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OBJECTIVETo investigate the association of both individual and combined healthy lifestyle factors with the risk of all-cause mortality among patients with osteoarthritis (OA).DESIGNProspective population-based cohort study.SETTINGUK biobank and US National Health and Nutrition Examination Survey (US NHANES, 2007-2018)PARTICIPANTS104, 142 UK participants with OA aged 39-72 years and 3, 472 US participants with OA aged 20-80 years.EXPOSURESIndividual healthy lifestyle factors and a combined healthy lifestyle score were constructed from body mass index (BMI) and self-reported information on diet, sleep duration, physical activity, sedentary time, social connection, smoking and alcohol drinking.MAIN OUTCOME MEASURESAll-cause mortality was the primary outcome in both studies. Secondary outcomes included cause-specific mortalities (cardiovascular, cancer, digestive and respiratory). Hazard ratios were adjusted for age, sex, economic situation, race, education and employment (UK biobank only).RESULTSUK Biobank documented 9,914 deaths during a median follow-up of 12.7 years, and US NHANES documented 463 deaths during a mean follow-up of 6.01 years. For all-cause mortality using restricted cubic spline graph (RCS) models, sleep duration had a U-shaped (with a nadir at 7 hours/day), moderate physical activity (MPA) had an L-shaped (with a turning point at 550 minutes/week), while BMI, vigorous physical activity (VPA) and sedentary time had J-shaped (with turning points at 28 kg/m2, 240 minutes/week and 5 hours/day, respectively) associations in the UK biobank. Similar results were observed in US NHANES. In multivariable Cox models, each healthy lifestyle factor was significantly associated with all-cause mortality (hazard ratio [HRs] range 0.49 to 0.84 for UK biobank, and 0.26 to 0.73 for US NHANES), and HRs (95% CI) for associations with combined healthy lifestyle score (scoring 6-8 vs. 0-2) were 0.38 (0.35, 0.41) in UK biobank and healthy lifestyle score (scoring 5-7 vs. 0-1) were 0.20 (0.13, 0.31) in US NHANES for all-cause mortality. The results for cause-specific mortality were largely similar and consistent across two cohorts.CONCLUSIONSThe nonlinear relationships suggested patients with OA had the lowest risk of all-cause mortality when BMI was 28 kg/m2, sleep was 7 hours/day, VPA was 240 minutes/week, sedentary time was less than 5 hours/day, MPA was more than 550 minutes/week. The newly constructed healthy lifestyle score for OA population was associated with a significantly lower risk of all-cause mortality.WHAT IS ALREADY KNOWN ON THIS TOPICHealthy lifestyles are thought to reduce the risk of multiple causes of mortality in the general population.People with osteoarthritis (OA) are at higher risk of mortality than the general population. However, evidence of associations between combined healthy lifestyle and risks of all-cause and cause-specific mortality among OA patients are lacking.Whether and what kind of healthy lifestyles in patients with OA could offset the risk of mortality are unknown.WHAT THIS STUDY ADDSBy using two nationwide cohort studies in UK and US, a comprehensive healthy lifestyle pattern that integrates 8 or 7 lifestyle factors was established among OA individuals for the first time.People who had the highest combined healthy lifestyle score were significantly associated with 62% to 80% lower risk of all-cause mortality compared with those who had the lowest score in both the UK and US OA populations.

Huang, Z-H, Ma, CZ-H, Wang, L-K, Wang, X-Y, Fu, S-N, and Zheng, Y-P. Real-time visual biofeedback via wearable ultrasound imaging can enhance the muscle contraction training outcome of young adults. J Strength Cond Res 36(4): 941-947, 2022-Real-time ultrasound imaging (RUSI) can serve as visual biofeedback to train deep muscle contraction in clinical rehabilitative settings. However, its effectiveness in resistance training in sports/fitness fields remains unexplored. This article introduced a newly developed wearable RUSI system that provided visual biofeedback of muscle thickening and movement and reported its effectiveness in improving the training outcomes of muscle thickness change (%) during dynamic contraction. Twenty-five healthy young men participated and performed pec fly exercise both with and without RUSI biofeedback. Statistical analysis was conducted to examine the reliability of the measurements and the immediate effects of (a) RUSI biofeedback of muscle contraction and (b) training intensity (50 vs. 80% of 1-repetition maximum [1RM]) on the pectoralis major (PMaj) thickness change measured by ultrasound images. In addition to significantly high inter-contraction reliability (ICC3,10.97), we observed significantly increased PMaj thickness change for both training intensities upon receiving biofeedback in subjects, compared with without biofeedback (p0.001). We also observed significantly larger PMaj thickness change at 80% of 1RM compared with 50% of 1RM (p = 0.023). The provision of visual biofeedback using RUSI significantly enlarged the magnitude of PMaj thickness change during pec fly exercises, potentially indicating that RUSI biofeedback could improve the ability of targeted muscle contraction of PMaj in healthy young adults. To our knowledge, this study has pioneered in applying RUSI as a form of biofeedback during weight training and observed positive effectiveness. Future iterations of the technique will benefit more subject groups, such as athletes and patients with neuromuscular disorders.

The aim of the study was to examine the immediate effect of 1 session of extracorporeal shockwave therapy (ESWT) on patellar tendon stiffness and to explore the relationship between the change in tendon stiffness and the pain intensity. Thirty-four male athletes aged 22.2 ± 3.8 with patellar tendinopathy were recruited. The participants were randomized into ESWT and sham groups. The ESWT group received 1500 impulses of ESWT at 4 Hz with maximal tolerable pain intensity and the sham group received intensities below 0.08 mJ/mm2. Supersonic Shearwave Imaging (SSI) was used to measure tendon shear modulus (an index of tissue stiffness), and a visual analogue scale was used to quantify the pain intensity during compression with 10 lb (4.535 kg) pressure directed on the most tender part and then during a single-leg declined-squat test. A significant reduction in tendon shear modulus (from 57.4 ± 25.5 kPa to 40.6 ± 17.6kPa, p = 0.001) was detected in the ESWT receiving ESWT with an intensity from 0.13-0.33 mJ/mm2 but not the sham group (from 47.7 ± 17.1 kPa to 41.0 ± 12.7 kPa; p = 0.06). In the ESWT group, the change in tendon shear modulus was associated with the change in the intensity of pain during single-legged declined-squat test (ρ = 0.55; p = 0.023) but not pressure pain (p > 0.05). These findings suggest that one session of ESWT induces reduction of tendon stiffness in volleyball and basketball players with patellar tendinopathy. The reduction in tendon stiffness is associated with reduction in pain during single-legged declined-squat test.

To conduct a systematic review and meta-analysis to summarize evidence regarding differential changes in physical activity (PA) involvements and exercise habits in people with and without chronic diseases during the COVID-19 outbreak.MEDLINE, Embase, SPORTDiscus, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane Library, and Physiotherapy Evidence Database were searched from November 2019 to May 2021.Two reviewers independently screened cross-sectional and longitudinal studies that investigated changes in PA-related outcomes in people with and without chronic diseases during the pandemic.PA-related outcomes and sedentary time were extracted from the included studies. Relevant risk of bias were assessed. Meta-analyses were conducted for each PA-related outcome, if applicable. Quality of evidence of each PA-related outcome was evaluated by Grading of Recommendations Assessment, Development, and Evaluation.Of 1226 identified citations, 36 articles (28 with and 8 without chronic diseases) with 800,256 participants were included. Moderate evidence from wearable sensors supported a significant reduction in pooled estimates of step count (standardized mean differences [SMD]=-2.79, P.01). Very limited to limited evidence substantiated significant decreases in self-reported PA-related outcomes and significant increases in sedentary behaviors among people with and without chronic diseases. Specifically, pooled estimates of metabolic equivalent-minute per week (SMD=-0.16, P=.02) and PA duration (SMD=-0.07, P.01) were significantly decreased, while sedentary time (SMD=0.09, P=.04) showed significant increases in the general population (small to large effects). Very limited evidence suggested no significant PA changes among people in a country without lockdown.During the pandemic, objective and self-reported assessments showed significant reductions in PA in people with and without chronic diseases globally. This mainly occurred in countries with lockdowns. Although many countries have adopted the "live with the coronavirus" policy, authorities should implement population-based strategies to revert the potential lockdown-related long-term deleterious effects on people's health.

Many experimental sleep deprivation (SD) studies were conducted to clarify the causal relationship between sleep and pain. This systematic review and meta-analysis aimed to update the evidence regarding the effects of different experimental SD paradigms on various pain outcomes. Five databases were searched from their inception to June 2022. Separate random-effects models were used to estimate the pooled effect sizes (ES) of different experimental SD paradigms on various pain outcomes. Thirty-one studies involving 699 healthy individuals and 47 individuals with chronic pain were included. For healthy individuals, limited evidence substantiated that total SD significantly reduced pain threshold and tolerance (ES 0.74-0.95), while moderate evidence supported that partial SD significantly increased spontaneous pain intensity (ES 0.30). Very limited to moderate evidence showed that sleep fragmentation significantly increased peripheral and central sensitization in healthy individuals (ES 0.42-0.79). Further, there was very limited evidence that total or partial SD significantly aggravated spontaneous pain intensity in people with chronic pain. Our results accentuated that different SD paradigms differentially increased subjective pain intensity and worsened peripheral/central pain sensitization in healthy individuals, whereas the corresponding findings in people with chronic pain remain uncertain. Further rigorous studies are warranted to quantify their relationships in clinical populations.

Persistent tendon pain that impairs function has inconsistent medical terms that can influence choice of treatment.1 When a person is told they have tendinopathy by clinician A or tendinitis by clinician B, they might feel confused or be alarmed at receiving what they might perceive as two different diagnoses. This may lead to loss of confidence in their health professional and likely adds to uncertainty if they were to search for information about their condition. Clear and uniform terminology also assists inter-professional communication. Inconsistency in terminology for painful tendon disorders is a problem at numerous anatomical sites. Historically, the term ‘tendinitis’ was first used to describe tendon pain, thickening and impaired function (online supplementary figure S1). The term ‘tendinosis’ has also been used in a small number of publications, some of which were very influential.2 3 Subsequently, ‘tendinopathy’ emerged as the most common term for persistent tendon pain.4 5 To our knowledge, experts (clinicians and researchers) or patients have never engaged in a formal process to discuss the terminology we use. We believe that health professionals have not yet agreed on the appropriate terminology for painful tendon conditions. ### Supplementary data [bjsports-2019-100885supp001.pdf] The authors of this paper, a group of international clinical and research experts from different disciplines, aimed to achieve a consensus in terminology for persistent tendon disorders. We ran a Delphi and consensus process that culminated in a face-to-face meeting at the fifth International Scientific Tendinopathy Symposium (ISTS) in Groningen, the Netherlands, on 26 September 2018 (placeholder for sentence about the other two papers and accompanying editorial if they get accepted). Here, we present the resulting consensus statements on terminology for persistent tendon pain. Our two-stage Delphi design, consensus process consisted of an online survey followed by a face-to-face meeting. One of us (AS) drafted 11 statements about terminology …

We aimed to establish consensus for reporting recommendations relating to participant characteristics in tendon research. A scoping literature review of tendinopathy studies (Achilles, patellar, hamstring, gluteal and elbow) was followed by an online survey and face-to-face consensus meeting with expert healthcare professionals (HCPs) at the International Scientific Tendon Symposium, Groningen 2018. We reviewed 263 papers to form statements for consensus and invited 30 HCPs from different disciplines and geographical locations; 28 completed the survey and 15 attended the meeting. There was consensus that the following data should be reported for cases and controls: sex, age, standing height, body mass, history of tendinopathy, whether imaging was used to confirm pathology, loading tests, pain location, symptom duration and severity, level of disability, comorbidities, physical activity level, recruitment source and strategies, and medication use history. Standardised reporting of participant characteristics aims to benefit patients and clinicians by guiding researchers in the conduct of their studies. We provide free resources to facilitate researchers adopting our recommendations.

Context:Reduction of the subacromial space (SAS) during arm elevation may contribute to rotator cuff (RC) tendinopathy. The effects of scapular taping on the SAS in athletes with and without RC tendinopathy are unknown.Objective:To investigate the immediate effects of scapular taping on the SAS in athletes with and without RC tendinopathy.Design:Randomized controlled study with repeated measures.Setting:University laboratory.Participants:A total of 43 male volleyball players (17 asymptomatic and 26 with RC tendinopathy, mean age = 22.9 [3.5] y) participated in the study.Intervention:Three scapular taping protocols—no taping (control), taping with tension (therapeutic taping), and taping without tension (sham taping).Main Outcome Measures:Ultrasound measurements of the SAS with the arm at 0° and 60° of shoulder abduction, and the change in the SAS between 0° and 60° of shoulder abduction (SAS0°–60°) were calculated.Results:Athletes with RC tendinopathy demonstrated larger SAS with therapeutic taping at 60° of shoulder abduction (6.9 [1.9] mm vs 5.8 [1.7] mm, mean difference = 1.1 mm, 95% confidence interval, −1.80 to −0.39,P = .002) when compared with the no taping condition. The tendinopathy group also showed less reduction in the SAS with therapeutic taping during SAS0°–60°(2.0 [1.4] mm vs 2.8 [1.4] mm,P = .02) when compared with the no taping condition. When tape was applied to the scapula in asymptomatic athletes, our results showed a relatively small increase in the SAS with therapeutic taping during arm resting at 0° of abduction when compared with the no taping condition (8.7 [0.9] mm vs 8.3 [0.8] mm, mean difference = 0.4 mm, 95% confidence interval, −0.71 to −0.11,P = .01).Conclusions:Athletes with RC tendinopathy demonstrated less reduction of the SAS with rigid scapular taping during early arm abduction. Such observation was not evidenced in asymptomatic athletes.

BackgroundThe absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a result, substantial synthesis/meta-analysis of tendon research findings is almost futile despite researchers publishing busily. We aimed to determine options for, and then define, core health-relateddomainsfor tendinopathy.MethodsWe conducted a Delphi study of healthcare professionals (HCP) and patients in a three-stage process. In stage 1, we extracted candidate domains from clinical trial reports and developed an online survey. Survey items took the form: ‘The ‘candidate domain’is important enough to be included as a core health-related domain of tendinopathy’; response options were: agree, disagree, or unsure. In stage 2, we administered the online survey and reported the findings. Stage 3 consisted of discussions of the findings of the survey at the ICON (International Scientific Tendinopathy Symposium Consensus) meeting. We set 70% participant agreement as the level required for a domain to be considered ‘core’; similarly, 70% agreement was required for a domain to be relegated to ‘not core’ (see Results next).ResultsTwenty-eight HCP (92% of whom had >10 years of tendinopathy experience, 71% consulted >10 cases per month) and 32 patients completed the online survey. Fifteen HCP and two patients attended the consensus meeting. Of an original set of 24 candidate domains, the ICON group deemed nine domains to be core. These were: (1) patient rating of condition, (2) participation in life activities (day to day, work, sport), (3) pain on activity/loading, (4) function, (5) psychological factors, (6) physical function capacity, (7) disability, (8) quality of life and (9) pain over a specified time. Two of these (2, 6) were an amalgamation of five candidate domains. We agreed that seven other candidate domainswere notcore domains: range of motion, pain on clinician applied test, clinical examination, palpation, drop out, sensory modality pain and pain without other specification. We were undecided on the other five candidate domains of physical activity, structure, medication use, adverse effects and economic impact.ConclusionNine core domains for tendon research should guide reporting of outcomes in clinical trials. Further research should determine the best outcome measures for each specific tendinopathy (ie, core outcome sets).

This study aims to compare the isometric strength of hip abductors and external rotators in male athletes with and without patellar tendinopathy (PT), and to examine the correlation between hip strength, pain, and functional scores. Sixty male athletes (30 with PT and 30 controls) were recruited from local volleyball and basketball teams. The isometric strength of the hip abductors and external rotators was quantified using a belt-stabilized handheld dynamometer. This study used the visual analog scale (VAS) and the Victorian Institute of Sport Assessment-Patella (VISA-p) questionnaire to measure the intensity of pain and functional scores in athletes with PT, respectively. The normalized isometric strength of the hip abductors and external rotators was significantly less in the PT group compared with controls. In subjects with PT, the normalized isometric strength was decreased by 22.0% (p = 0.000) in the hip abductors and by 20.0% in the hip external rotators (p = 0.004), compared with controls. Significant correlations were found between the normalized isometric strength of the hip abductors and intensity of pain (r = − 0.70; p

To examine the effect of scapular taping on the activity onset of scapular muscles and the scapular kinematics during arm elevation in volleyball players with rotator cuff (RC) tendinopathy.Randomized placebo-controlled repeated measures METHODS: Twenty-six male volleyball players with RC tendinopathy (mean age=23.6±3.3years) participated in the study. Electromyography (EMG) activity onset of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) and the three-dimensional scapular kinematics quantified by using an acromial marker cluster method were compared with three scapular taping protocols, namely, no taping, therapeutic taping, and placebo taping.The MT, LT and SA activated significantly earlier in both therapeutic taping (all p0.005) and placebo taping conditions than no taping conditions (all p0.002). There was a small increase in the scapular upward rotation when therapeutic taping and no taping conditions were compared (p=0.007).Scapular taping may enhance the neuromotor control of the scapular muscles. Whether it provides adequate support for normal scapular kinematics during arm movement in athletes with RC tendinopathy await for further studies.

Background Supraspinatus tendinopathy is one of the common causes of subacromial pain syndrome (SAPS) in overhead athletes. Changes in tendon vascularity have been reported in painful tendons; however, the prevalence and distribution have not been investigated in young overhead athletes. Methods We conducted a cross-sectional study of 47 overhead athletes (male, 31; female, 16) aged 18 to 36 years with SAPS for >3 months. A sonographer graded the severity of the tendinopathy and area of vascularization. Ultrasound imaging was used to measure supraspinatus tendon thickness, vascularity, and resting subacromial space. A self-written program was used to semiquantify the intensity of vascularity, expressed as the vascular index. Results The majority (87.2%) of the participants had signs of tendinopathy in the supraspinatus tendon, and 40 (85.1%) of the tendinopathic tendons had vascularity. The majority (66.0%) of the vascularized subjects presented with minimal increase in vascularity, and 19.1% had moderate to severe vascularization. Most (79.2%) of the vascularization was observed in the pericortical region. The vascular index was negatively correlated with the resting subacromial space in male athletes with a reduced subacromial space (ρ = −0.63; P = .038). Conclusion Of overhead athletes with SAPS, 87.2% had supraspinatus tendinopathy with minimal to moderate vascularization, with the majority of vascularization occurring in the pericortical region. In male athletes with a reduced subacromial space, greater vascularity in the supraspinatus tendon was associated with a smaller resting subacromial space.

To compare tendon strain and stiffness between athletes with patellar tendinopathy and healthy controls, and explore whether the intensity of pain and dysfunction were related to the mechanical properties of the tendon. Thirty-four male athletes with patellar tendinopathy and 13 healthy controls matched by age and activity levels were recruited. The in vivo mechanical properties of the patellar tendon were examined by ultrasonography and dynamometry. In subjects with patellar tendinopathy, the intensities of self-perceived pain (maximal pain in the past 7 days and pain during a single-legged declined-squat test) using the visual analogue scale and the assessment of functional disability using the Victorian Institute of Sport Assessment—patellar questionnaire, were collected. In subjects with patellar tendinopathy, tendon strain was significantly reduced by 22% (8.9 ± 3.7 vs. 14.3 ± 4.7%, P = 0.005) when compared with healthy controls. There was no significant group difference in tendon stiffness (P = 0.27). Significant negative correlations between tendon strain and the maximal self-perceived pain over 7 days (r = −0.37, P = 0.03), and pain during a single-legged declined-squat test (r = −0.37, P = 0.03) were detected. A trend of significant positive correlation was found between tendon stiffness and pain during a single-legged declined-squat test (r = 0.30, P = 0.09). Our findings show that tendon strain is reduced in athletes with patellar tendinopathy, and a lower tendon strain is associated with a greater magnitude of pain perceived.

Eccentric exercise is commonly used as a form of loading exercise for individuals with patellar tendinopathy. This study investigated the change of mechanical properties and clinical outcomes and their interrelationships after a 12-week single-legged decline-board exercise with and without extracorporeal shockwave therapy (ESWT).Randomized controlled trial.Outpatient clinic of a university.Thirty-four male in-season athletes with patellar tendinopathy for more than 3 months were randomized into exercise and combined groups.The exercise group received a 12-week single-legged decline-squat exercise, and the combined group performed an identical exercise program in addition to a weekly session of ESWT in the initial 6 weeks.Tendon stiffness and strain were examined using ultrasonography and dynamometry. Visual analog scale and Victoria Institute of Sports Assessment-patella (VISA-p) score were used to assess pain and dysfunction. These parameters were measured at preintervention and postintervention.Significant time effect but no significant group effect on the outcome measures; significant reduction in tendon stiffness (P = 0.02) and increase in tendon strain (P = 0.00); and reduction of intensity of pain (P = 0.00) and dysfunction (P = 0.00) were observed. Significant correlations between changes in tendon stiffness and VISA-p score (ρ = -0.58, P = 0.05); alteration in tendon strain, pain intensity (ρ = -0.63, P = 0.03); and VISA-p score (ρ = 0.60, P = 0.04) were detected after the exercise program.Eccentric exercise-induced modulation on tendon mechanical properties and clinical symptoms are associated in athletes with patellar tendinopathy.

Introduction Tendinopathy (local tendon pain associated with physical activity) is a challenge to treat despite recent advances. One factor contributing to this challenge is our limited ability to synthesise/meta-analyse research findings, which is further compounded by a lack of valid outcome measures. We determined the core outcome domains against which outcome measures could be recommended. Materials and methods We conducted a Delphi study of patients and health care professionals (HCP) in two parts: an online survey and consensus meeting. Online survey items were extracted from clinical trial reports. Agree, disagree, or unsure were options in response to: ‘The ‘item’ is important enough to be included in a core domain set of tendinopathy’. A-priori criterion of ≥70% participant agreement was deemed for selection of a core domain. Results 32 patients and 28 HCP (92% had >10 years of tendinopathy experience, 71% consulted >10 cases per month) completed the online survey. 2 patients and 15 HCP attended the consensus meeting. Of the original 24 items (from trial reports); 9 were core: Patient overall rating, participation, pain on activity/loading, disability, function, physical function capacity, quality of life, psychology, and pain over a specified timeframe. Eight items were not core domains: range of motion, palpation, clinical examination, structure, pain on examination or without other specification, drop out, and sensory modality pain. Remaining seven items did not meet criterion. Conclusion The core domain set serves as a guide for reporting of outcomes in clinical trials. Further research should determine these outcomes for each specific tendon.

To investigate the passive muscle tension of the quadriceps muscle heads in male athletes clinically diagnosed with patellar tendinopathy (PT) with those of healthy controls and explore the interplay between passive muscle tension and patellar tendon stiffness. Between November 2012 and December 2013, 66 male athletes (mean age of 21.1 ± 4.4 years) were examined using supersonic shear wave imaging technology. The passive tension of the vastus lateralis (VL) and rectus femoris (RF) muscles and patellar tendon stiffness were assessed. The shear elastic modulus of the VL muscle was increased by 26.5% (P

This study aimed to determine whether pre-exercise muscle stiffness is related to the amount of muscle damage induced by an eccentric exercise and to determine whether the post-exercise increase in stiffness is homogenously distributed between the synergist muscles. Fifty healthy participants were randomly assigned to an eccentric exercise group or a control group. The shear modulus (an index of stiffness) of rectus femoris (RF), vastus lateralis (VL) and vastus medialis oblique (VMO) was measured before, immediately after and at 48 h after eccentric exercise. The maximal isometric voluntary knee extension (MVC) torque was also measured. Significant reduction in MVC torque was observed in the eccentric group both at post and 48 H when compared with pre-exercise (both p .001). RF shear modulus increased significantly when assessed at 90° of knee flexion at post and 48 H after the eccentric exercise (p = .004 and .005, respectively). Slight but significant decrease in VL shear modulus was observed at post-exercise for the eccentric group (p = .002). No change was observed in VMO. The decrease in MVC at 48 H was negatively correlated with the RF shear modulus measured at 90° of knee flexion before the exercise. Eccentric exercise induced a wide range of peak torque reduction and muscle-head specific modulation on muscle stiffness. Participants with stiffer RF muscles exhibited greater decrease in force generating capacity at 48 H after eccentric exercise.

Tendon mechanical properties are linked to sports performance and tendon-related injuries, such as tendinopathy. Whether habitual loading, such as participation in regular jumping activities, would induce adaptation on tendon mechanical properties remains unclear. Forty healthy subjects (10 sedentary, 15 volleyball players, and 15 basketball players) aged between 18 and 35 years were recruited. Supersonic shearwave imaging was used to measure the shear elastic modulus and thickness and cross-sectional area (CSA) of the proximal patellar tendons of both knees at 30° of flexion. Significant group differences in tendon shear elastic modulus were found among the three groups. In the dominant leg, reduction in tendon shear elastic modulus by 18.9 % (p = 0.018) and 48.7 % (p = 0.000) were observed in the basketball and volleyball players, respectively, when compared with sedentary subjects. In the non-dominant leg, reduction in tendon shear elastic modulus were 27.3 % (p = 0.034) and 47.1 % (p = 0.02) in the basketball and volleyball players, respectively. The athlete groups were found to have larger CSA but with similar tendon thickness than sedentary group. The CSA were larger by 24–29 % and by 22–24 % in the basketball players and volleyball players, for the dominant and non-dominant legs, respectively (all p

Athletes with rotator cuff (RC) tendinopathy demonstrate an aberrant pattern of scapular motion which might relate to deficits in the scapular muscles. This study aimed to determine whether alteration in scapular kinematics is associated with deficits in the activity onset of scapular muscles. Forty-three male volleyball players (17 asymptomatic and 26 with RC tendinopathy) joined the study. Three-dimensional scapular kinematics was quantified using an acromial marker cluster method. The activity onset of the upper (UT), middle (MT), and lower trapezius (LT), and serratus anterior (SA) during arm abduction was assessed with electromyography. Athletes with RC tendinopathy demonstrated less scapular upward rotation (6.6±2.3 vs. 8.2±1.1°, p=0.021) in the early phase of shoulder abduction from 0° to 30° when compared to asymptomatic athletes. The tendinopathy group had delayed activity onset of LT (14.1±31.4ms vs. 74.4±45.1ms, p

To establish the test-retest reliability of ultrasound measurements on acromio-humeral distance (AHD) and supraspinatus tendon thickness; and to explore their relationships with shoulder rotational strengths.Test-retest observational study.Thirty-seven individuals (age: 21.5±1.4 years) participated in this study. Twenty-four were University volleyball players with 15 healthy and 9 players with shoulder impingement syndrome (SIS). Thirteen participants were healthy untrained individuals. Ultrasound measurements of AHD and supraspinatus tendon thickness were taken, and isokinetic testing of concentric shoulder internal rotation (IR) and external rotation (ER) at a speed of 90°/s was performed.The measurement of the AHD and the supraspinatus tendon thickness indicated excellent reliability (ICC=0.922, and ICC=0.933 respectively), and the minimum detectable difference (MDD) were 2.10mm and 0.64 mm respectively. A cut-off AHD distance of 23.9 mm had a sensitivity of 0.67 and specificity of 0.71 (area under curve (AUC): 0.70; p=0.05) in identifying individuals with and without SIS. Hence, individuals with AHD larger than 23.9 mm had greater possibility of having SIS. Positive correlations were found in AHD with supraspinatus tendon thickness (r=0.36, p0.05) and shoulder external rotational strengths (r=0.47-0.62, all p0.05) and ER/IR ratios (r=0.56-0.58, all p0.05).Ultrasound measurements of AHD and tendon thickness have excellent reliability. The reported cut-off AHD highlighted the potential role of ultrasound measurements in volleyball players for early identification of SIS. The AHD was related to the supraspinatus tendon thickness and shoulder external rotation strengths. Our findings provide a scientific basis for muscle training in overhead athletes such as volleyball players.

Sports training, especially for those requiring fast and skilled movements have been reported to improve one's postural control, but the underlying sensory integration mechanism is unknown. The purpose is to explore the sensory organisation strategies for maintaining standing balance in Taekwondo practitioners, and to examine the quasi-static and dynamic balance performance in subjects with and without TKD training. Case-control study was used as a study design. Eleven subjects with low level of Taekwondo training for 1-3 years, and eleven sedentary healthy subjects were assessed with the sensory organisation tests (SOT) under six visual and somatosensory input conditions and their balance upon landing from self- or operator-triggered drop test with the eyes closed condition. The SOT measured the equilibrium scores, whereas the drop test assessed the time to stabilisation (TTS), normalised peak force and distance of antero-posterior and medial-lateral centre of pressure on landing. Results for the SOT test revealed that Taekwondo subjects performed better during stance with eyes closed on a fixed support than the untrained group (p = 0.011). For the drop tests, the untrained group was slower in postural correction as revealed by the longer TTS than the Taekwondo group after the operator-triggered drops (p = 0.018). All subjects had a larger normalised peak force in operator-triggered than self-triggered drops. In conclusion, we observed that people with low-level Taekwondo training have better balance performance than untrained subjects as shown in the SOT results and shorter TTS with the drop test. They may rely more on the somatosensory and vestibular inputs for maintaining balance. People with balance problems may benefit from Taekwondo training.

Purpose. To translate, cross-culturally adapt and validate the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF-C) to Chinese.Method. Forward and backward translations were conducted by two bilingual professional translators. Content validity was verified by a panel of a senior orthopaedic surgeon and six physiotherapists. The IKDC-SKF-C was tested on 84 patients. Psychometric testing included internal consistency (Cronbach's α) and test–retest reliability. Convergent validity used Spearman's correlation coefficient (rho) tests by comparing its score with the Chinese version of SF-36.Results. The Internal consistency was excellent with Cronbach's α == 0.97. Test-retest reliability was supported with an ICC == 0.87. The IKDC-SKF-C was moderately related to concurrent measures of physical function and bodily pain (r == 0.64, p

This single-blinded, randomized controlled study investigated the effects of practicing Tai Chi on the postural control and cognitive performance of older women while dual tasking.: Community-dwelling older women (n=31) were recruited from community centers. They were randomized to Tai Chi group (n=15, 12-form Yang style Tai Chi training) or a control group (n=16, general interest classes) for 16 weeks. Balance was tested in single leg stance after stepping down from a step, with and without a concurrent auditory response task (auditory Stroop test). Balance was measured by total sway path and sway area of subject’s center of pressure (COP). The reaction time and the correctness of the auditory Stroop test were also measured.: Tai Chi subjects made fewer errors in auditory Stroop test under dual-task condition after Tai Chi training (p=0.01). They also showed significant decreases in the COP path (p: Tai Chi training improves the cognitive and postural control performance of older women when dual tasking.

Purpose: The objective of this study was to investigate modulation in prelanding muscle responses and its associated impact force on landing from unexpected and self-initiated drops in male basketball players with a history of bilateral multiple ankle sprains (BMAS). Methods: Prelanding EMG responses were recorded in four lower-limb muscles, together with the impact force on landing, while 20 healthy and 19 basketball players with BMAS performed unexpected, self-initiated drops from a height of 30 cm. Results: Group differences were detected after self-initiated but not unexpected drops. Two main changes in prelanding EMG responses were observed in the injured basketball players during the self-initiated drops. First, tibialis anterior (TA) was activated significantly earlier in the injured group, whereas left tensor fascia latae appeared closer to the moment of landing (P < 0.025) than in the healthy players. Second, cocontraction indexes between left TA and peroneus longus, and left TA and medial gastrocnemius, were significantly greater in the injured than in the healthy players (P < 0.025). On landing, higher magnitude-of-impact forces were observed in the injured players on the right leg (by 23%, P = 0.012). Conclusion: In basketball players with BMAS, modulation of prelanding muscle response latencies occurred in injured (ankle) and uninjured (hip) joints during self-initiated but not unexpected drops. Greater cocontraction index between the left ankle muscle pairs in preparation for landing from self-initiated drops, and a significantly higher magnitude of impact force in the right leg on landing, were observed in the injured players.

The objective of this study was to investigate the modulation of the ankle muscle electromyographic (EMG) response as a function of mental set. Thirteen young healthy subjects underwent 40 unexpected and self-initiated drops from 30 cm above two separate force-plates. Following unexpected drops, reflex activities were observed in the medial gastrocnemius (MG) and tibialis anterior (TA) at mean latencies (+/- SD) of 83.59 +/- 10.1 and 99.43 +/- 21.82 ms, respectively. Following self-initiated drops, the response latency of the MG was significantly shortened (to 71.98 +/- 10 ms, P0.05), and the TA was significantly lengthened (to 183.33 +/- 45 ms, P0.05) when compared with unexpected drops. Such a modulation was associated with a significant reduction of the impact force on landing as compared with unexpected drops (by 17%, P0.05). Interestingly, a negative correlation was found between the onset of the TA EMG response and the magnitude of the impact force on landing during expected (r= -0.66, P0.05) but not unexpected drops.