Case Report: Load, Intensity, and Performance Characteristics in Multiple Grand Tours

Introduction The aim of this study was to present the load, intensity, and performance characteristics of a general classification (GC) contender during multiple grand tours (GTs). This study also investigated which factors influence climbing performance. Methods Power output (PO) data were collected from a GC contender from the Vuelta a España 2015, the Giro d'Italia 2017, the Giro d'Italia 2018, and the Tour de France 2018. Load (e.g., Training Stress Score and kJ spent) and intensity in five PO zones were quantified. One-way ANOVA was used to identify differences between the GTs. Furthermore, performance during the four GTs was quantified based on maximal mean PO (W·kg-1) over different durations and by the relative PO (W·kg-1) on the key mountains in the GTs. Stepwise multiple regression analysis was used to identify which factors influence relative PO on the key mountains. Results No significant differences were found between load and intensity characteristics between the four GTs, with the exception that during the Giro d'Italia 2018, a significantly lower absolute time was spent in PO zone 5 (P = 0.005) compared with the other three GTs. The average relative PO on the key mountains (n = 33) was 5.9 ± 0.6 W·kg-1 and was negatively influenced by the duration of the climb and the total elevation gain before the key mountain, whereas the gradient of the mountain had a positive effect on relative PO. Conclusions The physiological load imposed on a GC contender did not differ between multiple GTs. Climbing performance was influenced by short-term fatigue induced by previous altitude meters in the stage and the duration and gradient of the mountain

Effects of unilateral leg muscle fatigue on balance control in perturbed and unperturbed gait in healthy elderly

AbstractThis study assessed effects of unilateral leg muscle fatigue (ULMF) on balance control in gait during the stance and swing phases of the fatigued leg in healthy elderly, to test the assumption that leg muscle strength limits balance control during the stance-phase.Ten subjects (aged 63.4, SD 5.5 years) walked on a treadmill in 4 conditions: unperturbed unfatigued, unperturbed fatigued, perturbed unfatigued, and perturbed fatigued. The perturbations were lateral trunk pulls just before contralateral heel contact. ULMF was evoked by unilateral squat exercise until task failure. Isometric knee extension strength was measured to verify the presence of muscle fatigue. Between-stride standard deviations and Lyapunov exponents of trunk kinematics were used as indicators of balance control. Required perturbation force and the deviation of trunk kinematics from unperturbed gait were used to assess perturbation responses.Knee extension strength decreased considerably (17.3% SD 8.6%) as a result ULMF. ULMF did not affect steady-state gait balance. Less force was required to perturb subjects when the fatigued leg was in the stance-phase compared to the swing-phase. Subjects showed a faster return to the unperturbed gait pattern in the fatigued than in the unfatigued condition, after perturbations in swing and stance of the fatigued leg.The results of this study are not in line with the hypothesized effects of leg muscle fatigue on balance in gait. The healthy elderly subjects were able to cope with substantial ULMF during steady-state gait and demonstrated faster balance recovery after laterally directed mechanical perturbations in the fatigued than in the unfatigued condition

Cross-cultural adaptation and validation of the Dutch version of the High Activity Arthroplasty Score

Introduction: The high Activity Arthroplasty Score ( hAAS) has been designed to differentiate in the functional ability between normal and more active patients after total knee arthroplasty (TKA) and total hip arthroplasty (T hA). no such questionnaire is currently available in the Dutch language. The objective of this study was to evaluate the Dutch version of the hAAS in ThA and TKA patients. Patients & Methods: The forward and backward translated Dutch version of the hAAS combined with the national Dutch patient reported outcome measures (PR oMS) were sent to two hundred patients of all ages who underwent TKA or T hA. The internal consistency, construct validity and ceiling/floor effects of the hAAS were evaluated. Results: 108 patients (51 ThA and 57 TKA) participated in this study. A good internal consistency with a Cronbach’s alpha of 0.78, 0.81 and 0.84 was found in all patients, the Th A and the TKA group respectively. Significant positive correla- tions were observed between the hAAS and VAS Qo l, EQ-5D, all K oo S sub-scores except the symptoms score, and all hoo S sub-scores except the Qo l score. A negative correlation was found with the VAS pain. no ceiling or floor effect was seen in the hAAS. Discussion: The Dutch version of the hAAS can be used to evaluate the functional ability in more active patients of all ages who underwent ThA or TKA with an acceptable internal consistency and construct validity, with no ceiling or floor effects

THE ROLE OF PELVIS AND THORAX ROTATION VELOCITY IN BASEBALL PITCHING

The objective of the present study was to examine the relative timing of pelvis and thorax rotations in achieving high throwing velocities in baseball pitching. During the preseason, a kinematic analysis was performed on eight pitchers. Peak angular velocities of the pelvis and thorax were determined and separation, defined as the time between the moments of maximal rotation velocity of the pelvis and thorax, was calculated. By themselves, maximal pelvis and thorax rotation velocity were not associated with throwing velocity. Separation was positively and significantly associated with throwing velocity. Results indicate that the relative timing of pelvis and thorax peak rotation velocity in pitching fastballs in baseball is a determinant of throwing velocity in skilled pitchers

To Improve Your Surgical Drilling Skills, Make Use of Your Index Fingers

BACKGROUND: Surgery has greatly benefited from various technologic advancements over the past decades. Surgery remains, however, mostly manual labor performed by well-trained surgeons. Little research has focused on improving osseous drilling techniques. The objective of this study was to compare the accuracy and precision of different orthopaedic drilling techniques involving the use of both index fingers. QUESTIONS/PURPOSES: (1) Does the shooting grip technique and aiming at the contralateral index finger improve accuracy and precision in drilling? (2) Is the effect of drilling technique on accuracy and precision affected by the experience level of the performer? METHODS: This study included 36 participants from two Dutch training hospitals who were subdivided into three groups (N = 12 per group) based on their surgical experience (that is, no experience, residents, and surgeons). The participants had no further experience with drilling outside the hospital nor were there other potential confounding variables that could influence the test outcomes. Participants were instructed to drill toward a target exit point on a synthetic bone model. There were four conditions: (1) clenched grip without aiming; (2) shooting grip without aiming; (3) clenched grip with aiming at the contralateral index finger; and (4) shooting grip aiming at the contralateral index finger. Participants were only used to a clenched grip without aiming in clinical practice. Each participant had to drill five times per technique per test, and the test was repeated after 4 weeks. Accuracy was defined as the systematic error of all measurements and was calculated as the mean of the five distances between the five exit points and the target exit point, whereas precision was defined as the random error of all measurements and calculated as the SD of those five distances. Accuracy and precision were analyzed using mixed-design analyses of variance. RESULTS: Accuracy was highest when using a clenched grip with aiming at the index finger (mean 4.0 mm, SD 1.1) compared with a clenched grip without aiming (mean 5.0 mm, SD 1.2, p = 0.004) and a shooting grip without aiming (mean 4.9 mm, SD 1.4, p = 0.015). The shooting grip with aiming at the index finger (mean 4.1 mm, SD 1.2) was also more accurate than a clenched grip without aiming (p = 0.006) and a shooting grip without aiming (p = 0.014). Shooting grip with aiming at the opposite index finger (median 2.0 mm, interquartile range [IQR] 1.2) showed the best precision and outperformed a clenched grip without aiming (median 2.9 mm, IQR 1.1, p = 0.016), but was not different than the shooting grip without aiming (median 2.2 mm, IQR 1.4) or the clenched grip with aiming (median 2.4 mm, IQR 1.3). The accuracy of surgeons (mean 4.1 mm, SD 1.1) was higher than the inexperienced group (mean 5.0 mm, SD 1.1, p = 0.012). The same applied for precision (median 2.2 mm, IQR 1.0 versus median 2.8 mm, IQR 1.4, p = 0.008). CONCLUSIONS: A shooting grip combined with aiming toward the index finger of the opposite hand had better accuracy and precision compared with a clenched grip alone. Based on this study, experience does matter, because the orthopaedic surgeons outperformed the less experienced participants. Based on our study, we advise surgeons to aim at the index finger of the opposite hand when possible and to align the ipsilateral index finger to the drill bit. LEVEL OF EVIDENCE: Level II, therapeutic study

LOOK MUMMY, NO HANDS! THE EFFECT OF TRUNK MOTION ON FORWARD WHEELCHAIR PROPULSION

Wheelchair and trunk-mounted IMUs provide a powerful and easy to use method for measuring wheelchair mobility performance. Yet, to develop more specific outcome measures, additional equipment can aid in gaining more insight. A new pushrim hit detection (RhIDE) method was used to investigate forward propulsion measured by frame acceleration in push and recovery phase. Four subjects sprinted at different intensities, while wheelchair velocity, acceleration, trunk movement and push phases were measured. Results show that 25-30% of the total forward propulsion per push (61 to 91 N∙s) was performed after hand release. This explorative study shows the significance of propulsion due to trunk movement in the recovery phase. Future research with this measurement setup and daily wheelchair users could help unravel the true share of trunk motion in forward propulsion, and its timing

Historical Improvement in Speed Skating Economy

Half the improvement in 1500-m speed-skating world records can be explained by technological innovations and the other half by athletic improvement. It is hypothesized that improved skating economy is accountable for much of the athletic improvement. Purpose - To determine skating economy in contemporary athletes and to evaluate the change in economy over the years. Methods - Contemporary skaters of the Dutch national junior team (n=8) skated 3 bouts of 6 laps at submaximal velocity, from which skating economy was calculated (in mL O2·kg-1·km-1). A literature search provided historic data of skating velocity and submaximal VO2 (in mL·kg-1·min-1), from which skating economy was determined. The association between year and skating economy was determined using linear regression analysis. Correcting the change in economy for technological innovations resulted in an estimate of the association between year and economy due to athletic improvement. Results An average (±SD) skating economy of 73.4±6.4 mL O2·kg-1·km-1 was found in contemporary athletes. Skating economy improved significantly over the historical timeframe (-0.57 mL O2·kg-1·km-1 per year, 95% confidence interval [-0.84, -0.31]). In the final regression model for the klapskate era, with altitude as confounder, skating economy improved with a non-significant -0.58 mL O2·kg-1·km-1 each year ([-1.19, 0.035]). Conclusions Skating economy was 73.4±6.4 mL O2·kg-1·km-1 in contemporary athletes and improved over the past ~50 years. The association between year and skating economy due to athletic improvement, for the klapskate era, approached significance, suggesting a possible improvement in economy over these years

Improving mobility performance in wheelchair basketball

Objective: This study aimed to investigate which characteristics of athlete, wheelchair and athlete-wheelchair interface are the best predictors of wheelchair basketball mobility performance. Design: A total of 60 experienced wheelchair basketball players performed a wheelchair mobility performance test to assess their mobility performance. To determine which variables were the best predictors of mobility performance, forward stepwise linear regression analyses were performed on a set of 33 characteristics, including 10 athlete, 19 wheelchair, and 4 athlete-wheelchair interface characteristics. Results: A total of 8 of the characteristics turned out to be significant predictors of wheelchair basketball mobility performance. Classification, experience, maximal isometric force, wheel axis height, and hand rim diameter-which both are interchangeable with each other and wheel diameter-camber angle, and the vertical distance between shoulder and rear wheel axis-which was interchangeable with seat height-were positively associated with mobility performance. The vertical distance between the front seat and the footrest was negatively associated with mobility performance. Conclusion: With this insight, coaches and biomechanical specialists are provided with statistical findings to determine which characteristics they could focus on best to improve mobility performance. Six out of 8 predictors are modifiable and can be optimized to improve mobility performance. These adjustments could be carried out both in training (maximal isometric force) and in wheelchair configurations (eg, camber angle)

Gait quality assessed by trunk accelerometry after total knee arthroplasty and its association with patient related outcome measures

Background: With an increasingly younger population and more active patients, assessment of functional outcome is more important than ever in patients undergoing total knee arthroplasty. Accelerometers have been used successfully to objectively evaluate gait quality in other fields. The aim of this study was to assess gait quality with accelerometers before and after surgery, and to assess added value of resulting parameters to patient reported outcome measures scores. Methods: Sixty-five patients (mean age 65 years (range 41–75)) who underwent primary total knee arthroplasty were evaluated using a tri-axial trunk accelerometer preoperatively and 1 year after surgery. Gait quality parameters derived from the accelerometry data were evaluated in three dimensions at both time points. Factor analysis was performed on all outcome variables and changes from before to 1 year after surgery in the most representative variable for each factor were studied. Findings: Factor analysis identified three separate gait quality factors, with questionnaire and gait quality parameters loading on different factors. Both gait quality factor scores and questionnaire factor scores improved significantly 1 year after surgery. As expected based on the factor analysis, only weak to moderate associations were found between patient reported outcome measures and gait quality before surgery, after surgery and in change scores. Interpretation: The independence of patient reported outcome measures and gait quality parameters measured with trunk accelerometry indicates that gait quality parameters provide additional information on functional outcome after total knee arthroplasty. Providing caretakers with objectively measurable targets using accelerometry could help improve outcome of these patients

A different approach for the ergonomic evaluation of pushing and pulling in practice

Abstract Recent epidemiological studies show that pushing and pulling increase the risks of shoulder complaints and not necessarily of low back complaints. Moreover, the magnitude of the exerted hand forces during pushing and pulling is poorly related to the magnitude of the mechanical loading of the low back and the shoulder. In light of that, this paper combines results of several studies to present an approach for evaluating not only the exerted hand forces, but also the low back and shoulder load during pushing and pulling in practice. The approach specifies, based on scientific evidence, that (1) in order to validly obtain exposure (frequency and duration) to pushing and pulling, 10 workers should be observed during eight periods of 30 min; (2) how the exerted hand forces and the load of the low back and shoulder can be estimated in practice based solemnly on the weight of the object, one-handed or two-handed pushing or pulling, and the height of the handle; and finally, (3) how these outcomes can be evaluated in combination with existing guidelines regarding exerted hand forces, compression forces on the low back and the moments at the shoulder. Two cases will be presented here to illustrate the application of the approach. Relevance to industry The presented approach is the first to offer practitioners a fairly simple method for the ergonomic evaluation of pushing and pulling carts and four-wheeled containers in practice, especially as regarding the shoulder load.