Asymmetry after Hamstring Injury in English Premier League: Issue Resolved, Or Perhaps Not?

Hamstring injuries constitute one of the most concerning injuries in English Premier League football, due to its high primary incidence but also its recurrence. Functional methods assessing hamstring function during high-risk performance tasks such as sprinting are vital to identify potential risk factors. The purpose of this study was to assess horizontal force deficits during maximum sprint running on a non-motorized treadmill in football players with previous history of hamstring strains as a pre-season risk-assessment in a club setting. 17 male football players from one Premier League Club were divided into 2 groups, experimental (n= 6, age = 24.5 ± 2.3 years) and control (n= 11, age = 21.3 ± 1.2 years), according to history of previous hamstring injury. Participants performed a protocol including a 10 seconds maximum sprint on a non-motorized treadmill. Force deficits during acceleration phase and steady state phases of the sprint were assessed between limbs and between groups. The main outcome measures were horizontal and vertical peak forces during the acceleration phase or steady state. There were no significant differences in peak forces between previously injured and non-injured limbs, or between groups, challenging the ideas around functional force deficits in sprint running as a diagnostic measure of hamstring re-injury risk

Training load monitoring in team sports: A novel framework separating physiological and biomechanical load-adaptation pathways

There have been considerable advances in monitoring the training load in running-based team sports in recent years. Novel technologies nowadays offer ample opportunities to continuously monitor the activities of a player. These activities lead to internal biochemical stresses on the various physiological sub-systems. However, they also cause internal mechanical stresses on the various musculoskeletal tissues. Based on the amount and periodization of these stresses, the sub-systems and tissues adapt. So by monitoring external loads one hopes to estimate internal loads to predict adaptation, and this through understanding the load-adaptation pathways. We propose a new theoretical framework in which physiological and biomechanical load-adaptation pathways are considered separately, shedding a new light on some of the previously published evidence. We hope that it can help the various practitioners in this field (trainers, coaches, medical staff, sport scientists) to align their thoughts when considering the value of monitoring load, and that it can help researchers design experiments that can better rationalise training load monitoring for improving performance whilst preventing injury

Can two-dimensional measured peak sagittal plane excursions during drop vertical jumps help identify three-dimensional measured joint moments?

Background: Less optimal sagittal plane movement patterns are believed to increase knee injury risk in female athletes. To facilitate clinical screening with a user-friendly method, the purpose of the present study was to examine the temporal relationships between two-dimensional measured sagittal plane kinematics and three-dimensional joint moments during the double-leg drop vertical jump (DVJ) and single-leg DVJ (SLDVJ). Methods: Fifty injury-free female athletes were tested. Maximal excursions of hip flexion, knee flexion and ankle dorsiflexion were measured through two-dimensional video analysis. Three-dimensional motion and ground reaction forces were recorded to calculate external hip flexion, knee flexion and knee abduction moments during the entire stance phase of DVJ and SLDVJ. One-dimensional statistical parametric mapping was used to examine relationships between peak two-dimensional kinematic variables and three-dimensional moment profiles. Results: Hip flexion was significantly related to the hip and knee flexion moment for both tests and knee abduction moment for DVJ during the time frames corresponding with highest three-dimensional moments, while knee flexion was significantly related to the hip flexion moment during these time frames. No significant relationships were found for ankle dorsiflexion with any of the joint moments. Conclusions: Two-dimensional measured sagittal plane hip flexion angles at the deepest landing position were associated with peak joint moments of the hip and knee during DVJ and SLDVJ, while the amount of knee flexion was only associated with the hip flexion moment. Assessment of knee injury risk with two-dimensional video analysis could benefit from measuring maximal hip flexion, more so than knee flexion

The relationship between whole-body external loading and body-worn accelerometry during team sports movements

Purpose: The aim of this study was to investigate the relationship between whole-body accelerations and body-worn accelerometry during team sports movements. Methods: Twenty male team sport players performed forward running, and anticipated 45° and 90° side-cuts at approach speeds of 2, 3, 4 and 5 m·s-1. Whole-body Centre of Mass (CoM) accelerations were determined from ground reaction forces collected from one foot-ground-contact and segmental accelerations were measured from a commercial GPS/accelerometer unit on the upper trunk. Three higher specification accelerometers were also positioned on the GPS unit, the dorsal aspect of the pelvis, and the shaft of the tibia. Associations between mechanical load variables (peak acceleration, loading rate and impulse) calculated from both CoM accelerations and segmental accelerations were explored using regression analysis. In addition one-dimensional Statistical Parametric Mapping (SPM) was used to explore the relationships between peak segmental accelerations and CoM acceleration profiles during the whole foot-ground-contact. Results: A weak relationship was observed for the investigated mechanical load variables regardless of accelerometer location and task (R2 values across accelerometer locations and tasks: peak acceleration 0.08-0.55, loading rate 0.27-0.59 and impulse 0.02-0.59). Segmental accelerations generally overestimated whole-body mechanical load. SPM analysis showed that peak segmental accelerations were mostly related to CoM accelerations during the first 40-50% of contact phase. Conclusions: Whilst body-worn accelerometry correlates to whole-body loading in team sports movements and can reveal useful estimates concerning loading, these correlations are not strong. Body-worn acclerometry should therefore be used with caution to monitor whole-body mechanical loading in the field

Knee and Hip Joint Kinematics Predict Quadriceps and Hamstrings Neuromuscular Activation Patterns in Drop Jump Landings.

PURPOSE: The purpose was to assess if variation in sagittal plane landing kinematics is associated with variation in neuromuscular activation patterns of the quadriceps-hamstrings muscle groups during drop vertical jumps (DVJ). METHODS: Fifty female athletes performed three DVJ. The relationship between peak knee and hip flexion angles and the amplitude of four EMG vectors was investigated with trajectory-level canonical correlation analyses over the entire time period of the landing phase. EMG vectors consisted of the {vastus medialis(VM),vastus lateralis(VL)}, {vastus medialis(VM),hamstring medialis(HM)}, {hamstring medialis(HM),hamstring lateralis(HL)} and the {vastus lateralis(VL),hamstring lateralis(HL)}. To estimate the contribution of each individual muscle, linear regressions were also conducted using one-dimensional statistical parametric mapping. RESULTS: The peak knee flexion angle was significantly positively associated with the amplitudes of the {VM,HM} and {HM,HL} during the preparatory and initial contact phase and with the {VL,HL} vector during the peak loading phase (p<0.05). Small peak knee flexion angles were significantly associated with higher HM amplitudes during the preparatory and initial contact phase (p<0.001). The amplitudes of the {VM,VL} and {VL,HL} were significantly positively associated with the peak hip flexion angle during the peak loading phase (p<0.05). Small peak hip flexion angles were significantly associated with higher VL amplitudes during the peak loading phase (p = 0.001). Higher external knee abduction and flexion moments were found in participants landing with less flexed knee and hip joints (p<0.001). CONCLUSION: This study demonstrated clear associations between neuromuscular activation patterns and landing kinematics in the sagittal plane during specific parts of the landing. These findings have indicated that an erect landing pattern, characterized by less hip and knee flexion, was significantly associated with an increased medial and posterior neuromuscular activation (dominant hamstrings medialis activity) during the preparatory and initial contact phase and an increased lateral neuromuscular activation (dominant vastus lateralis activity) during the peak loading phase

Dynamic Neuromuscular Control of the Lower Limbs in Response to Unexpected Single-Planar versus Multi-Planar Support Perturbations in Young, Active Adults.

PURPOSE: An anterior cruciate ligament (ACL) injury involves a multi-planar injury mechanism. Nevertheless, unexpected multi-planar perturbations have not been used to screen athletes in the context of ACL injury prevention yet could reveal those more at risk. The objective of this study was to compare neuromuscular responses to multi-planar (MPP) and single-planar perturbations (SPP) during a stepping-down task. These results might serve as a basis for future implementation of external perturbations in ACL injury screening programs. METHODS: Thirteen young adults performed a single leg stepping-down task in eight conditions (four MPP and four SPP with a specified amplitude and velocity). The amplitudes of vastus lateralis (VL), vastus medialis (VM), hamstrings lateralis (HL), hamstrings medialis (HM) EMG activity, medio-lateral and anterior-posterior centre of mass (COM) displacements, the peak knee flexion and abduction angles were compared between conditions using an one-way ANOVA. Number of stepping responses were monitored during all conditions. RESULTS: Significantly greater muscle activity levels were found in response to the more challenging MPP and SPP compared to the less challenging conditions (p < 0.05). No differences in neuromuscular activity were found between the MPP conditions and their equivalents in the SPP. Eighteen stepping responses were monitored in the SPP versus nine in the MPP indicating that the overall neuromuscular control was even more challenged during the SPP which was supported by greater COM displacements in the SPP. CONCLUSION: The more intense MPP and SPP evoked different neuromuscular responses resulting in greater muscle activity levels compared to small perturbations. Based on the results of COM displacements and based on the amount of stepping responses, dynamic neuromuscular control of the knee joint appeared less challenged during the MPP. Therefore, future work should investigate extensively if other neuromuscular differences (i.e. co-activation patterns and kinetics) exist between MPP and SPP. In addition, future work should examine the influence on the neuromuscular control of the magnitude of the perturbations and the magnitude of stepping height and stepping distance

Mechanical Player Load™ using trunk-mounted accelerometry in football: Is it a reliable, task- and player-specific observation?

The aim of the present study was to examine reliability and construct convergent validity of Player Load™ (PL) from trunk-mounted accelerometry, expressed as a cumulative measure and an intensity measure (PL · min(-)(1)). Fifteen male participants twice performed an overground football match simulation that included four different multidirectional football actions (jog, side cut, stride and sprint) whilst wearing a trunk-mounted accelerometer inbuilt in a global positioning system unit. Results showed a moderate-to-high reliability as indicated by the intra-class correlation coefficient (0.806-0.949) and limits of agreement. Convergent validity analysis showed considerable between-participant variation (coefficient of variation range 14.5-24.5%), which was not explained from participant demographics despite a negative association with body height for the stride task. Between-task variations generally showed a moderate correlation between ranking of participants for PL (0.593-0.764) and PL · min(-)(1) (0.282-0.736). It was concluded that monitoring PL(®) in football multidirectional actions presents moderate-to-high reliability, that between-participant variability most likely relies on the individual's locomotive skills and not their anthropometrics, and that the intensity of a task expressed by PL · min(-)(1) is largely related to the running velocity of the task

Is knee neuromuscular activity related to anterior cruciate ligament injury risk? A pilot study.

BACKGROUND: There is limited evidence on neuromuscular risk factors for anterior cruciate ligament (ACL) injuries, with most work mainly focusing on hamstrings and quadriceps muscle strength. This prospective pilot study explored if neuromuscular activation patterns of the quadriceps and hamstrings during a drop vertical jump influence ACL injury risk. METHODS: Forty-six female athletes performed a drop vertical jump at baseline. Injuries were monitored throughout a one-year follow-up. Neuromuscular activation patterns of the vastus medialis, vastus lateralis, hamstrings medialis and hamstrings lateralis, and selected landing kinematic and kinetic profiles (knee flexion, knee abduction and hip flexion angles, and knee abduction moments), were compared between athletes who sustained a non-contact ACL injury and those who remained injury free. Electromyogram vector fields were created to represent neuromuscular activation patterns of muscle pairs around the knee joint rather than only considering individual muscle activations, and compared using Statistical Parametric Mapping. RESULTS: Four athletes sustained an ACL injury. Significantly greater {hamstrings medials, hamstrings lateralis}, {vastus lateralis, hamstrings lateralis} and {hamstrings lateralis, vastus medialis} activations, mainly due to greater hamstrings lateralis activation, were found in the injured group around peak loading and just before take-off (P < 0.001). No group differences were found in knee flexion, knee abduction and hip flexion angles, or knee abduction moments. CONCLUSIONS: This pilot study revealed initial evidence that athletes already showed altered neuromuscular activation patterns prior to sustaining an ACL injury, namely increased lateral and posterior muscle activations

Maintenance treatment of renal anaemia in haemodialysis patients with methoxy polyethylene glycol-epoetin beta versus darbepoetin alfa administered monthly: a randomized comparative trial

Background. Several studies with erythropoiesis-stimulating agents claim that maintenance therapy of renal anaemia may be possible at extended dosing intervals; however, few studies were randomized, results varied, and comparisons between agents were absent. We report results of a multi-national, randomized, prospective trial comparing haemoglobin maintenance with methoxy polyethylene glycol-epoetin beta and darbepoetin alfa administered once monthly

Incorporation of tetanus-epitope into virus-like particles achieves vaccine responses even in older recipients in models of psoriasis, Alzheimer’s and cat allergy

Monoclonal antibodies are widely used to treat non-infectious conditions but are costly. Vaccines could offer a cost-effective alternative but have been limited by sub-optimal T-cell stimulation and/or weak vaccine responses in recipients, for example, in elderly patients. We have previously shown that the repetitive structure of virus-like-particles (VLPs) can effectively bypass self-tolerance in therapeutic vaccines. Their efficacy could be increased even further by the incorporation of an epitope stimulating T cell help. However, the self-assembly and stability of VLPs from envelope monomer proteins is sensitive to geometry, rendering the incorporation of foreign epitopes difficult. We here show that it is possible to engineer VLPs derived from a non human-pathogenic plant virus to incorporate a powerful T-cell-stimulatory epitope derived from Tetanus toxoid. These VLPs (termed CMVTT) retain self-assembly as well as long-term stability. Since Th cell memory to Tetanus is near universal in humans, CMVTT-based vaccines can deliver robust antibody-responses even under limiting conditions. By way of proof of concept, we tested a range of such vaccines against chronic inflammatory conditions (model: psoriasis, antigen: interleukin-17), neurodegenerative (Alzheimer’s, β-amyloid), and allergic disease (cat allergy, Fel-d1), respectively. Vaccine responses were uniformly strong, selective, efficient in vivo, observed even in old mice, and employing low vaccine doses. In addition, randomly ascertained human blood cells were reactive to CMVTT-VLPs, confirming recognition of the incorporated Tetanus epitope. The CMVTT-VLP platform is adaptable to almost any antigen and its features and performance are ideally suited for the design of vaccines delivering enhanced responsiveness in aging populations