Strength and power training in rehabilitation: underpinning principles and practical strategies to return athletes to high performance

Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed

Motion estimation and signaling techniques for 2D+t scalable video coding

We describe a fully scalable wavelet-based 2D+t (in-band) video coding architecture. We propose new coding tools specifically designed for this framework aimed at two goals: reduce the computational complexity at the encoder without sacrificing compression; improve the coding efficiency, especially at low bitrates. To this end, we focus our attention on motion estimation and motion vector encoding. We propose a fast motion estimation algorithm that works in the wavelet domain and exploits the geometrical properties of the wavelet subbands. We show that the computational complexity grows linearly with the size of the search window, yet approaching the performance of a full search strategy. We extend the proposed motion estimation algorithm to work with blocks of variable sizes, in order to better capture local motion characteristics, thus improving in terms of rate-distortion behavior. Given this motion field representation, we propose a motion vector coding algorithm that allows to adaptively scale the motion bit budget according to the target bitrate, improving the coding efficiency at low bitrates. Finally, we show how to optimally scale the motion field when the sequence is decoded at reduced spatial resolution. Experimental results illustrate the advantages of each individual coding tool presented in this paper. Based on these simulations, we define the best configuration of coding parameters and we compare the proposed codec with MC-EZBC, a widely used reference codec implementing the t+2D framework

Do people with musculoskeletal pain differ from healthy cohorts in terms of global measures of strength? A systematic review and meta-analysis

Objective It is currently unknown if people with musculoskeletal pain display different multi-joint strength capacities than healthy cohorts. The aim was to investigate whether people with musculoskeletal pain show differences in global measures of strength in comparison to healthy cohorts. Data sources A systematic review was conducted using three databases (Medline, CINAHL and SPORTDiscus) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Review methods Studies involving participants with painful musculoskeletal conditions and multi-joint strength assessment measured at baseline were included. A meta-analysis was also performed to compute standardized mean differences (± 95% confidence intervals), using Hedge’s g, and examined the differences in multi-joint strength at baseline between participants with painful musculoskeletal conditions and healthy participants. Results 5043 articles were identified, of which 20 articles met the inclusion criteria and were included in the qualitative analysis. The available evidence revealed that multi-joint strength values were limited to knee osteoarthritis, fibromyalgia, chronic low back pain, and rheumatoid arthritis. Only four studies were included in the quantitative synthesis and revealed that only small differences in both chest press (g= -0.34, 95% CI [-0.64, -0.03]) and leg press (g= -0.25, 95% CI [-0.49, -0.02]) existed between adult women with fibromyalgia and active community women. Conclusion There is a paucity of multi-joint strength values in participants with musculoskeletal pain. Quantitative comparison with healthy cohorts was limited, except for those with fibromyalgia. Adult women with fibromyalgia displayed reduced multi-joint strength values in comparison to active community women

Single leg drop jump is affected by physical capacities in male soccer players following ACL reconstruction

Single leg drop jump (SLDJ) assessment is commonly used during the later stages of rehabilitation to identify residual deficits in reactive strength but the effects of physical capacity on kinetic and kinematic variables in male soccer players following ACL reconstruction remains unknown. Isokinetic knee extension strength, kinematics from an inertial measurement unit 3D system and SLDJ performance variables and mechanics derived from a force plate were measured in 64 professional soccer players (24.7 ± 3.4 years) prior to return to sport (RTS). SLDJ between-limb differences were measured (part 1) and players were divided into tertiles based on isokinetic knee extension strength (weak, moderate and strong) and reactive strength index (RSI) (low, medium and high) (part 2). Moderate to large significant differences between the ACL reconstructed and uninjured limb in SLDJ performance (d = 0.92 – 1.05), kinetic (d = 0.62 – 0.71) and kinematic variables (d = 0.56) were evident. Stronger athletes jumped higher (p = 0.002; d = 0.85), produced greater concentric (p = 0.001; d = 0.85) and eccentric power (p = 0.002; d = 0.84). Similar findings were present for RSI, but the effects were larger (d = 1.52 – 3.84). Weaker players, and in particular those who had lower RSI, displayed landing mechanics indicative of a “stiff” knee movement strategy. SLDJ performance, kinetic and kinematic differences were identified between-limbs in soccer players at the end of their rehabilitation following ACL reconstruction. Players with lower knee extension strength and RSI displayed reduced performance and kinetic strategies associated with increased injury risk

The effects of training interventions on inter-limbs asymmetries: a systematic review with meta-analysis

Inter-limb asymmetries have been recently investigated in athletic populations. However, the effects of training interventions on inter-limb asymmetries have been scarcely examined. Therefore, the aim of this study was to determine the effects of training interventions on changes in inter-limb asymmetries from pre- to post-training. Furthermore, to examine the effects of training programs on intervention groups compared to control groups. A database search was completed (MEDLINE, CINAHL, and SPORTDiscus). Eight studies were then included in the meta-analysis. Results showed small reductions in inter-limb asymmetries in single leg broad jump (SLBJ) and change of direction (COD) speed from pre- to post-training interventions, whereas moderate effects were found in single leg countermovement jump (SLCMJ) and single leg (SL) lateral jump. When comparing the training interventions to the control groups, results showed small effects in favour of the training groups for reducing inter-limb asymmetries in SLBJ and large effects in SLCMJ, and COD speed. Thus, training interventions can evoke small to moderate reductions in inter-limb asymmetries from pre- to post-training programs. Strength training performed unilaterally or bilaterally may elicit these reductions. Furthermore, training interventions showed larger effects compared to the control groups in reducing inter-limb asymmetries. However, further research is needed

Total score of athleticism: Profiling strength and power characteristics in professional soccer players following anterior cruciate ligament reconstruction to assess return to sport readiness

Single leg drop jump (SLDJ) assessment is commonly used during the later stages of rehabilitation to identify residual deficits in reactive strength but the effects of physical capacity on kinetic and kinematic variables in male soccer players following ACL reconstruction remains unknown. Isokinetic knee extension strength, kinematics from an inertial measurement unit 3D system and SLDJ performance variables and mechanics derived from a force plate were measured in 64 professional soccer players (24.7 ± 3.4 years) prior to return to sport (RTS). SLDJ between-limb differences were measured (part 1) and players were divided into tertiles based on isokinetic knee extension strength (weak, moderate and strong) and reactive strength index (RSI) (low, medium and high) (part 2). Moderate to large significant differences between the ACL reconstructed and uninjured limb in SLDJ performance (d = 0.92 – 1.05), kinetic (d = 0.62 – 0.71) and kinematic variables (d = 0.56) were evident. Stronger athletes jumped higher (p = 0.002; d = 0.85), produced greater concentric (p = 0.001; d = 0.85) and eccentric power (p = 0.002; d = 0.84). Similar findings were present for RSI, but the effects were larger (d = 1.52 – 3.84). Weaker players, and in particular those who had lower RSI, displayed landing mechanics indicative of a “stiff” knee movement strategy. SLDJ performance, kinetic and kinematic differences were identified between-limbs in soccer players at the end of their rehabilitation following ACL reconstruction. Players with lower knee extension strength and RSI displayed reduced performance and kinetic strategies associated with increased injury risk

The benefits of strength training on musculoskeletal system health: practical applications for interdisciplinary care

Global health organizations have provided recommendations regarding exercise for the general population. Strength training has been included in several position statements due to its multi-systemic benefits. In this narrative review, we examine the available literature, first explaining how specific mechanical loading is converted into positive cellular responses. Secondly, benefits related to specific musculoskeletal tissues are discussed, with practical applications and training programmes clearly outlined for both common musculoskeletal disorders and primary prevention strategies

Reverse engineering in strength and conditioning: applications to agility training

Typically, a coach may follow a process in which they first identify the key performance indicators of their sport, determine the physical attributes that map back to them, and then distribute the development of those capacities over the allocated timeframe. Furthermore, effective training plans are based on a theoretical or biological basis for how we move and adapt to exercise stimuli, coupled with an understanding of how these are best sequenced, such that one stimulus and subsequent adaptation can potentiate the next. Thus, reverse or backward engineering, when appropriately converged with the plans of those devised around nutrition, conditioning, technical, and tactical training for example likely gives athletes the best chance of attaining their performance goals. The aim of this paper is to describe the application of reverse engineering, exampling it within the context of developing an athlete who can demonstrate a high level of agility

A comparison of strength and power characteristics prior to anterior cruciate ligament rupture and at the end of rehabilitation in professional soccer players

Background: Strength and power is often reduced on the involved vs. contralateral limb and healthy controls following anterior cruciate ligament (ACL) reconstruction but no study has compared to pre-injury values at the time of return to sport (RTS). Hypothesis: Divergent recovery patterns in strength and power characteristics will be present at RTS relative to pre-injury baseline data and healthy matched controls. Study design: Cohort study Level of evidence: Level 3 Methods: Isokinetic strength tests, bilateral and single leg countermovement jumps (CMJ; SLCMJ) were measured prior to ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow up testing prior to RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group pre-injury. Values recorded at RTS of the ACL group were compared to pre-injury. We also compared the uninjured and ACL groups at baseline and RTS. Results: Compared to pre-injury, ACL normalised quadriceps peak torque of the involved limb (% difference = -7%), SLCMJ height (% difference = -12.08%) and Reactive Strength Index modified (RSImod) (% difference = -5.04%) were reduced following ACL reconstruction. No significant reductions in CMJ height, RSImod and relative peak power were indicated at RTS in the ACL group when compared to pre-injury values but deficits were present relative to controls. The uninvolved limb significantly improved quadriceps (% difference = 9.34%) and hamstring strength (% difference = 7.36%) from pre-injury to RTS. No significant differences from baseline were shown in SLCMJ height, power and reactive strength of the uninvolved limb following ACL reconstruction. Conclusion: Strength and power in professional soccer players at RTS following ACL reconstruction were often reduced compared to preinjury values and matched healthy controls. Clinical relevance: Deficits were more apparent in the SLCMJ suggesting dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate