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Perceptual-cognitive function and unplanned athletic movement task performance: a systematic review
(2020)
The performance of choice-reaction tasks during athletic movement has been demonstrated to evoke unfavorable biomechanics in the lower limb. However, the mechanism of this observation is unknown. We conducted a systematic review examining the association between (1) the biomechanical and functional safety of unplanned sports-related movements (e.g., jumps/runs with a spontaneously indicated landing leg/cutting direction) and (2) markers of perceptual–cognitive function (PCF). A literature search in three databases (PubMed, ScienceDirect and Google Scholar) identified five relevant articles. The study quality, rated by means of a modified Downs and Black checklist, was moderate to high (average: 13/16 points). Four of five papers, in at least one parameter, found either an association of PCF with task safety or significantly reduced task safety in low vs. high PCF performers. However, as (a) the outcomes, populations and statistical methods of the included trials were highly heterogeneous and (b) only two out of five studies had an adequate control condition (pre-planned movement task), the evidence was classified as conflicting. In summary, PCF may represent a factor affecting injury risk and performance during unplanned sports-related movements, but future research strengthening the evidence for this association is warranted.
Hintergrund: Traditionell werden Faszien, die bindegewebigen Hüllen der Skelettmuskulatur, als ein eher passives, abgrenzendes Gewebe beschrieben. Sie könnten für das Bewegungssystem jedoch eine größere Rolle spielen als bislang angenommen. Aktuellen Studien zufolge sind Faszien in der Lage, ihre Steifigkeit etwa mittels Zellkontraktion zu modifizieren. Konzepte myofaszialer Ketten postulieren zudem, dass das kollagene Bindegewebe die Muskeln des Körpers nicht voneinander trennt, sondern morphologisch verbindet. Veränderungen der mechanischen Eigenschaften von Faszien könnten sich daher auch auf benachbarte bzw. entfernte Körperstrukturen auswirken.
Fragestellung: Obwohl die Rationale zahlreicher Studien auf Konzepten myofaszialer Ketten begründet wird, ist deren Existenz bis dato nicht belegt. Die vorliegende, kumulative Dissertation verfolgt das Ziel, die morphologische Existenz myofaszialer Ketten zu überprüfen und ihre funktionelle Bedeutung für das Bewegungssystem zu beurteilen.
Publikation I – Validierung einer Skala zur methodologischen Bewertung von Kadaverstudien
Die im Rahmen dieses Papers entwickelte QUACS-Skala (QUality Appraisal for Cadaveric Studies) bildet die Grundvoraussetzung für das im Rahmen von Publikation II angefertigte systematische Review zur Existenz myofaszialer Ketten. Bislang lag im Bereich anatomischer Kadaverstudien am Leichenpräparat kein Instrument zur Beurteilung der Studienqualität vor. Ein solches ist gemäß den Leitlinien für evidenzbasierte Medizin jedoch zur Anfertigung eines systematischen Reviews notwendig. Die im Rahmen von Publikation I entwickelte, 13 dichotome Items umfassende QUACS-Skala besitzt eine hohe Interrater-Reliabilität (ICC: .87) sowie eine hohe Konstruktvalidität (Kendall’s Tau B-Koeffizient: .69) und ist daher geeignet, um die methodologische Qualität anatomischer Kadaverstudien zu erfassen.
Publikation II – Systematisches Review zur Existenz myofaszialer Ketten
Die mit diesem Paper vorgenommene systematische Literaturanalyse orientierte sich an den PRISMA-Guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Zwei unabhängige Untersucher identifizierten mittels standardisierter Suche in drei Datenbanken (Pubmed inkl. MeSH-Terms, ScienceDirect, GoogleScholar) anatomische Kadaverstudien, die eine strukturelle Kontinuität zwischen Komponenten der myofaszialen Ketten nach Myers (2014) berichten (z.B. zwischen Waden- und hinterer Oberschenkelmuskulatur). Ihre methodologische Qualität wurde mithilfe der QUACS-Skala ermittelt. Die Einstufung der Evidenz erfolgte anhand der Richtlinien der Cochrane-Gesellschaft. Die initiale Recherche ergab 6589 Artikel, von denen 62 den definierten Einschlusskriterien entsprachen. Es besteht starke Evidenz für die vollständige Existenz dreier myofaszialer Ketten (oberflächliche Rückenlinie, funktionelle Rückenlinie, funktionelle Frontallinie). Moderate bis starke Evidenz liegt für gut die Hälfte der Kontinuitäten der Spirallinie (5 von 9 bestätigte Übergänge) bzw. Laterallinie (2 von 5 bestätigte Übergänge). Keine Evidenz ist für die Existenz der oberflächlichen Frontallinie verfügbar.
Publikation III – Interventionsstudie zu den Ferneffekten von Dehnübungen der unteren Extremität
Die dreiarmige, randomisiert-kontrollierte Studie wurde entsprechend der CONSORT-Guidelines durchgeführt (Consolidated Standards of Reporting Trials) und verfolgte das Ziel, die Auswirkung von Dehnübungen der unteren Extremität auf die Beweglichkeit der Halswirbelsäule zu ermitteln.
An eine vorherige Pilotstudie anknüpfend wurden 63 Probanden (36±13 Jahre, 32 männl.) zufallsbasiert drei Gruppen zugeteilt: statisches Dehnen der Waden- und hinteren Oberschenkelmuskulatur (Ferndehnen, FD), statisches Dehnen der Nackenstrecker (lokales Dehnen, LD), Wartekontrolle (KON). Als Outcome wurde vor (M1), unmittelbar nach (M2) sowie 5 Minuten nach der Intervention (M3) mittels ultraschalloptometrischer Messung die Beweglichkeit der Halswirbelsäule erfasst. Sowohl FD als auch LD steigerten nach der Intervention gegenüber KON mit einer Ausnahme (Rotation in LD bei M2) zu beiden Messzeitpunkten ihre Beweglichkeit in allen Ebenen (p<.05). Keine Unterschiede traten zwischen FD und LD auf (p>.05).
Diskussion: Die Muskeln des menschlichen Körpers sind strukturell nicht voneinander unabhängig, sondern – wie Publikation II zeigt - zumindest zu großen Teilen direkt miteinander verbunden. Das alleinige Vorliegen myofaszialer Ketten impliziert jedoch noch keine funktionelle Relevanz. Die im Rahmen von Publikation III durchgeführte Studie liefert Hinweise darauf, dass bewegungsbasierte Interventionen auf Basis myofaszialer Ketten zu relevanten Ferneffekten führen. Zu ermitteln bleiben die Ursachen für die richtungsunspezifischen Beweglichkeitssteigerungen im Bereich der Halswirbelsäule nach Ferndehnübungen sowie die einen möglichen mechanischen Krafttransfer beeinflussenden Faktoren.
Many countries have restricted public life during the SARS-CoV2 pandemic. As related measures limited the access to sports facilities, this dissertation aimed (1) to examine changes in physical activity (PA) and well-being in affected countries, and (2) to determine the effectiveness of a digital home exercise program in this context.
Part 1 (PA/well-being) of the dissertation was a digital survey administered in 14 countries. Participants reported a 41 - 42% reduction of PA (NPAQ-SF) during restrictions (n=13,503 valid responses). Compliance with international PA guidelines decreased by nearly 19%. Mental well-being declined substantially (n=14,975 responses; 68.1 to 51.9 points on the WHO5 index) and the proportion of individuals at risk of depression tripled (14.2% to 45.2%). Physical well-being (SF-36 Pain) decreased slightly (85.8% to 81.3%). About two thirds (68.1%) of the respondents reported being interested in digital home exercise.
For Part 2 (digital home exercise) of the dissertation, an international multicenter randomized, controlled trial was performed allocating healthy adults (n=763; 33±12 years) to an intervention (IG) or control (CG) group. In contrast to the CG, the IG was offered live-streamed home exercise for four weeks. Subsequently, both groups had access to pre-recorded workouts for another four weeks. Outcomes were measured weekly using validated questionnaires. Mixed-models data analyses revealed an up to 1.65-fold (95% CI: 1.4-1.94; week 1) increase of PA relative to the CG. Moreover, small improvements in exercise motivation (SKK scale), psychological well-being (WHO-5 index), sleep quality (MOS Sleep Scale), and anxiety symptoms (GAD-7 Scale) were observed for IG.
The results of this dissertation suggest that public life restrictions associated with the pandemic had significant adverse effects on movement behavior and well-being. Digital home exercise can help to maintain and/or increase health- beneficial PA and well-being and may hence represent a supportive element of viral containment efforts.
Background: Running is a popular sport with high injury rates. Although risk factors have intensively been investigated, synthesized knowledge about the differences in injury rates of female and male runners is scarce. Objective: To systematically investigate the differences in injury rates and characteristics between female and male runners. Methods: Database searches (PubMed, Web of Science, PEDro, SPORTDiscus) were conducted according to PRISMA guidelines using the keywords “running AND injur*”. Prospective studies reporting running related injury rates for both sexes were included. A random-effects meta-analysis was used to pool the risk ratios (RR) for the occurrence of injuries in female vs. male runners. Potential moderators (effect modifiers) were analysed using meta-regression. Results: After removal of duplicates, 12,215 articles were screened. Thirty-eight studies were included and the OR of 31 could be pooled in the quantitative analysis. The overall injury rate was 20.8 (95% CI 19.9–21.7) injuries per 100 female runners and 20.4 (95% CI 19.7–21.1) injuries per 100 male runners. Meta-analysis revealed no differences between sexes for overall injuries reported per 100 runners (RR 0.99, 95% CI 0.90–1.10, n = 24) and per hours or athlete exposure (RR 0.94, 95% CI 0.69–1.27, n = 6). Female sex was associated with a more frequent occurrence of bone stress injury (RR (for males) 0.52, 95% CI 0.36–0.76, n = 5) while male runners had higher risk for Achilles tendinopathies (RR 1. 86, 95% CI 1.25–2.79, n = 2). Meta-regression showed an association between a higher injury risk and competition distances of 10 km and shorter in female runners (RR 1.08, 95% CI 1.00–1.69). Conclusion: Differences between female and male runners in specific injury diagnoses should be considered in the development of individualised and sex-specific prevention and rehabilitation strategies to manage running-related injuries.
The lumbodorsal fascia (LF) has been proposed to represent a possible source of idiopathic low back pain. In fact, histological studies have demonstrated the presence of nociceptive free nerve endings within the LF, which, furthermore, appear to exhibit morphological changes in patients with chronic low back pain. However, it is unclear how these characteristics relate to the aetiology of the pain. In vivo elicitation of back pain via experimental stimulation of the LF suggests that dorsal horn neurons react by increasing their excitability. Such sensitization of fascia-related dorsal horn neurons, in turn, could be related to microinjuries and/or inflammation in the LF. Despite available data point towards a significant role of the LF in low back pain, further studies are needed to better understand the involved neurophysiological dynamics.
Background: Self-myofascial release (SMR) aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in flexibility, but the underlying mechanisms are still poorly understood. In addition to neuronal mechanisms, improved flexibility may be driven by acute morphological adaptations, such as a reduction in passive tissue stiffness or improved movement between fascial layers. The aim of the intended study is to evaluate the acute effects of SMR on the passive tissue stiffness of the anterior thigh muscles and the sliding properties of the associated fasciae.
Methods: In a crossover study de sign, 16 participants will receive all of the following interventions in a permutated random order: (1) one session of 2 × 60 s of SMR at the anterior thigh, (2) one session of 2 × 60 s of passive static stretching of the anterior thigh and (3) no intervention. Passive tissue stiffness, connective tissue sliding, angle of first stretch sensation, as well as maximal active and passive knee flexion angle, will be evaluated before and directly after each intervention.
Discussion: The results of the intended study will allow a better understanding of, and provide further evidence on, the local effects of SMR techniques and the underlying mechanisms for flexibility improvements.
A large body of evidence suggests that the 11+ warm-up programme is effective in preventing football-related musculoskeletal injuries. However, despite considerable efforts to promote and disseminate the programme, it is unclear as to whether team head coaches are familiar with the 11+ and how they rate its feasibility. The present study aimed to gather information on awareness and usage among German amateur level football coaches. A questionnaire was administered to 7893 individuals who were in charge of youth and adult non-professional teams. Descriptive and inferential statistics were used to analyse the obtained data. A total of 1223 coaches (16%) returned the questionnaire. There was no risk of a non-response bias (p>.05). At the time of the survey, nearly half of the participants (42.6%) knew the 11+. Among the coaches who were familiar with the programme, three of four reported applying it regularly (at least once per week). Holding a license (φ = .28, p < .0001), high competitive level (Cramer-V = .13, p = .007), and coaching a youth team (φ = .1, p = .001) were associated with usage of 11+. Feasibility and suitability of the 11+ were rated similarly by aware and unaware coaches. Although a substantial share of German amateur level coaches is familiar with the 11+, more than half of the surveyed participants did not know the programme. As the non-usage does not appear to stem from a lack of rated feasibility and suitability, existing communication strategies might need to be revised.
Latent myofascial trigger points (MTrP) have been linked to several impairments of muscle function. The present study was conducted in order to examine whether a single bout of self-myofascial release using a foam roller is effective in reducing MTrP sensitivity. Fifty healthy, pain-free subjects (26.8±6 years, 21 men) with latent MTrP in the lateral gastrocnemius muscle were included in the randomized, controlled trial. One week after a familiarization session, they were randomly allocated to three groups: (1) static compression of the most sensitive MTrP using a foam roll, (2) slow dynamic foam rolling of the lateral calf and (3) placebo laser acupuncture of the most sensitive MTrP. Treatment duration in each group was 90 seconds. The pressure pain threshold (PPT) of the most sensitive MTrP was assessed using a handheld algometer prior to and after the intervention. A repeated measures analysis of variance (3x2) did not reveal significant between‑group interactions (p>.05) but showed a significant time effect (F=7.715, p<.05). While placebo and dynamic selfmyofascial release did not change MTrP sensitivity (p>.05), static compression of MTrP increased the PPT (2.6±0.8 to 3.0±1.1, d=.35; p<.05). Static self-myofascial release using a foam roller might represent an alternative to reduce pressure pain of latent MTrP. Additional research should aim to extend these findings to patients and athletes with myofascial pain syndromes.
The ecological validity of neuropsychological testing (NT) has been questioned in the sports environment. A frequent criticism is that NT, mostly consisting of pen and paper or digital assessments, lacks relevant bodily movement. This study aimed to identify the determinants of a newly developed testing battery integrating both cognitive and motor demands. Twenty active individuals (25 ± 3 years, 11 males) completed the new motor-cognitive testing battery (MC), traditional NT (Stroop test, Trail Making test, Digit Span test) and isolated assessments of motor function (MF; Y-balance test, 20m-sprint, counter-movement jump). Kendal’s tau and partial Spearman correlations were used to detect associations between MC and NT/MF. Except for two items (Reactive Agility A and counter-movement jump; Run-Decide and sprint time; r = 0.37, p < 0.05), MC was not related to MF. Similarly, MC and NT were mostly unrelated, even when controlling for the two significant motor covariates (p > 0.05). The only MC item with (weak to moderate) associations to NT was the Memory Span test (Digit Span backwards and composite; r = 0.43–0.54, p < 0.05). In sum, motor-cognitive function appears to be largely independent from its two assumed components NT and MF and may represent a new parameter in performance diagnostics.
Introduction Current: evidence suggests that the loss of mechanoreceptors after anterior cruciate ligament (ACL) tears might be compensated by increased cortical motor planning. This occupation of cerebral resources may limit the potential to quickly adapt movements to unforeseen external stimuli in the athletic environment. To date, studies investigating such neural alterations during movement focused on simple, anticipated tasks with low ecological validity. This trial, therefore, aims to investigate the cortical and biomechanical processes associated with more sport-related and injury-related movements in ACL-reconstructed individuals.
Methods and analysis: ACL-reconstructed participants and uninjured controls will perform repetitive countermovement jumps with single leg landings. Two different conditions are to be completed: anticipated (n=35) versus unanticipated (n=35) successful landings. Under the anticipated condition, participants receive the visual information depicting the requested landing leg prior to the jump. In the unanticipated condition, this information will be provided only about 400 msec prior to landing. Neural correlates of motor planning will be measured using electroencephalography. In detail, movement-related cortical potentials, frequency spectral power and functional connectivity will be assessed. Biomechanical landing quality will be captured via a capacitive force plate. Calculated parameters encompass time to stabilisation, vertical peak ground reaction force, and centre of pressure path length. Potential systematic differences between ACL-reconstructed individuals and controls will be identified in dependence of jumping condition (anticipated/ unanticipated, injured/uninjured leg and controls) by using interference statistics. Potential associations between the cortical and biomechanical measures will be calculated by means of correlation analysis. In case of statistical significance (α<0.05.) further confounders (cofactors) will be considered.
Ethics and dissemination: The independent Ethics Committee of the University of Frankfurt (Faculty of Psychology and Sports Sciences) approved the study. Publications in peer-reviewed journals are planned. The findings will be presented at scientific conferences.
Trial status: At the time of submission of this manuscript, recruitment is ongoing.
Trial registration number: NCT03336060; Pre-results.
