Effects of sudden walking perturbations on neuromuscular reflex activity and three-dimensional motion of the trunk in healthy controls and back pain symptomatic subjects.

Background Back pain patients (BPP) show delayed muscle onset, increased co-contractions, and variability as response to quasi-static sudden trunk loading in comparison to healthy controls (H). However, it is unclear whether these results can validly be transferred to suddenly applied walking perturbations, an automated but more functional and complex movement pattern. There is an evident need to develop research-based strategies for the rehabilitation of back pain. Therefore, the investigation of differences in trunk stability between H and BPP in functional movements is of primary interest in order to define suitable intervention regimes. The purpose of this study was to analyse neuromuscular reflex activity as well as three-dimensional trunk kinematics between H and BPP during walking perturbations. Methods Eighty H (31m/49f;29±9yrs;174±10cm;71±13kg) and 14 BPP (6m/8f;30±8yrs;171±10cm;67±14kg) walked (1m/s) on a split-belt treadmill while 15 right-sided perturbations (belt decelerating, 40m/s2, 50ms duration; 200ms after heel contact) were randomly applied. Trunk muscle activity was assessed using a 12-lead EMG set-up. Trunk kinematics were measured using a 3-segment-model consisting of 12 markers (upper thoracic (UTA), lower thoracic (LTA), lumbar area (LA)). EMG-RMS ([%],0-200ms after perturbation) was calculated and normalized to the RMS of unperturbed gait. Latency (TON;ms) and time to maximum activity (TMAX;ms) were analysed. Total motion amplitude (ROM;[°]) and mean angle (Amean;[°]) for extension-flexion, lateral flexion and rotation were calculated (whole stride cycle; 0-200ms after perturbation) for each of the three segments during unperturbed and perturbed gait. For ROM only, perturbed was normalized to unperturbed step [%] for the whole stride as well as the 200ms after perturbation. Data were analysed descriptively followed by a student´s t-test to account for group differences. Co-contraction was analyzed between ventral and dorsal muscles (V:R) as well as side right:side left ratio (Sright:Sleft). The coefficient of variation (CV;%) was calculated (EMG-RMS;ROM) to evaluate variability between the 15 perturbations for all groups. With respect to unequal distribution of participants to groups, an additional matched-group analysis was conducted. Fourteen healthy controls out of group H were sex-, age- and anthropometrically matched (group Hmatched) to the BPP. Results No group differences were observed for EMG-RMS or CV analysis (EMG/ROM) (p>0.025). Co-contraction analysis revealed no differences for V:R and Srigth:Sleft between the groups (p>0.025). BPP showed an increased TON and TMAX, being significant for Mm. rectus abdominus (p = 0.019) and erector spinae T9/L3 (p = 0.005/p = 0.015). ROM analysis over the unperturbed stride cycle revealed no differences between groups (p>0.025). Normalization of perturbed to unperturbed step lead to significant differences for the lumbar segment (LA) in lateral flexion with BPP showing higher normalized ROM compared to Hmatched (p = 0.02). BPP showed a significant higher flexed posture (UTA (p = 0.02); LTA (p = 0.004)) during normal walking (Amean). Trunk posture (Amean) during perturbation showed higher trunk extension values in LTA segments for H/Hmatched compared to BPP (p = 0.003). Matched group (BPP vs. Hmatched) analysis did not show any systematic changes of all results between groups. Conclusion BPP present impaired muscle response times and trunk posture, especially in the sagittal and transversal planes, compared to H. This could indicate reduced trunk stability and higher loading during gait perturbations

Standardizing Terminology and Assessment for Orofacial Conditions in Juvenile Idiopathic Arthritis : International, Multidisciplinary Consensus-based Recommendations

Objective. To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). Methods. Using a sequential expert group–defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus. Results. Seven standardized operational terms were defined: TMJ arthritis, TMJ involvement, TMJ arthritis management, dentofacial deformity, TMJ deformity, TMJ symptoms, and TMJ dysfunction. Conclusion. Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.publishersversionPeer reviewe

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA

Global maps of soil temperature

Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km2 resolution for 0–5 and 5–15 cm soil depth. These maps were created by calculating the difference (i.e. offset) between in situ soil temperature measurements, based on time series from over 1200 1-km2 pixels (summarized from 8519 unique temperature sensors) across all the world\u27s major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (−0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications

Global maps of soil temperature

Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km² resolution for 0–5 and 5–15 cm soil depth. These maps were created by calculating the difference (i.e., offset) between in-situ soil temperature measurements, based on time series from over 1200 1-km² pixels (summarized from 8500 unique temperature sensors) across all the world’s major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (-0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in-situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications

Global maps of soil temperature.

Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km2 resolution for 0-5 and 5-15 cm soil depth. These maps were created by calculating the difference (i.e. offset) between in situ soil temperature measurements, based on time series from over 1200 1-km2 pixels (summarized from 8519 unique temperature sensors) across all the world's major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (-0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications

Pre Participation Examination in Long distance Race car drivers

Professionelle GT Langstreckenmotorsportler (Rennfahrer) müssen den hohen motorischen und kognitiven Ansprüchen ohne Verlust der Performance während eines Rennens endgegenwirken können. Sie müssen stets, bei hoher Geschwindigkeit fokussiert und konzentriert auf ihr Auto, die Rennstrecke und ihre Gegner reagieren können. Darüber hinaus sind Rennfahrer zusätzlich durch die notwendige Kommunikation im Auto mit den Ingenieuren und Mechanikern in der Boxengasse gefordert. Daten über die tatsächliche Beanspruchung und häufig auftretende Beschwerden und/oder Verletzung von Profiathleten liegen kaum vor. Für eine möglichst gute Performance im Auto während eines Rennens ist es notwendige neben der körperlichen Beanspruchung auch die häufigen Krankheitsbilder zu kennen. Auf Basis dessen kann eine optimale Prävention oder notwendige Therapie zur möglichst schnellen Reintegration in den Sport abgeleitet und entwickelt werden. Die vorliegende Arbeit befasst sich durch ein regelmäßiges Gesundheitsmonitoring mit der Erfassung häufiger Beschwerden und oder Verletzungen im GT Langestreckenmotorsport zur Ableitung eines präventiven (trainingstherapeutischen) und therapeutischen Konzeptes. Darüber hinaus, soll über die Einschätzung der körperlichen Leistungsfähigkeit der Athleten, auf Basis der Beanspruchung im Rennfahrzeug ein mögliches Trainingskonzept in Abhängigkeit der Saison entwickelt werden. Insgesamt wurden über 15 Jahre (2003-2017) 37 männliche Athleten aus dem GT Langstreckenmotorsport 353mal im Rahmen eines Gesundheitsmonitorings untersucht. Dabei wurden Athleten maximal 14 Jahre und mindestens 1 Jahr sportmedizinische betreut. Diese 2x im Jahr stattfindende Untersuchung beinhaltete im Wesentlichen eine sportmedizinische Untersuchung zur Einschätzung der Tauglichkeit für den Sport und die Erfassung der körperlichen Leistungsfähigkeit. Über das Gesundheitsmonitoring hinaus erfolgte die Betreuung zusätzlich an der Rennstrecke zur weiteren Erfassung der Beschwerden, Erkrankungen und Verletzungen der Athleten während ihrer sportartspezifischen Belastung. Zusammengefasst zeigen die Athleten geringe Prävalenzen und Inzidenzen der Krankheitsbilder bzw. Beschwerden. Ein Unterschied der Prävalenzen zeigt sich zwischen den Gesundheitsuntersuchungen und der Betreuung an der Rennstrecke. Die häufigsten Beschwerdebilder zeigen sich aus Orthopädie und Innerer Medizin. So sind Infekte der oberen Atemwege sowie Allergien neben Beschwerden der unteren Extremität und der Wirbelsäule am häufigsten. Demzufolge werden vorrangig physio- und trainingstherapeutische Konsequenzen abgeleitet. Eine medikamentöse Therapie erfolgt im Wesentlichen während der Rennbetreuung. Zur Reduktion der orthopädischen und internistischen Beschwerden sollten präventive Maßnahmen mehr betont werden. Die körperliche Leistungsfähigkeit zeigt im Wesentlichen über die Untersuchungsjahre eine stabile Performance für die Ausdauer-, Kraft und sensomotorische Leistungsfähigkeit. Die Ausdauerleistungsfähigkeit kann in Abhängigkeit der Sportartspezifik mit einer guten bis sehr guten Ausprägung definiert werden. Die Kraftleistungsfähigkeit und die sensomotorische Leistungsfähigkeit lassen sportartspezifische Unterschiede zu und sollte körpergewichtsbezogen betrachtet werden. Ein sportmedizinisches und trainingstherapeutisches Konzept müsste demnach eine regelmäßige ärztlich-medizinische Untersuchung mit dem Fokus der Orthopädie, Inneren Medizin und Hals- Nasen-Ohren-Kunde beinhalten. Darüber hinaus sollte eine regelmäßige Erfassung der körperlichen Leistungsfähigkeit zur möglichst effektiven Ableitung von Trainingsinhalten oder Präventionsmaßnahmen berücksichtig werden. Auf Grundlage der hohen Reisetätigkeit und der ganzjährigen Saison könnte ein 1-2x jährlich stattfindendes Trainingslager, im Sinne eines Grundlagen- und Aufbautrainings zur Optimierung der Leistungsfähigkeit beitragen, das Konzept komplementieren. Zudem scheint eine ärztliche Rennbetreuung notwendig.Professional long distance race car drivers (GT- Sportscars) are highly challenged regarding physical load during racing without any lost of performance. It is needed that those athletes are able to react in time in addiction to high speed and other race car drivers on the track. Studies about common injuries or overuse are rare and not longitudinal analysed. Based on known sports specific injuries or overuse, necessary prevention strategies or therapy concept are helpful for an evident Return to Sport. This study is based on prospective longitudinal Analyses of common injuries and overuse in professional race car drivers with differentiation to prevention and therapeutic concepts. Additionally, based on physical capacity (endurance, strength, sensorymotor- control) a needed training recommendation is derived. Overall 37 male professional longdistance race car drivers were analysed over 15 years (2003-2017). Therefore 353 preparticipation examinations (PPE) and physical fitness tests were included. The number of Athletes ranged between 6-19 per year with a support from 1 to 15 years. Additionally to the PPE and physical fitness tests the needed medical care at the track during race were analysed for the years 2015 and 2016. Summarized, longdistance race car drivers are showing low Prevalence’s of injuries or overuse. Frequent complaints are infections of the upper respiratory tract, allergies and tendinopathy of the lower limb together with chronic unspecific low back pain. The therapeutic derivation on track was for the most part drug-treated. A useful consequence for the reduction of the common orthopedic and internistic complaints are preventive methods like aerobic endurance training, sleep hygiene, (eccentric) strength training and balance training. The physical capacite is stable over the years. The endurance capacity shows in dependence to the sports specific a good capacity. The strength and sensorymotor control capacity shows sports specific differences. A sports medical and preventive/ therapeutic concept in longdistance motorsports has to include regular PPE with focus on orthopedic and internistic examinations. Additionally a regularly measurement of the physical capacity (endurance, strength and sensorymotor control) is needed for evident and individual recommendations for training and prevention. Regarding the high all year intercontinental travelling and the season over the whole year a 1-2 times organized fitness camp could compliment a sports medical concept as well as medical care on the track

Tendinopathies of the Lower Extremities in Sport - Diagnostics and Therapy

Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are affected, especially the Achilles and patellar tendons. Repeated overuse in sports and/or daily activities is assumed as the aetiology. Besides the clinical examination including a comprehensive anamnesis of pain and training/loading, sonographic imaging has a high training/loading relevance for the diagnosis of tendon pathologies of the lower extremity. Training concepts are considered in first line as the treatment of choice. A combination with physical therapy interventions can be useful. In cases of a more severe pathology and long-standing complaints multimodal therapeutic options should be employed. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment

Dose-response relationship of core-specific sensorimotor interventions in healthy, well-trained participants: study protocol for a (MiSpEx) randomized controlled trial

Abstract Background Core-specific sensorimotor exercises are proven to enhance neuromuscular activity of the trunk, improve athletic performance and prevent back pain. However, the dose-response relationship and, therefore, the dose required to improve trunk function is still under debate. The purpose of the present trial will be to compare four different intervention strategies of sensorimotor exercises that will result in improved trunk function. Methods/design A single-blind, four-armed, randomized controlled trial with a 3-week (home-based) intervention phase and two measurement days pre and post intervention (M1/M2) is designed. Experimental procedures on both measurement days will include evaluation of maximum isokinetic and isometric trunk strength (extension/flexion, rotation) including perturbations, as well as neuromuscular trunk activity while performing strength testing. The primary outcome is trunk strength (peak torque). Neuromuscular activity (amplitude, latencies as a response to perturbation) serves as secondary outcome. The control group will perform a standardized exercise program of four sensorimotor exercises (three sets of 10 repetitions) in each of six training sessions (30 min duration) over 3 weeks. The intervention groups’ programs differ in the number of exercises, sets per exercise and, therefore, overall training amount (group I: six sessions, three exercises, two sets; group II: six sessions, two exercises, two sets; group III: six sessions, one exercise, three sets). The intervention programs of groups I, II and III include additional perturbations for all exercises to increase both the difficulty and the efficacy of the exercises performed. Statistical analysis will be performed after examining the underlying assumptions for parametric and non-parametric testing. Discussion The results of the study will be clinically relevant, not only for researchers but also for (sports) therapists, physicians, coaches, athletes and the general population who have the aim of improving trunk function. Trial registration German Clinical Trials Register, ID: DRKS00012917. Registered on 22 August 2017