J. Funct. Morphol. Kinesiol., Volume 6, Issue 3 (September 2021) – 23 articles

This study interviewed retired professional rugby union players (≤10 years since retirement) to discuss their careers in the game of rugby union. The primary aim of the study was to document their understanding of concussion knowledge and the analogies they use to describe concussion. In addition, these interviews were used to determine any explicit and implicit pressures of playing professional rugby as described by ex-professional rugby players. Overall, 23 retired professional rugby players were interviewed. The participants had played the game of rugby union (n = 23) at elite professional standard. A semi-structured individual interview design was conducted with participants between June to August 2020. The research team reviewed the transcripts to identify the major themes from the interviews using a reflexive thematic analysis approach. Four major themes were identified: (1) medical and theoretical understanding of concussion, (2) descriptions of concussion and disassociated language, (3) personal concussion experience, and (4) peer influences on concussion within the sport. These were further divided into categories and subcategories. The interviews highlighted that players did not fully understand the ramifications of concussive injury and other injury risk, as it became normalised as part of their sport. This normalisation was supported by trivialising the seriousness of concussions and using dismissive language amongst themselves as players, or with coaching staff. As many of these ex-professional players are currently coaching rugby (48%), these interviews could assist coaches in treating concussion as a significant injury and not downplaying the seriousness of concussion in contact sports. Full article

The tensor of vastus intermedius is a newly discovered muscle that is located at the anterior compartment of the thigh. The aim of the present study is to report, assess and synthetize the existing evidence on the anatomy, variation and morphological characteristics of the TVI as well as to examine its clinical importance. A systematic review was performed evaluating both anatomical and medical imaging studies which provided information about TVI anatomy, prevalence, variations and morphological characteristics. The search strategy was conducted in major electronic databases. Two reviewers worked independently to screen all possible references via a title/abstract examination. Methodological quality was examined with the Anatomical Quality Assurance checklist. A total of 295 cadaveric knees were included in the nine studies where in 244 (82.7%) cases the TVI was identified. Based on this evidence, it appears that the TVI is located between the vastus lateralis and vastus intermedius. The muscle belly is located proximally, and it is combined with a broad and flat aponeurosis before forming a tendinous structure that is attached at the medial aspect of the patella. The TVI presented some morphological variations and complex muscle architecture that varied along its length. There is insufficient good quality evidence as more than half of the included studies were ranked as having a “High” risk of bias with various methodological issues. Higher quality studies are recommended to evaluate the TVI morphology to better understand its functional and clinical importance. Full article

Muscle injuries are the most common trauma in team and individual sports. The muscles most frequently affected are those of the lower limb, and in particular hamstrings, adductors, rectus femoris and calf muscles. Although several scientific studies have tried to propose different rehabilitation protocols, still too often the real rehabilitation process is not based on scientific knowledge, especially in non-elite athletes. Moreover, the growing use of physical and instrumental therapies has made it increasingly difficult to understand what can be truly effective. Therefore, the aim of the present paper is to review proposed therapeutic algorithms for muscle injuries, proposing a concise and practical summary. Following a three-phase rehabilitation protocol, this review aims to describe the conservative treatment of indirect structural muscle injuries, which are the more routinely found and more challenging type. For each phase, until return to training and return to sport are completed, the functional goal, the most appropriate practitioner, and the best possible treatment according to current evidence are expressed. Finally, the last section is focused on the specific exercise rehabilitation for the four main muscle groups with a structured explanatory timetable. Full article

Acquiring optimal motor skills in preschool children presents a key element for proper psychomotor development. Therefore, the aim of this study was to determine gender differences and the effects of a multi-year exercise program on the level of motor skills in 161 preschool children (5–6 yo). Participants were divided into one control and three experimental groups. Motor skills were assessed with the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). To determine the difference in scores for each BOT-2 test between control and experimental groups, one-way ANOVA was used for girls and boys separately, while two-way ANOVA was used to determine the difference between the genders in the overall BOT-2 score. The results indicate that a 1-year multilateral exercise program has a positive effect on the level of motor skills in preschool children. Interestingly, additional years of participation in exercise programs yielded the maintenance of acquired motor skills level. Additionally, the exercise program affected preschool girls more than boys considering both individual and composite BOT-2 scores. According to the findings of this study, the presented exercise program could have potential benefits on multilateral development of the motor skills in preschool children, which could facilitate the balance of locomotor and manipulative skills. Therefore, the integration of multilateral programs intended for preschool children could be considered for implementation within the kindergarten curriculum. Full article

Stretching is usually used as part of rehabilitation protocols for groin pain or injury, but its specific contribution to and within multimodal recovery protocols is unclear. Our goal was to systematically review the effects of stretching for the recovery from groin pain or injury. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, with eligibility criteria defined according to PICOS: (Participants) athletes with groin pain or injuries; (Interventions) interventions with stretching as the differentiating factor; (Comparators) comparators not applying stretching; (Outcomes) symptom remission or improvement and/or time to return to sport and/or return to play; (Study design) randomized controlled trials. Searches were performed on 26 March 2021, in CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science, with no limitations regarding language or date, and no filters. Of 117 retrieved results, 65 were duplicates and 49 were excluded at the screening stage. The three articles eligible for full-text analysis failed to comply with one or more inclusion criteria (participants, intervention and/or comparators). We then went beyond the protocol and searched for non-randomized trials and case series, but no intervention was found where stretching was the differentiating factor. We found no trials specifically assessing the effects of stretching on recovery or improvement of groin pain or injury in athletes. Currently, the efficacy of these interventions is unknown, and more research is warranted. Full article

Background: Exercise training induces adaptive physiological and morphological modifications in the entire organism; however, excessive loads of training may increase damage in tissues. The purpose of this study was to evaluate the effect of silymarin in lung and liver histological changes in rats subjected to exercise training (ET). Methods: Male Wistar rats were subjected to an 8-week ET treadmill program 5 days per week, 60 min/session, and were previously administered 100 mg ascorbic acid or 100 mg of silymarin. Results: Silymarin increased alveolar and bronchial muscle size, improve vascularization, and reduced tissue inflammation. In liver, silymarin promoted the reduction of lipid content. Conclusion: Silymarin supplementation may improve inflammation in pulmonary tissue after 8 weeks of the ET treadmill program, improve cell recovery, and reduce intrahepatic lipid content. Full article

Screw stripping during bone fixation is a common occurrence during operations that results in decreased holding capacity and bone healing. We aimed to evaluate the rescue of the stripped screw site using screws of different dimensions. Five screw configurations were tested on cadaveric specimens for pull-out strength (POS). The configurations included a control screw tightened without stripping, a configuration voluntarily stripped and left in place, and three more configurations in which the stripped screws were replaced by a different screw with either increased overall length, diameter, or thread length. Each configuration was tested five times, with each screw tested once. The POS of the control screw, measured to be 153.6 ± 27 N, was higher than the POS measured after stripping and leaving the screw in place (57.1 ± 18 N, p = 0.001). The replacement of the stripped screw resulted in a POS of 158.4 ± 64 N for the screw of larger diameter, while the screws of the same diameter but increased length or those with extended thread length yielded POS values of 138.4 ± 42 and 185.7 ± 48 N, respectively. Screw stripping is a frequent intraoperative complication that, according to our findings, cannot be addressed by leaving the screw in place. The holding capacity of a stripped screw implanted in cancellous bone can successfully be restored with a different screw of either larger diameter, longer length, or extended thread length. Full article

Electromyography (EMG) onsets determined by computerized detection methods have been compared against the onsets selected by experts through visual inspection. However, with this type of approach, the true onset remains unknown, making it impossible to determine if computerized detection methods are better than visual detection (VD) as they can only be as good as what the experts select. The use of simulated signals allows for all aspects of the signal to be precisely controlled, including the onset and the signal-to-noise ratio (SNR). This study compared three onset detection methods: approximated generalized likelihood ratio, double threshold (DT), and VD determined by eight trained individuals. The selected onset was compared against the true onset in simulated signals which varied in the SNR from 5 to 40 dB. For signals with 5 dB SNR, the VD method was significantly better, but for SNRs of 20 dB or greater, no differences existed between the VD and DT methods. The DT method is recommended as it can improve objectivity and reduce time of analysis when determining EMG onsets. Even for the best-quality signals (SNR of 40 dB), all the detection methods were off by 15–30 ms from the true onset and became progressively more inaccurate as the SNR decreased. Therefore, although all the detection methods provided similar results, they can be off by 50–80 ms from the true onset as the SNR decreases to 10 dB. Caution must be used when interpreting EMG onsets, especially on signals where the SNR is low or not reported at all. Full article

A desire to make fitness testing cheaper and easier to conduct in a team-sport setting has led to the development of numerous field aerobic fitness tests. This has contributed to a growing confusion among strength and conditioning coaches about which one to use. The main aim of this narrative review was to examine the reliability, validity, sensitivity and usefulness of the commonly used field aerobic fitness tests and to provide practical guidelines for their use in soccer. The University of Montreal track test (UMTT) and Vam Eval test seem the best options for estimation of maximal oxygen uptake (VO_2max) while the highest signal-to-noise ratio of the 30-15 intermittent fitness test (30-15IFT) suggests its superior sensitivity to track changes in fitness. The UMTT and 30-15IFT are the best solutions for prescription of long and short high-intensity interval training sessions, respectively. All field tests mostly present with marginal usefulness, but the smallest worthwhile change for UMTT or Vam Eval test, Yo-YoIRT2 and 30-15IFT are smaller than their stage increment making the improvement of only one stage in the test performance already worthwhile. Strength and conditioning coaches are advised to choose the test based on their specific purpose of testing. Full article

(1): The superficial and deep parts of the infrapatellar fat pat (IFP) have different morphological and functional characteristics. Knee pain often occurs during movement, and it is important to clarify the movement of the IFP during knee joint movement. The purpose of this study is to clarify that the movement of the superficial and deep parts of the IFP are different during knee extension in vivo using ultrasonography (US). (2): US was performed on 15 knees of 15 healthy adults. The probe was placed longitudinally at the center of the patellar tendon and the IFP was imaged. Measurements were taken during active extension of the knee from 90 degrees to 10 degrees of knee flexion at a rate of 30 times/min. The captured US videos were analyzed using Flow particle image velocimetry (Flow PIV) fluid measurement software. The region-of-interest (ROI) was set at the superficial part and the deep part of the IFP, and the flow velocity was calculated for each. (3): The flow velocity of the deep part (1.37 ± 0.13 cm/s) of the IFP was significantly faster than that of the superficial part (0.80 ± 0.23 cm/s). (4): Our results show that the flow velocity of the IFP is different between the superficial and deep parts and that US may be a better assessment tool for the movement of the IFP. Full article

Basketball is a sport in continuous evolution, being one of these key aspects of the players’ physical fitness that has an impact on the game. Therefore, this study aimed to characterize and identify the physical fitness level and profiles of basketball players according to sex. Total of 26 semi-professional basketball players were assessed (13 male, 13 female) through inertial devices in different previously validated fitness tests. T-test for independent samples and principal component analysis were used to analyze sex-related differences and to identify physical fitness profiles. The results showed differences according to sex in all physical fitness indexes (p < 0.01; d > 1.04) with higher values in males, except in accelerometer load during small-sided games (p = 0.17; d < 0.20). Four principal components were identified in male and female basketball players, being two common ([PC1] aerobic capacity and in-game physical conditioning, [PC4 male, PC3 female] unipodal jump performance) and two different profiles (male: [PC2] bipodal jump capacity and acceleration, [PC3] curvilinear displacement; female: [PC2] bipodal jump capacity and curvilinear displacement, [PC4] deceleration). In conclusion, training design must be different and individualized according to different variables, including physical fitness profiles between them. For practical applications, these results will allow knowing the advantages and weaknesses of each athlete to adapt training tasks and game systems based on the skills and capabilities of the players in basketball. Full article

Exercise prescription based on exercise test results is complicated by the need to downregulate the absolute training intensity to account for cardiovascular drift in order to achieve a desired internal training load. We tested a recently developed generalized model to perform this downregulation using metabolic equivalents (METs) during exercise testing and training. A total of 20 healthy volunteers performed an exercise test to define the METs at 60, 70, and 80% of the heart rate (HR) reserve and then performed randomly ordered 30 min training bouts at absolute intensities predicted by the model to achieve these levels of training intensity. The training HR at 60 and 70% HR reserve, but not 80%, was significantly less than predicted from the exercise test, although the differences were small. None of the ratings of perceived exertion (RPE) values during training were significantly different than predicted. There was a strong overall correlation between predicted and observed HR (r = 0.88) and RPE (r = 0.52), with 92% of HR values within ±10 bpm and 74% of RPE values within ±1 au. We conclude that the generalized functional translation model is generally adequate to allow the generation of early absolute training loads that lead to desired internal training loads. Full article

The purpose of this study was to investigate the effects of listening to preferred versus non-preferred warm-up music on anaerobic sprint performance in Division I NCAA female athletes. Female collegiate athletes (n = 14) were recruited for this study. In a counterbalanced, crossover study design, participants completed two separate visits, each with a different warm-up music condition: preferred (Pref) or non-preferred (Non-pref). During each visit, participants completed a 3 min standardized cycling warm-up at 50 Watts while listening to Pref or Non-pref music. Following this, participants completed 3 × 15 s Wingate Anaerobic Tests (WAnTs) with a 2 min active recovery period in between tests. Motivation to exercise was measured immediately following the warm-up (WU), WAnT1, WAnT2, and WAnT3. The rate of perceived exertion (RPE) was also measured after each WAnT. Each visit was separated by a minimal recovery period of 48 h. Mean power, total work, RPE, and motivation were analyzed. Mean power (p = 0.044; d = 0.91) and total work (p = 0.045; d = 0.78) were significantly higher during the Pref music condition versus Non-pref. RPE remained unchanged regardless of condition (p = 0.536; d = 0.01). Motivation was significantly higher with Pref warm-up music compared to Non-pref (p < 0.001; d = 1.55). These results show that listening to Pref warm-up music has an ergogenic benefit during repeated sprints in comparison to Non-pref music and improves motivation to exercise. Listening to warm-up music prior to high-intensity repeated exercise may aid in optimizing performance and training in collegiate athletes. Full article

The purpose of our work is to evaluate the correlation between skeletal Class II malocclusion and temporomandibular disorders, by assessing potential different frequency scores compared with Class I and Class III skeletal malocclusion, and to evaluate associated etiological and risk factors. Fifty-five subjects were examined, 35 females and 20 males, with a mean age of 18 ± 1.3 years, divided into two groups: those with TMD and those without TMD, and prevalence was evaluated in the two groups of Class II subjects. Symptoms and more frequent signs were also examined in the TMD group. Regarding Group A (subjects with the presence of TMD), we found that 48% have a Class II, 16% have Class I, and 28% have Class III. In the totality of the group A sample, only 8% were male subjects. In Group B (subjects without TMD), we found that 40% were females, with 26.7% in Class I, 10% in Class II, and 3.3% in Class III; the male subjects in this group (60%) were distributed with 33.3% in Class I, 16.7% in Class II, and 10% in Class III. Class II malocclusion is not a causal factor of TMD but may be considered a predisposing factor. Full article

The aim of the present study was to study the effects of cycling and pure concentric and pure eccentric high-intensity interval exercise (HIIE) on skeletal muscle (i.e., vastus lateralis) and cerebral oxygenation. Twelve healthy males (n = 12, age 26 ± 1 yr, body mass 78 ± 2 kg, height 176 ± 2 cm, body fat 17 ± 1% of body mass) performed, in a random order, cycling exercise and isokinetic concentric and eccentric exercise. The isokinetic exercises were performed on each randomly selected leg. The muscle and the cerebral oxygenation were assessed by measuring oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue saturation index. During the cycling exercise, participants performed seven sets of seven seconds maximal intensity using a load equal to 7.5% of their body mass while, during isokinetic concentric and eccentric exercise, they were performed seven sets of five maximal muscle contractions. In all conditions, a 15 s rest was adopted between sets. The cycling HIIE caused greater fatigue (i.e., greater decline in fatigue index) compared to pure concentric and pure eccentric isokinetic exercise. Muscle oxygenation was significantly reduced during HIIE in the three exercise modes, with no difference between them. Cerebral oxygenation was affected only marginally during cycling exercise, while no difference was observed between conditions. It is concluded that a greater volume of either concentric or eccentric isokinetic maximal intensity exercise is needed to cause exhaustion which, in turn, may cause greater alterations in skeletal muscle and cerebral oxygenation. Full article

(1): Heart rate performance curve (HRPC) in incremental exercise was shown to be not uniform, causing false intensity estimation applying percentages of maximal heart rate (HR_max). HRPC variations are mediated by β-adrenergic receptor sensitivity. The aim was to study age and sex dependent differences in HRPC patterns in adults with β-blocker treatment (BB) and healthy controls (C). (2): A total of 535 (102 female) BB individuals were matched 1:1 for age and sex (male 59 ± 11 yrs, female 61 ± 11 yrs) in C. From the maximum incremental cycle ergometer exercise a first and second heart rate (HR) threshold (Th1 and Th2) was determined. Based on the degree of the deflection (kHR), HRPCs were categorized as regular (downward deflection (kHR > 0.1)) and non-regular (upward deflection (kHR < 0.1), linear time course). (3): Logistic regression analysis revealed a higher odds ratio to present a non-regular curve in BB compared to C (females showed three times higher odds). The odds for non-regular HRPC in BB versus C decreased with older age (OR interaction = 0.97, CI = 0.94–0.99). Maximal and submaximal performance and HR variables were significantly lower in BB (p < 0.05). %HR_max was significantly lower in BB versus C at Th2 (male: 77.2 ± 7.3% vs. 80.8 ± 5.0%; female: 79.2 ± 5.1% vs. 84.0 ± 4.3%). %P_max at Th2 was similar in BB and C. (4): The HRPC pattern in incremental cycle ergometer exercise is different in individuals receiving β-blocker treatment compared to healthy individuals. The effects were also dependent on age and sex. Relative HR values at Th2 varied substantially depending on treatment. Thus, the percentage of Pmax seems to be a stable and independent indicator for exercise intensity prescription. Full article

Wearable sensors have the potential to facilitate remote monitoring for patients recovering from knee replacement surgery. Using IMU sensors attached to the patients’ leg, knee flexion can be monitored while the patients are recovering in their home environment. Ideally, these flexion angle measurements will have an accuracy and repeatability at least on par with current clinical standards. To validate the clinical accuracy of a two-sensor IMU system, knee flexion angles were measured in eight subjects post-TKA and compared with other in-clinic angle measurement techniques. These sensors are aligned to the patients’ anatomy by taking a pose resting their operated leg on a box; an initial goniometer measurement defines the patients’ knee flexion while taking that pose. The repeatability and accuracy of the system was subsequently evaluated by comparing knee flexion angles against goniometer readings and markerless optical motion capture data. The alignment pose was repeatable with a mean absolute error of 1.6 degrees. The sensor accuracy through the range of motion had a mean absolute error of 2.6 degrees. In conclusion, the presented sensor system facilitates a repeatable and accurate measurement of the knee flexion, holding the potential for effective remote monitoring of patients recovering from knee replacement surgery. Full article

Official tests are used to assess the fitness status of soccer referees, and their results correlate with match performance. However, FIFA-approved tests expose the referees to high physical demands and are difficult to implement during the sportive year. The aim of our study was to evaluate the correlation between the 6 × 40-m sprint and Yo-Yo Intermittent Recovery Level 1 (IR1) official tests and other field-based tests that require no or little equipment, are not time-consuming, and impose low physical demands. All tests were performed by male referees from the Regional Section of the Italian Referee Association (n = 30). We observed a strong correlation between 6 × 40-m sprint and Illinois agility tests (r = 0.63, p = 0.001) and a moderate correlation between Yo-Yo IR1 and hand-grip strength in the dominant (r = 0.45, p = 0.014) and non-dominant hand (r = 0.41, p = 0.031). Interestingly, only a moderate correlation (r = −0.42, p = 0.025) was observed between the FIFA official tests, 6 × 40-m sprint and Yo-Yo IR1. These results suggest that Illinois agility and hand-grip tests could represent simple and low-physical-impact tools for repeated assessment and monitoring of referee fitness throughout the sportive season. Full article

Peripheral spondyloarthritis (SpA) has predominant peripheral (arthritis, enthesitis, or dactylitis) involvement. The severity of the symptoms can have a significant impact on the quality of life. There is no therapeutic gold standard, and physical exercise, with the opposition of resistance, remains controversial. Herein, we report the case of a woman who, at the age of 50, comes to our center with evident motor difficulties. She was previously diagnosed with SpA and was in therapy with a biological drug (adalimumab) for over one year. The training program and the nutritional intervention plan improved her condition, as pointed out by WOMAC, SQS, RAD-36 questionnaire, and BIA analysis, suspending biological therapy for almost two years. During this period, she achieved in sequence: (i) the Italian master deadlift championship, and (ii) the Italian master powerlifting championship, both for two consecutive years. Full article

This study was designed to provide an overview of weightlifting performance as a function of age group and sex and evaluate the potential of countermovement jump height (CMJH) as a tool to gauge performance potential. Data from 130 youth athletes (female, n = 65 & male, n = 65) were used to examine progression of performance (Total and Sinclair total) and the relationship between CMJH and Sinclair total while considering interactions between CMJH and age and/or sex. ANOVAs with post hoc analyses revealed that both totals had a statistical first-order polynomial interaction effect between age group and sex and the difference between age groups of 12–13 and 14–15 years old was statistically greater for male than female. A linear model, developed to examine the relationship, revealed that CMJH and CMJH x sex x age rejected the null hypothesis. Our primary findings are that male youth weightlifters have a higher rate of performance progression, possibly owing to puberty, and CMJH may be a better gauging tool for older male youth weightlifters. Full article

Interventions to increase physical activity in children have adopted broad approaches and achieved varying success. There is a need to adopt approaches underpinned with a theoretical basis. Accordingly, the aim here was to implement and evaluate a 12-week intervention designed using the concepts of the COM-B model to determine the effect this has on physical activity levels. One hundred and forty-seven school-age children (mean age 8.9 ± 1.3 years) took part in a 12-week program delivered in a school setting. Topics included physical activity, healthy eating, sleep quality and reducing screen time/sedentary activities when not in school. A sample of participants wore a wrist-worn accelerometer for seven days pre-and post-intervention (N = 11). The physical activity frequency was unchanged (2.9 ± 1.0 AU) when compared with post-intervention values (3.1 ± 0.8 AU, mean increase 6.8 ± 3.7%, p > 0.05). Changes were observed in the daily consumption of fruit and vegetables (pre-intervention 44.6% vs. post-intervention 60.2%, p < 0.05). Sedentary time, light activity, moderate activity and vigorous activity were unchanged post-intervention (p > 0.05). There is a need to adopt a broader approach that incorporates a theoretical basis and considers the complex ways by which physical activity behaviours are influenced. Full article