Biomechanical determinants of knee joint loads associated with increased anterior cruciate ligament loading during cutting : a systematic review and technical framework

Background: Cutting actions are associated with non-contact ACL injuries in multidirectional sports due to the propensity to generate large multiplanar knee joint loads (KJLs) that have the capacity to increase ACL loading and strain. Numerous studies have investigated the biomechanical determinants of KJLs in cutting tasks. The aim of this systematic review was to comprehensively review the literature regarding biomechanical determinants of KJLs during cutting, in order to develop a cutting technical framework alongside training recommendations for practitioners regarding KJL mitigation. Methods: Databases (SPORTDiscus, Web of Science and PubMed) were systematically searched using a combination of the following terms: “Biomechanical determinants”, or “Knee abduction moment”, or “Technical determinants”, or “Knee loading”, or “Knee loads”, or “Mechanical determinants”, or “ACL strain”, or “Knee adduction moment”, or “Anterior tibial shear”, or “Knee internal rotation moment”, or “Knee valgus moment” AND “Change of direction”, or “Cutting manoeuvre”, or “Run and cut”, or “Run-and-cut”, or “Sidestepping”, or “Side-stepping”, or “Shuttle run”. Inclusion criteria were as follows: studies examining a cutting task < 110° with a preceding approach run that examined biomechanical determinants of KJLs using three-dimensional motion analysis. Results: The search returned 6404 possibly eligible articles, and 6 identified through other sources. Following duplicate removal, 4421 titles and abstracts were screened, leaving 246 full texts to be screened for inclusion. Twenty-three full texts were deemed eligible for inclusion and identified numerous determinants of KJLs; 11 trunk, 11 hip, 7 knee, 3 multiplanar KJLs, 5 foot/ankle and 7 identifying ground reaction forces (GRFs) as determinants of KJLs. Conclusion: Using the framework developed from the results, cutting KJLs can be mitigated through the following: reducing lateral foot-plant distances, thus lowering hip abduction and orientating the foot closer to neutral with a mid-foot or forefoot placement strategy; minimising knee valgus and hip internal rotation angles and motion at initial contact (IC) and weight acceptance (WA); avoiding and limiting lateral trunk flexion and attempt to maintain an upright trunk position or trunk lean into the intended direction; and finally, reducing GRF magnitude during WA, potentially by attenuation through increased knee flexion and emphasising a greater proportion of braking during the penultimate foot contact (PFC)

Pregnancy in the female athlete - Part 1: antenatal

As female participation in sport and exercise continues to increase, there is a strong likelihood that a strength and conditioning (S&C) coach will work with a pregnant athlete. High profile athletes such as Serena Williams and Dame Jessica Ennis-Hill have shown recently that it is not uncommon for female athletes to become mothers during their careers, rather than after they have retired. However, historically pregnancy was perceived as time spent away from sport and being active was wrongly associated with a high, unreasonable risk to the unborn foetus. The challenge for the S&C coach working with pregnant athletes is navigating the wide range of global recommendations that are often aimed at active or inactive individuals, but not at elite athletes. It is fundamental that any coach working with pregnant athletes is knowledgeable about the physiological and anatomical changes that occur throughout the trimesters, the nutritional demands of pregnancy, and its effect on weight management in order to appropriately facilitate athlete and foetal health during the antenatal period. Therefore, the aim of this initial review is to summarise current literature and provide key insights that promote best practice for practitioners working with pregnant athletes. The use of ‘women’ throughout this paper will refer to the general population and ‘sportswomen’ to the athletic population. ‘Antenatal’ refers to a pregnant woman before childbirth and the term ‘postnatal’ means after childbirth, something which will be covered in part 2 of this review series

The relationship between vertical leg stiffness and gross mechanical efficiency in cyclists

Background: Professional cyclists have been shown to have a mechanical efficiency that is 11% higher compared to amateur cyclists (Coyle et al. 1991: Med Sci Sports Exerc, 23 (1), 93-107). The variations in power between professional and amateur cyclists are associated with a greater torque development at the first phase of the pedal revolution (Coyle et al. 1991). It has also been shown in cyclists that a relationship exists between vertical leg stiffness and the peak power output (PPO) (r = 0.75, p < 0.01) achieved during a 30 s Wingate test (Pitchers et al. 2013: The relationship of vertical leg stiffness, peak power output and V̇O2max in recreationally active cyclists: identification of the interface between human and bike. 9th Annual Conference of the United Kingdom Strength & Conditioning Association, Nottingham, UK). Vertical leg stiffness may be important to cycling performance as the majority of the force produced is vertical and optimisation of the stretch shortening cycle may limit energy wastage during the propulsive phase (So et al. 2005: Phys Ther Sports, 6, 89-96; Fonda & Sarabon 2010: Sport Sci Rev, 19 (1), 187-210). The relationship between vertical leg stiffness and mechanical efficiency during cycling has yet to be examined. \ud Purpose: To assess the relationship between vertical leg stiffness and gross mechanical efficiency (GE) in cycling. \ud Methods: In a single group, within subjects design, 11 recreationally active male cyclists (age 34 ± 6 y, V̇O2max 57.4 ± 7.5 ml∙kg∙min-1, body mass 81 ± 1.2 kg, stature 1.81 ± 0.06 m) completed two testing sessions, with a minimum of 48 hr rest between each session. In the first testing session participants completed a stiffness familiarisation before an incremental cycle test to establish V̇O2max. At the second session participants completed 20 sub-maximal bilateral hops at a frequency of 2.3 Hz. This was followed by three 8 min sub-maximal cycling bouts at 50, 55 and 60 % of the participants’ individual maximal minute power (MMP) to establish GE (Table I). \ud Results: Mean values for GE and vertical leg stiffness were 19.0 ± 1.4 % and 34.1 ± 9.0 kN∙m-1, respectively. Pearson’s correlation coefficient revealed no relationship between vertical leg stiffness and GE (r = -0.07, p = 0.85). \ud Discussion: The main finding is that in recreationally active male cyclists there is no relationship between vertical leg stiffness and GE. In this group these findings indicate that GE is likely influenced more by other biological systems rather than the mechanical properties of the musculoskeletal system. However, these data may not be reflective of an elite sample where higher leg stiffness might be more likely to influence GE at higher power outputs.\ud Conclusion: Whilst vertical leg stiffness has been shown to have a strong relationship with PPO (Pitchers et al 2013) in recreational cyclists, this is not the case for GE. Further work is needed to establish if this is also the case in an elite population

Do diagnostic delays in cancer matter?

background: The United Kingdom has poorer cancer outcomes than many other countries due partly to delays in diagnosing symptomatic cancer, leading to more advanced stage at diagnosis. Delays can occur at the level of patients, primary care, systems and secondary care. There is considerable potential for interventions to minimise delays and lead to earlier-stage diagnosis. methods: Scoping review of the published studies, with a focus on methodological issues. results: Trial data in this area are lacking and observational studies often show no association or negative ones. This review offers methodological explanations for these counter-intuitive findings. conclusion: While diagnostic delays do matter, their importance is uncertain and must be determined through more sophisticated methods

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes?:Systematic review

background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. methods: Systematic review of the literature and narrative synthesis. results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers

The physical demands of mixed martial arts: A narrative review using the ARMSS model to provide a hierarchy of evidence.

The physical demands of mixed martial arts (MMA) training and competition is not yet well quantified. The Applied Research Model for the Sport Sciences (ARMSS) provides a framework through which to conduct sport science, determining pertinent questions to test research findings in real-world settings. The aim of this review was to evaluate MMA research within the context of ARMSS to critically analyse our understanding of the physical requirements of MMA training and competition. Research databases were searched, with 70 peer-reviewed articles being discussed in relation to the specific stage of the ARMSS in which their results best fit. MMA research was found to be mostly foundational and descriptive in nature and has generally not developed along systematic lines. The internal and external loads and responses to training and competition have not been adequately identified. Therefore, it is not currently possible to state which variables are key predictors of success, or how coaches can optimally manipulate these variables. We propose that MMA research be refocused to be conducted within ARMSS. Specifically, stage 2 studies describing the physical, physiological and technical demands of MMA training and competition, and stage 3 studies determining the physiological predictors of performance should be initially prioritised

Biomechanical determinants of knee joint loads associated with increased anterior cruciate ligament loading during cutting: A systematic review and technical framework

Background: Cutting actions are associated with non-contact ACL injuries in multidirectional sports due to the propensity to generate large multiplanar knee joint loads (KJLs) that have the capacity to increase ACL loading and strain. Numerous studies have investigated the biomechanical determinants of KJLs in cutting tasks. The aim of this systematic review was to comprehensively review the literature regarding biomechanical determinants of KJLs during cutting, in order to develop a cutting technical framework alongside training recommendations for practitioners regarding KJL mitigation. Methods: Databases (SPORTDiscus, Web of Science and PubMed) were systematically searched using a combination of the following terms: “Biomechanical determinants”, or “Knee abduction moment”, or “Technical”, or “Knee loading”, or “Knee loads”, or “Mechanical determinants”, or “ACL strain”, or “Knee adduction moment”, or “Anterior tibial shear”, or “Knee internal rotation moment”, or “Knee valgus moment” AND “Change of direction”, or “Cutting manoeuvre”, or “Run and cut”, or “Run-and-cut”, or “Sidestepping”, or “Side-stepping”, or “Shuttle run”. Inclusion criteria were as follows: studies examining a cutting task < 110° with a preceding approach run that examined biomechanical determinants of KJLs using three-dimensional motion analysis. Results: The search returned 6404 possibly eligible articles, and 6 identified through other sources. Following duplicate removal, 4421 titles and abstracts were screened, leaving 246 full texts to be screened for inclusion. Twenty-three full texts were deemed eligible for inclusion and identified numerous determinants of KJLs; 11 trunk, 11 hip, 7 knee, 3 multiplanar KJLs, 5 foot/ankle and 7 identifying ground reaction forces (GRFs) as determinants of KJLs. Conclusion: Using the framework developed from the results, cutting KJLs can be mitigated through the following: reducing lateral foot-plant distances, thus lowering hip abduction and orientating the foot closer to neutral with a midfoot or forefoot placement strategy; minimising knee valgus and hip internal rotation angles and motion at initial contact (IC) and weight acceptance (WA); avoiding and limiting lateral trunk flexion and attempt to maintain an upright trunk position or trunk lean into the intended direction; and finally, reducing GRF magnitude during WA, potentially by attenuation through increased knee flexion and emphasising a greater proportion of braking during the penultimate foot contact (PFC)

The Potential of Plant-Produced Virus-like Particle Vaccines for African Horse Sickness and Other Equine Orbiviruses

African horse sickness is a devastating viral disease of equids. It is transmitted by biting midges of the genus Culicoides with mortalities reaching over 90% in naïve horses. It is endemic to sub-Saharan Africa and is seasonally endemic in many parts of southern Africa. However, outbreaks in Europe and Asia have occurred that caused significant economic issues. There are attenuated vaccines available for control of the virus but concerns regarding the safety and efficacy means that alternatives are sought. One promising alternative is the use of virus-like particles in vaccine preparations, which have the potential to be safer and more efficacious as vaccines against African horse sickness. These particles are best made in a complex, eukaryotic system, but due to technical challenges, this may cause significant economic strain on the developing countries most affected by the disease. Therefore, this review also summarises the success so far, and potential, of recombinant protein expression in plants to reduce the economic strain of production