Editorial: Neuromuscular diagnostics and sensorimotor performance in training and therapy: beyond the pure biomechanical approach

Traditional movement science research has adopted methodology that describes differences in movement among groups or conditions using biomechanical variables to infer underlying features of neuromuscular control. Historically, this approach marked the onset of the complex analysis of movement biomechanics bring relevant insights into the mechanics of human movement (1). Hypotheses were developed by extrapolating data from healthy active to injured populations (2). The last decade before the millennium provided first references to the neuromechanical aspects of movement, thus expanding the view towards the neuromotor control aspect of movement generation and adjustment (3). In the 2000s, substantial evidence is reported on spinal and supraspinal adaptations after balance or sensorimotor training which delivered important evidence-based knowledge that was rapidly implemented in clinical practice (4). Moreover, studies that combined both “mechanical” and “neuromuscular” views evolved (5, 6). We can postulate, that we still need more evidence-based knowledge on the interplay between the underlying neurophysiologic movement generation and the observed mechanical motor output. These integral neuro-biomechanical approaches still rely heavily on a biomedical perspective that is lately challenged by the call for biopsychosocial paradigms to cover all relevant aspects in human movement analysis to draw meaningful conclusions for diagnostics, prevention and therapy (7). Research can rarely incorporate all dimensions at one time but our claim should be that we focus on experimental paradigms that purposely integrate both biomechanical and neuromechanical pieces of the puzzle to seek a more comprehensive understanding of typical and impaired movement. There are promising examples of such approaches that now combine classic biomechanical research with neurophysiological methods and patient reported outcomes or other psychometric measures (8, 9). The aim of this Research Topic is therefore to provide a collection of studies that contribute to these integrative approaches by using diverse viewpoints and subsequently diverse methodology from study protocols, scoping or systematic reviews or experimental and interventional studies. They all contribute with different pieces of the puzzle “beyond the pure biomechanical approach”. Three investigations provided insight into motor control and muscle coordination in patient populations and those with experimentally imposed pian. Bartsch-Jimenez et al. described differences in “fine synergies” derived from electromyographic data of multiple lower leg muscles between persons with foot drop and controls that may reflect potentially relevant for motor adaptations to impaired ankle control. Chan and Sigward found that achieving loading symmetry in standing requires attention in those who are recovering from ACL reconstruction while it is more automatic in healthy controls. Bertrand-Charette et al. described the influence of acute ankle pain on motor output and performance of a standard balance test used to assess function in individuals with ankle injuries. While these studies targeted specific adaptations, Quarmby et al.’s systematic review of evidence regarding mechanical and neuromuscular control impairments in individuals with Achilles tendinopathy highlights limited consensus and areas for future work. Other contributors provided insight into the effects of neurocognitive and neurophysiological based interventions. Rogan and Taeymans describe in their systematic review the evidence of positive effects of whole-body vibration on sensorimotor function in the elderly which highlights the therapeutic potential in this population. Faes et al. investigated the effects of a whole-body vibration intervention on several dimensions like movement control, well-being, and cognition in a randomized controlled trial. Hegi et al. summarized the existing body of evidence on sensor-based augmented visual feedback that should be used in coordination training to elicit sensorimotor adaptations. Mourits et al. describe a study protocol of a quasi-randomized controlled trial investigation of a game based intervention that combines neurocognitive effects of an external focus of attention and game like motivation along with patient specific real time spine motion to improve movement control of the spine. Finally, Mathieu-Kälin et al. described an assessment tool for develop to measure movement quality during hop tests. This tool adds important valuation of the control strategies used to complete a task beyond that of just performance. The goal of the Research Topic was accomplished by presenting studies that incorporated a variety of manscirpt that represent “out of the box” neuro-biomechanical approaches to investigate underlying features of impaired movement. The broad range of paradigms and methodological approaches of the Research Topic certainly reflects the initial idea and the contributions highlight different aspects on the pathway to more mutifaceted approaches. The guest editor team would love to see many views, downloads, and citations of the papers included in this Research Topic and we anticipate that in the future more contributions to Frontiers and Sports and Active living could be “virtually” added to this topic

Is assessing trunk muscle endurance in military with sub-acute and chronic low back pain clinically meaningful?

IntroductionTrunk muscle endurance (TME) tests are commonly used by clinicians to assess muscle performance changes in response to rehabilitation in patients with low back pain (LBP). The aim of this study was to assess the responsiveness of three TME-tests in patients with LBP and to evaluate the relationships between changes in TME and improvement in self-reported function.Materials and MethodsEighty-four LBP patients were evaluated at baseline and after completion of a 6-week training program. Function was assessed with the modified Oswestry Disability Index (ODI) while TME was estimated using three tests: (1) the Biering-Sørensen, (2) the side bridge endurance tests (both sides), and (3) the trunk flexor endurance test. The standardized response mean (SRM) and the minimal clinical important difference (MCID) for each TME-test, and the relationships between changes in TME and improvement in ODI were calculated.ResultsSRMs were small to large for TME-tests (range: 0.43–0.82), and large for the ODI (2.85) and no clinically useful MCID was identified for the TME-tests (area under the curve below 0.70). No significant correlations were found between changes in the TME and change in ODI scores (r < 0.15; all P > 0.05).ConclusionOur results show a weak responsiveness of TME-tests in patients with LBP. There was no association between endurance performance change and self-reported functional change. TME-tests may not be a key component of rehabilitation monitoring in patients with LBP

Reintroduction of Running after Anterior Cruciate Ligament Reconstruction with a Hamstrings Graft: Can We Predict Short-Term Success?

Context: Return to running (RTR) after anterior cruciate ligament reconstruction (ACLR) is a crucial milestone. However, how and when to start a running program are uncertain. Objective: To explore the feasibility of a structured program to reintroduce running after ACLR and evaluate the predictive value of potential predictors of short-term success. Design: Longitudinal cohort study. Setting: Local research center and participants' homes. Patients or Other Participants: Thirty-five participants were recruited after ACLR. Intervention(s): Program with a progression algorithm to reintroduce running (10 running sessions in 14 days). Main Outcome Measure(s): The criterion for short-term success was no exacerbation of symptoms. Potential predictors were (1) the International Knee Documentation Committee (IKDC) subjective knee form score, (2) ACL Return to Sport after Injury questionnaire score, (3) quadriceps and hamstrings strength, (4) step-down endurance test, and (5) modified Star Excursion Balance test. Descriptive statistics were performed to study the feasibility of the RTR program, and Poisson regression analysis was used to evaluate predictors of success. Results: Of the 34 participants, 33 completed the RTR program. Sixteen participants experienced some temporary exacerbation of symptoms, but only 1 had to stop the program. The initial IKDC score was the only significant predictor of a successful RTR, with an area under the receiver operating characteristic curve of 80.4%. An IKDC cut-off of 63.7/100 differentiated responders and nonresponders with the highest sensitivity and specificity (77.8% and 75.0%, respectively). A participant with an IKDC score above this threshold had a 3-fold greater chance of success. Conclusions: Our results confirm the feasibility of our RTR program and progression algorithm after ACLR. Clinicians should use an IKDC score of .64 as a criterion to reintroduce running after ACLR to increase the likelihood of short-term success

ACL Injury Risk Factors Decrease & Jumping Performance Improvement in Female Basketball Players: A Prospective Study

The aim of this explorative study was to determine the most effective physical training program to reduce neuromuscular risk factors of Anterior Cruciate Ligament (ACL) tear and to improve jumping performance. Twenty-four female basketball players were divided into three groups: Specific Physical Training Group (SPTG), combined specific Physical and Mental Training Group (PMTG) and Control Group (CG). The training program was conducted over a period of eight weeks including two sessions per week during basketball practice. Dynamic valgus, Peak Vertical Impact Force (PVIF), Rate of Force Development (RFD), and jumping performance were measured at pre- and post-tests. When all the participants were pooled, statistics showed a decrease (-36%) in dynamic valgus. No significant results were observed for PVIF and RFD. Jumping performance improved by 12% in SPTG and remained constant in PMTG and CG. Adding specific physical training to basketball practice should be the most effective program to prevent ACL tear while improving jumping performance in young female basketball players

ACL Injury Risk Factors Decrease & Jumping Performance Improvement in Female Basketball Players: A Prospective Study

The aim of this explorative study was to determine the most effective physical training program to reduce neuromuscular risk factors of Anterior Cruciate Ligament (ACL) tear and to improve jumping performance. Twenty-four female basketball players were divided into three groups: Specific Physical Training Group (SPTG), combined specific Physical and Mental Training Group (PMTG) and Control Group (CG). The training program was conducted over a period of eight weeks including two sessions per week during basketball practice. Dynamic valgus, Peak Vertical Impact Force (PVIF), Rate of Force Development (RFD), and jumping performance were measured at pre- and post-tests. When all the participants were pooled, statistics showed a decrease (-36%) in dynamic valgus. No significant results were observed for PVIF and RFD. Jumping performance improved by 12% in SPTG and remained constant in PMTG and CG. Adding specific physical training to basketball practice should be the most effective program to prevent ACL tear while improving jumping performance in young female basketball players

A non‐weight bearing protocol after ACL reconstruction improves static anterior tibial translation in patients with elevated slope and increased weight bearing tibial anterior translation

Abstract Purpose Aim of this study is to evaluate the impact of a non‐weight bearing (NWB) protocol within 21 post‐operative days after anterior cruciate ligament (ACL) reconstruction on static and dynamic anterior tibial translations (SATT and DATT, respectively). The hypothesis is that delayed WB would improve ATT at 9 months follow‐up. Methods A series of patients treated with ACL reconstruction was retrospectively reviewed, comparing a group with immediate post‐operative weight bearing (WB group) and a group without post‐operative weight bearing (NWB group). The NWB protocol was applied to patients with posterior tibial slope (PTS) ≥ 12°, pre‐operative SATT ≥ 5 mm, and/or meniscal lesions of root or radial type. SATT, and PTS were measured on 20° flexion monopodal lateral x‐rays, while DATT on Telos™ x‐rays at pre‐operative and 9‐months follow‐up. Results One hundred seventy‐nine patients were included (50 NWB group, 129 WB group). The SATT worsened in the WB group with a mean increase of 0.7 mm (SD 3.1 mm), while in the NWB group, the SATT improved with a mean decrease of 1.4 mm (SD 3.1 mm) from the pre‐operative to 9 months’ follow‐up (p < 0.001). The side‐to‐side Telos™ evaluation showed a significant improvement in DATT within both the groups (p < 0.001), but there was no difference between the two groups (p = 0.99). Conclusion The post‐operative protocol of 21 days without WB led to an improvement in SATT at 9 months without an influence on DATT, and it is recommended for patients with a SATT ≥ 5 mm and/or a PTS ≥ 12° as part of an “à la carte” approach to ACL reconstruction. Level of evidence Level IV, Retrospective case serie

Study of the Kinetics of the Determinants of Performance During a Mountain Ultramarathon: Multidisciplinary Protocol of the First Trail Scientifique de Clécy 2021

International audienceBackground The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. Objective The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. Methods The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra–trail-running events and with no contraindications to the practice of this sport. Results The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. Conclusions The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. International Registered Report Identifier (IRRID) RR1-10.2196/3802

Study of the Kinetics of the Determinants of Performance During a Mountain Ultramarathon: Multidisciplinary Protocol of the First Trail Scientifique de Clécy 2021

Background The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. Objective The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. Methods The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra–trail-running events and with no contraindications to the practice of this sport. Results The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. Conclusions The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. International Registered Report Identifier (IRRID) RR1-10.2196/38027info:eu-repo/semantics/publishe