THE RELATIONSHIP BETWEEN MUSCULOSKELETAL STRENGTH, PHYSIOLOGICAL CHARACTERISTICS, AND KNEE KINESTHESIA FOLLOWING FATIGUING EXERCISE

Fatiguing exercise may result in impaired functional joint stability and increased risk of unintentional injury. While there are several musculoskeletal and physiological characteristics related to fatigue onset, their relationship with proprioceptive changes following fatigue has not been examined. The purpose of this study was to establish the relationship between musculoskeletal and physiological characteristics and changes in proprioception, measured by threshold to detect passive motion (TTDPM), following fatiguing exercise. Twenty, physically active females participated (age: 28.65 ± 5.6 years, height: 165.6 ± 4.3 cm, weight: 61.8 ± 8.0 kg, BMI: 22.5± 2.3 kg/m2, BF: 23.3 ± 5.4%). During Visit 1, subjects completed an exercise history and 24-hour dietary questionnaire, and body composition, TTDPM familiarization, isokinetic knee strength, and maximal oxygen uptake/lactate threshold assessments. During Visit 2, subjects completed TTDPM and isometric knee strength testing prior to and following a fatiguing exercise protocol. Wilcoxon signed rank tests determined TTDPM and isometric knee strength changes from pre- to post- fatigue. Spearman’s rho correlation coefficients determined the relationship between strength and physiological variables with pre- to post-fatigue changes in TTDPM and with pre-fatigue and post-fatigue TTDPM in extension and flexion (α=0.05). No significant differences were demonstrated from pre-fatigue to post-fatigue TTDPM despite a significant decrease in isometric knee flexion strength (P<0.01) and flexion/extension ratio (P<0.05) following fatigue. No significant correlations were observed between strength or physiological variables and changes in TTDPM from pre- to post-fatigue in extension or flexion. Flexion/extension ratio was significantly correlated with pre-fatigue TTDPM in extension (r=-0.231, P<0.05). Peak oxygen uptake was significantly correlated with pre-fatigue (r=-0.500, P<0.01) and post-fatigue (r=-0.520, P<0.05) TTDPM in extension. No significant relationships were demonstrated between musculoskeletal and physiological characteristics and changes in TTDPM following fatigue. The results suggest that highly trained individuals may have better proprioception, and that the high fitness level of subjects in this investigation may have contributed to absence of TTDPM deficits following fatigue despite reaching a high level of perceptual and physiological fatigue. Future studies should consider various subject populations, other musculoskeletal strength characteristics, and different modalities of proprioception to determine the most important contributions to proprioceptive changes following fatigue

The Effect of Muscle Fatigue on Muscle Force-Couple Activation of the Shoulder

Context: Muscle fatigue is an important concept in regard to the muscle function of the shoulder joint. Its effect on the muscle force couples of the glenohumeral joint has not been fully identified. Objective: To examine the effects of muscle fatigue on muscle force-couple activation in the normal shoulder. Design: Pretest, posttest. Patients: Ten male subjects, age 18Ð30 years, with no previous history of shoulder problems. Main Outcome Measures: EMG (area) values were assessed for the anterior and middle deltoid, subscapularis, and infraspinatus muscles during 4 dynamic stabilizing exercises before and after muscle fatigue. The exercises examined were a push-up, horizontal abduction, segmental stabilization, and rotational movement on a slide board. Results: No significant differences were observed for any of the muscles tested. Conclusions: The results of our study indicate that force-couple coactivation of the glenohumeral joint is not significantly altered after muscle fatigue

Accuracy of Recall of Musculoskeletal Injuries in Elite Military Personnel: A Cross-Sectional Study

Background Self-reported data are often used in research studies among military populations. Objective The accuracy of self-reported musculoskeletal injury data among elite military personnel was assessed for issues with recall. Design Cross-sectional study. Setting Applied research laboratory at a military installation. Participants A total of 101 subjects participated (age 28.5±5.6 years). Study participants were active duty military personnel, with no conditions that precluded them from full duty. Primary and secondary outcome measures Self-reported and medical record reviewed injuries that occurred during a 1-year period were matched by anatomic location, injury side (for extremity injuries), and injury year and type. The accuracy of recall was estimated as the per cent of medical record reviewed injuries correctly recalled in the self-report. The effect of injury anatomic location, injury type and severity and time since injury, on recall, was also assessed. Injuries were classified as recent (≤4 years since injury) or old injuries (\u3e4 years since injury). Recall proportions were compared using Fisher\u27s exact tests. ResultsA total of 374 injuries were extracted from the subjects\u27 medical records. Recall was generally low (12.0%) and was not different between recent and old injuries (P=0.206). Injury location did not affect recall (P=0.418). Recall was higher for traumatic fractures as compared with less severe non-fracture injuries (P values 0.001 to \u3c0.001). Recall for non-fracture injuries was higher for recent as compared with old injuries (P=0.033). This effect of time since injury on recall was not observed for fractures (P=0.522). Conclusions The results of this study highlight the importance of weighing the advantages and disadvantages of self-reported injury data before their use in research studies in military populations and the need for future research to identify modifiable factors that influence recall

A Comparison of Cervical and Trunk Musculoskeletal Characteristics between Female and Male Army Helicopter Pilots

Introduction: Neck pain (NP) and low back pain (LBP) are prevalent among military helicopter pilots. Although there have been few studies on sex differences in the NP/LBP prevalence in this population, females are shown to be at a greater risk of NP/LBP in civilian studies. This disparity may be due to musculoskeletal characteristics differences that predispose females for NP/LBP. The purpose of this study was to compare cervical and trunk musculoskeletal characteristics between male and female pilots. Methods: A total of 8 female pilots (Age: 27.6 ± 4.2yrs, HT: 166.1 ± 7.7cm, WT: 67.9 ± 10.6kg) were tested, and they were matched (1:1 matching ratio) with male pilots (Age: 27.8 ± 4.2yrs, HT: 175.0 ± 6.8cm, WT: 79.5 ± 5.8kg), based on age (± three years) and flight experience (± two years). Cervical/trunk strength and flexibility were tested using the hand-held/isokinetic dynamometer and inclinometers, respectively. Strength values were normalized to body weight for analyses. Paired t-tests or Wilcoxon Signed Rank tests were used to examine sex differences across all variables (p \u3c 0.05). Results: Female pilots had significantly lower cervical flexion strength, trunk flexion strength, and trunk rotation strength (p \u3c 0.05). For flexibility measures, female pilots had significantly greater cervical rotation flexibility (p \u3c 0.05). No significant differences were observed in the lumbar spine flexibility. Discussion/Conclusion: The current preliminary study found sex differences in cervical and trunk musculoskeletal characteristics in Army helicopter pilots. Continued efforts are warranted to explore sex-specific intervention strategy and its effectiveness in reducing the NP/LBP prevalence among military helicopter pilots

Residual Impact of Previous Injury on Musculoskeletal Characteristics in Special Forces Operators

Background: Musculoskeletal injuries are a significant burden to United States Army Special Operations Forces. The advanced tactical skill level and physical training required of Army Special Operators highlights the need to optimize musculoskeletal characteristics to reduce the likelihood of suffering a recurrent injury. Purpose: To identify the residual impact of previous injury on musculoskeletal characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Isokinetic strength of the knee, shoulder, and back and flexibility of the shoulder and hamstrings were assessed as part of a comprehensive human performance protocol, and self-reported musculoskeletal injury history was obtained. Subjects were stratified based on previous history of low back, knee, or shoulder injury, and within-group and between-group comparisons were made for musculoskeletal variables. Results: Knee injury analysis showed no significant strength or flexibility differences. Shoulder injury analysis found internal rotation strength of the healthy subjects (H) was significantly higher compared with injured (I) and uninjured (U) limbs of the injured group (H, 60.8 ± 11.5 percent body weight [%BW]; I, 54.5 ± 10.5 %BW; U, 55.5 ± 11.3 %BW) (P = .014 [H vs I] and P = .05 [H vs U]). The external rotation/internal rotation strength ratio was significantly lower in the healthy subjects compared with injured and uninjured limbs of the injured group (H, 0.653 ± 0.122; I, 0.724 ± 0.121; U, 0.724 ± 0.124) (P = .026 [H vs I] and P = .018 [H vs U]). Posterior shoulder tightness was significantly different between the injured and uninjured limb of the injured group (I, 111.6° ± 9.4°; U, 114.4° ± 9.3°; P = .008). The back injury analysis found no significant strength differences between the healthy and injured groups. Conclusion: Few physical differences existed between operators with prior knee or back injury. However, operators with a previous history of shoulder injury demonstrated significantly less shoulder strength than uninjured operators as well as decreased shoulder flexibility on the injured side. All operators, regardless of prior injury, must perform the same tasks; therefore, a targeted injury rehabilitation/human performance training specifically focused on internal rotation strength and tightness of the posterior capsule may help reduce the risk for recurrence of injury. Operators presenting with musculoskeletal asymmetries and/or insufficient strength ratios may be predisposed to musculoskeletal injury. Clinical Relevance: Specific fitness programs to compensate for deficiencies in strength and flexibility need to be designed that may reduce the risk of injuries in Special Forces Operators

Reliability and Validity of a Flume-Based Maximal Oxygen Uptake Swimming Test

A mode-specific swimming protocol to assess maximal aerobic uptake (VO2maxsw) is vital to accurately evaluate swimming performance. A need exists for reliable and valid swimming protocols that assess VO2maxsw in a flume environment. The purpose was to assess: (a) reliability and (b) “performance” validity of a VO2maxsw flume protocol using the 457-m freestyle pool performance swim (PS) test as the criterion. Nineteen males (n = 9) and females (n = 10) (age, 28.5 ± 8.3 years.; height, 174.7 ± 8.2 cm; mass, 72.9 ± 12.5 kg; %body fat, 21.4 ± 5.9) performed two flume VO2maxsw tests (VO2maxswA and VO2maxswB) and one PS test [457 m (469.4 ± 94.7 s)]. For test–retest reliability (Trials A vs. B), moderately strong relationships were established for VO2maxsw (mL·kg−1·min−1)(r= 0.628, p = 0.002), O2pulse (mL O2·beat−1)(r = 0.502, p = 0.014), VEmax (L·min−1) (r = 0.671, p = 0.001), final test time (sec) (0.608, p = 0.004), and immediate post-test blood lactate (IPE (BLa)) (0.716, p = 0.001). For performance validity, moderately strong relationships (p \u3c 0.05) were found between VO2maxswA (r =−0.648, p = 0.005), O2pulse (r= −0.623, p = 0.008), VEmax (r = −0.509 p = 0.037), and 457-m swim times. The swimming flume protocol examined is a reliable and valid assessment of VO2maxsw., and offers an alternative for military, open water, or those seeking complementary forms of training to improve swimming performance

Asymmetric resting scapular posture in healthy overhead athletes

Context: Observation of the scapular posture is one of the most important components of the physical examination in overhead athletes. Postural asymmetry is typically considered to be associated with injuries. However, asymmetry in the overhead athlete&apos;s scapula may be normal due to the dominant use of the limb. Objective: To quantify the differences in resting scapular posture between the dominant and nondominant sides in 3 groups of healthy overhead athletes (baseball pitchers, volleyball players, and tennis players) using an electromagnetic tracking device. Design: Cross-sectional design. Setting: University-based biomechanics laboratory. Patients or Other Participants: A total of 43 players participated, including 15 baseball pitchers, 15 volleyball players, and 13 tennis players. All participants were healthy college-aged men. Intervention(s): Bilateral 3-dimensional scapular kinematics with the arm at rest were measured using an electromagnetic tracking device. Main Outcome Measure(s): Bilateral scapular position and orientation were measured. Between-groups and between-sides differences in each variable were analyzed using separate analyses of variance. Results: In tennis players, the scapula was more protracted on the dominant side than on the nondominant side (P , .05). In all overhead athletes, the dominant-side scapula was more internally rotated (P 5 .001) and anteriorly tilted (P 5 .001) than the nondominant-side scapula was. Conclusions: The dominant-side scapula of the overhead athletes was more internally rotated and anteriorly tilted than the nondominant-side scapula. The dominant-side scapula of the tennis players was more protracted than that on the nondominant side. Clinicians evaluating overhead athletes need to recognize that scapular posture asymmetry in unilateral overhead athletes may be normal. Our results emphasize the importance of the baseline evaluation in this population in order to accurately assess pathologic change in bilateral scapular positions and orientations after injury