were no significant correlations between pain and recorded kinematic and kinetic variables. Considering there were no biomechanical differences observed between pitchers, coaches and athletic trainers should take caution with athlete assessment since athletes may not display altered biomechanics. Further examination into the duration and degree of pain is needed in an attempt to fully understand the implication of pain and pitching mechanics.

Several studies suggest resistance training (RT) while supplementing with various protein supplements can enhance strength and muscle mass in older individuals. However, to date, no study has examined the effects of RT with a peanut protein powder (PP) supplement on these outcomes. Herein, 39 older, untrained individuals (n=17 female, n=22 male; age=58.6±8.0 years; body mass index =28.7±5.8) completed a 6-week (n=22) or 10-week (n=17) RT program, where full-body training was implemented twice weekly (ClinicalTrials.gov trial registration NCT04015479; registered July 11, 2019). Participants in each program were randomly assigned to consume either a PP supplement once per day (75 total g powder providing 30 g protein, >9.2 g essential amino acids, ~315 kcal; n=20) or no supplement (CTL; n=19). Right leg vastus lateralis (VL) muscle biopsies were obtained prior to and 24 hours following the first training bout in all participants to assess the change in myofibrillar protein synthetic rates (MyoPS) as measured via the deuterium-oxide (D2O) tracer method. Pre- and Post-intervention testing in all participants was conducted using dual energy x-ray absorptiometry (DXA), VL ultrasound imaging, a peripheral quantitative computed tomography (pQCT) scan at the mid-thigh, and right leg isokinetic dynamometer assessments. Integrated MyoPS rates over a 24-hour period were not significantly different (p

The knee valgus angle (KVA) is heavily researched as it has been shown to correlate to anterior cruciate ligament (ACL) injuries when measured during jumping activities. Many different methods of KVA calculation are often treated as equivalent. The purpose of this study is to elucidate differences between these commonly used angles within and across activities to determine if they can indeed properly be treated as equivalent. The kinematics of 23 female athletes, D1 soccer, D1 basketball, and club soccer (height = 171.2 ± 88.9 cm, weight = 66.3 ± 8.6 kg, age = 19.8 ± 1.9 years), was analyzed using a motion capture system during activities related to their sport and daily living. The abduction KVA, measured using body fixed axes, only correlated to the two-dimensional (2D) global reference frame angle (KVA 2G) in three of the six activities (walking, squatting, and walking down stairs), and one out of six in the three-dimensional (3D) measurements (jogging). This suggests that the abduction KVA does not always relate to other versions of KVA. The KVA with reference to the pelvis coordinate system (KVA 2P) correlated to the KVA 2G in six out of six activities (r = 0.734 ± 0.037, P << 0.001) suggesting the pelvis can be utilized as a reference plane during rotating tasks, such as run-to-cut, when a fixed global system is less meaningful. Not all measures of KVA are equivalent and should be considered individually. A thorough understanding of the equivalence or nonequivalence of various measures of KVA is essential in understanding ACL injury risk.

As biologic augmentation methods emerge, objective measures of soft tissues are necessary for developmental study. The purpose of this study was to develop a quantitative MRI mapping protocol for the ACL. The objectives were (1) to provide age-based T2 relaxation, T2* relaxation, and volume values in healthy individuals, (2) to establish the intra-rater and inter-rater reliability of ACL mapping, and (3) to determine whether 3-T or 7-T MRI is more appropriate for future clinical trials. Thirty healthy participants, aged 18–62, asymptomatic for knee pathology and without history of knee injury underwent both a 3-T and 7-T MRI. Manual image mapping of the anterior cruciate ligament was performed by two observers and processed to obtain T2, T2*, and volume values. Analysis of variance and two-way random effects model were used to calculate statistical significance and intraclass correlation coefficients. Across all participants, 3-T and 7-T mean T2, T2* and volume values were 37.1 ± 7.9 and 39.7 ± 6.2 ms (p = 0.124), 10.9 ± 1.3 and 10.9 ± 0.9 ms (p = 0.981), and 2380 ± 602 and 2484 ± 736 mm3 (p = 0.551), respectively. The T2, T2*, and volume did not vary between age cohorts (p > 0.05). Excellent inter-rater and intra-rater reliability regarding T2 and T2* values was found. While ACL volume exhibited good inter-rater reliability and excellent intra-rater reliability. T2 relaxation values and ACL volume do not vary with age and therefore can be used as a quantifiable, non-invasive method to assess ACL graft maturation. 7-T MRI analysis was not superior to 3-T MRI analysis, suggesting that 3-T MRI is practical and capable for future comparative studies.

The purpose of this study was to evaluate pitching mechanics between female softball pitchers with upper extremity pain and those without upper extremity pain. Specifically, the trunk, shoulder and elbow kinematics and shoulder kinetics during the change-up softball pitch were examined. Fifty-five collegiate softball pitchers participated, divided into those with upper extremity pain (20.0±1.3 yrs.; 174.4±6.9 cm; 82.9±12.4 kg; 11.1±2.6 yrs. of experience; n=23) and those who were pain-free (19.9±1.4 yrs.; 173.8±6.9 cm; 81.4±12.5 kg; 10.0±2.5 yrs. of experience; n=32). Pitching mechanics were obtained via the trakSTAR™ electromagnetic tracking system (Ascension Technologies, Inc., Burlington, VT, USA). Mann-Whitney U tests revealed significant differences in shoulder horizontal abduction at foot contact (p=0.014, U=153, Z=2.450) and trunk lateral flexion at ball release (p=0.012, U=150, Z=–2.515); and between shoulder distraction force at ball release (p=0.034, U=168, Z=–2.124). The pain group illustrated greater shoulder horizontal abduction at foot contact, less trunk lateral flexion towards the throwing side at ball release, and greater shoulder distraction at ball release than the pain-free group. The differences in trunk and shoulder kinematics, and shoulder kinetics between groups allows for insight into further studies examining injury pervasiveness in softball pitching.

New Findings What is the central question of this study? Does 60 min of peristaltic pulse external pneumatic compression (EPC) alter gene and protein expression patterns related to metabolism, vascular biology, redox balance and inflammation in vastus lateralis biopsy samples? What is the main finding and its importance? A single bout of EPC transiently upregulates PGC-1α mRNA, while also upregulating endothelial nitric oxide synthase protein and nitric oxide metabolite concentrations in vastus lateralis biopsy samples. We investigated whether a single 60 min bout of whole-leg, lower pressure external pneumatic compression (EPC) altered select vascular, metabolic, antioxidant and inflammation-related mRNAs. Ten participants (eight male, two female; aged 22.0 ± 0.4 years) reported to the laboratory 4 h postprandial, and vastus lateralis muscle biopsies were obtained before (PRE) and 1 and 4 h after EPC treatment. Messenger RNA expression was analysed using real-time RT-PCR, and significant mRNA findings were investigated further by Western blot analysis of respective protein concentrations. Peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) mRNA increased by 77% 1 h following EPC compared with PRE levels (P = 0.005), but no change in protein concentration 1 or 4 h post-EPC was observed. Increases in endothelial nitric oxide sythase (eNOS) mRNA (+44%) and superoxide dismutase 2 (SOD2) mRNA (+57%) 1 h post-EPC as well as an increase in interleukin-10 mRNA (+132%) 4 h post-EPC compared with PRE levels were observed, but only approached significance (P = 0.076, 0.077 and 0.074, respectively). Interestingly, eNOS protein (+40%, P = 0.025) and nitrate and nitrite (NOx) concentrations (+69%, P = 0.025) increased 1–4 h post-EPC. Moreover, SOD2 protein tended to increase from PRE to 4 h post-EPC (+43%, P = 0.074), although no changes in tissue 4-hydroxnonenal levels was observed. An acute bout of EPC transiently upregulates PGC-1α mRNA, while also upregulating eNOS protein and NOx concentrations in vastus lateralis biopsy samples. Future research should characterize the origin of these responses (e.g. vascular or muscle fibre cells) and how the acute effects of EPC application on gene and protein expression observed herein are associated with functional improvements (e.g. metabolism, vascular function) in acute and chronic models.

To compare the effects of external pneumatic compression (EPC) and sham when used concurrently with high intensity interval training (HIIT) on performance-related outcomes and recovery-related molecular measures. Eighteen recreationally endurance-trained male participants (age: 21.6 ± 2.4 years, BMI: 25.7 ± 0.5 kg/m2, VO2peak: 51.3 ± 0.9 mL/kg/min) were randomized to balanced sham and EPC treatment groups. Three consecutive days of HIIT followed by EPC/sham treatment (Days 2–4) and 3 consecutive days of recovery (Days 5–7) with EPC/sham only on Days 5–6 were employed. Venipuncture, flexibility and pressure-to-pain threshold (PPT) measurements were made throughout. Vastus lateralis muscle was biopsied at PRE (i.e., Day 1), 1-h post-EPC/sham treatment on Day 2 (POST1), and 24-h post-EPC/sham treatment on Day 7 (POST2). 6-km run time trial performance was tested at PRE and POST2. No group × time interaction was observed for flexibility, PPT, or serum measures of creatine kinase (CK), hsCRP, and 8-isoprostane. However, there was a main effect of time for serum CK (p = 0.005). Change from PRE in 6-km run times at POST2 were not significantly different between groups. Significant between-groups differences existed for change from PRE in atrogin-1 mRNA (p = 0.018) at the POST1 time point (EPC: − 19.7 ± 8.1%, sham: + 7.7 ± 5.9%) and atrogin-1 protein concentration (p = 0.013) at the POST2 time point (EPC: − 31.8 ± 7.5%, sham: + 96.0 ± 34.7%). In addition, change from PRE in poly-Ub proteins was significantly different between groups at both the POST1 (EPC: − 26.0 ± 10.3%, sham: + 34.8 ± 28.5%; p = 0.046) and POST2 (EPC: − 33.7 ± 17.2%, sham: + 21.4 ± 14.9%; p = 0.037) time points. EPC when used concurrently with HIIT and in subsequent recovery days reduces skeletal muscle markers of proteolysis.

Next-generation RNA sequencing was employed to determine the acute and subchronic impact of peristaltic pulse external pneumatic compression (PEPC) of different target inflation pressures on global gene expression in human vastus lateralis skeletal muscle biopsy samples. Eighteen (N = 18) male participants were randomly assigned to one of the three groups: (1) sham (n = 6), 2) EPC at 30-40 mmHg (LP-EPC; n = 6), and 3) EPC at 70-80 mmHg (MP-EPC; n = 6). One hour treatment with sham/EPC occurred for seven consecutive days. Vastus lateralis skeletal muscle biopsies were performed at baseline (before first treatment; PRE), 1 h following the first treatment (POST1), and 24 h following the last (7th) treatment (POST2). Changes from PRE in gene expression were analyzed via paired comparisons within each group. Genes were filtered to include only those that had an RPKM ≥ 1.0, a fold-change of ≥1.5 and a paired t-test value of

Summary We investigated whether a single 60-min bout of whole leg, peristaltic pulse external pneumatic compression (EPC) altered select growth factor-related mRNAs and/or various phospho(p)-proteins related to cell growth, proliferation, inflammation and apoptosis signalling (e.g. Akt-mTOR, Jak-Stat). Ten participants (8 males, 2 females; aged 22·2 ± 0·4 years) reported to the laboratory 4 h post-prandial, and vastus lateralis muscle biopsies were obtained prior to (PRE), 1 h and 4 h post-EPC treatment. mRNA expression was analysed using real-time RT-PCR and phosphophorylated and cleaved proteins were analysed using an antibody array. No changes in selected growth factor-related mRNAs were observed following EPC. All p-proteins significantly altered by EPC decreased, except for p-rps6 (Ser235/236) which increased 31% 1 h post-EPC compared to PRE levels (P = 0·016). Notable decreases also included p-BAD (Ser112; −28%, P = 0·004) at 4 h post-EPC compared to PRE levels. In summary, an acute bout of EPC transiently upregulates p-rps6 as well as affecting other markers in the Akt-mTOR signalling cascade. Future research should characterize whether chronic EPC application promotes alterations in lower-limb musculature and/or enhances exercise-induced training adaptations.

We sought to investigate recovery markers following a single bout of whole-leg external pneumatic compression (EPC). Post-prandial (> 4 hours) and rested participants (N=12) were treated with 1-h o...

Purpose We sought to compare the effects of external pneumatic compression (EPC) and sham when used concurrently with resistance training on performance-related outcomes and molecular measures related to recovery. Methods Twenty (N = 20) resistance-trained male participants (aged 21.6±2.4 years) were randomized to balanced sham or EPC intervention groups. The protocol consisted of 3 consecutive days of heavy, voluminous back squat exercise followed by EPC/sham treatment (Days2-4) and 3 consecutive days of recovery (Days5-7) with EPC/sham only on Days5-6. On Day1 (PRE), and Days3-7, venipuncture, flexibility and pressure-to-pain threshold (PPT) measures were performed. Vastsus lateralis muscle tissue was biopsied at PRE, 1-h post-EPC/sham treatment on Day2 (POST1) and 24-h post-EPC/sham treatment on Day7 (POST2). Isokinetic peak torque was assessed at PRE and POST2. Results Peak isokinetic strength did not change from PRE to POST2 in either group. The PPT was significantly lower on Days3-6 with sham, indicating greater muscle soreness, though this was largely abolished in the EPC group. A significant decrease in flexibility with sham was observed on Day3 (+16.2±4.6% knee joint angle; P0.01). Vastus lateralis poly-ubiquitinated proteins significantly increased at the POST2 time point relative to PRE with sham (+66.6±24.6%; P