SCR Sep 2015 PDF PDF

MONTHLY REVIEW
SEPTEMBER 2015
What is EMG activity?
The Muscle Activity Edition

By Chris Beardsley
Welcome!
Welcome to the muscle activity edition! Here, we clear
up some misconceptions about the nature of muscle
activity during exercise with heavy and light loads and
discuss what these findings might mean in practice. In
the last couple of weeks, two studies have been
published showing that heavy loads lead to more
muscle activity than light loads, with surface
electromyography (EMG). Some commentators have
interpreted these studies to mean that motor unit
recruitment is also greater during resistance training
with heavy loads than with light loads. However, these
statements are not correct, as muscle activity is not
the same as motor unit recruitment. While this might
seem a mere technicality, it is actually very important.
What is muscle activity?

Muscle activity is a measure of the strength of the
signal from the central nervous system (CNS) to the
muscle. Individual muscle fibers within the muscle are
innervated in groups by motor units. The number of
motor units that are innervated to perform a given
action is thought to be determined by the size of the
signal from the central nervous system. Historically,
the strength of this signal has been attributed to three
main factors: motor unit recruitment, motor unit firing
frequency (also called rate coding or discharge rates),
and motor unit synchronization (Behm, 1995). More
recently, some studies have suggested that what has
previously been termed motor unit synchronization
may be an artifact rather than a real phenomenon
(Farina, 2015), leaving only two factors to comprise
muscle activity: motor unit recruitment and motor unit
firing frequency.
What are motor unit recruitment and motor

unit firing frequency?
Motor unit recruitment refers to how many motor units
are recruited in order to achieve a task. Tasks with low
force requirements typically recruit small numbers of
motor units, while tasks requiring a high degree of
force may require all motor units to be recruited. Like
the myth that humans only use a small percentage of
their brains to think, there is a prevalent myth that
humans use a small fraction of their motor units. In
fact, many recent studies report that most young
subjects achieve nearly full voluntary recruitment
(mostly >90%) (e.g. Venturelli, 2015; Kennedy, 2015,
Kluka, 2015). Motor unit firing frequency (also known
as rate coding) refers to the number of pulses that are
sent in a period of time to the recruited motor units.
When a large number of pulses are sent in a short
period of time, the muscle fibers innervated by the
motor units do not have a chance to relax between
contractions and the muscle achieves a state of
tetanus, where maximal possible force is generated.
EMG activity is a measurement of muscle activity,

which (as explained above) is a compound function of
both motor unit recruitment and also motor unit firing
frequency. In unfatigued conditions during muscle
contractions with steadily increasing force (i.e. not
explosive), the EMG activity measured is very closely
related to the tensile force that is produced within a
muscle during an exercise. Faster muscle actions lead
to greater motor unit recruitment than slower muscle
actions (Duchateau, 2006). However, fatigue changes
this relationship substantially and the behavior of the
muscle becomes much more complex.
How is EMG activity related to motor unit

recruitment?
Since EMG activity measures muscle activity, it cannot
differentiate between changes in either motor unit
recruitment or motor unit firing frequency. An increase
in EMG activity could be a result of either a change in
motor unit recruitment or motor unit firing frequency
or both, or even a small reduction in one and a larger
increase in the other (Suzuki, 2002). Therefore, it is
inappropriate to assume that differences in EMG
activity directly represent similar differences in motor
unit recruitment (Enoka, 2015). Other methods are
necessary for finding out which is responsible for the
change in muscle activity measured by EMG methods.
How is EMG activity related to muscle force?

Despite concerns regarding the relationship between
EMG activity and motor unit recruitment, researchers
have found that under controlled conditions (with no
fatigue, and with steadily increasing force), when
force production is increased from low to moderate
levels, this also involves an increase in motor unit
recruitment. In contrast, as force production increases
from moderate to high levels, this involves an increase
in motor unit firing frequency. Research has also
revealed that this phenomenon is muscle specific, with
larger muscles relying for longer upon increases in
motor unit recruitment than smaller muscles
(Masakado, 1994). The intrinsic hand muscles rely
upon increases in motor unit recruitment only up to
around 50% of maximum voluntary isometric force
(MVIC) but the lower body musculature is not fully
recruited until around 80% of MVIC. Increases in
muscle force above these levels are produced by
increases in motor unit firing frequency.
How is EMG activity related to hypertrophy?

Studies using MRI scans have found that the location
of greatest activation (as measured by transverse
relaxation time) along the length of a muscle is wellcorrelated with the resulting magnitude of the regional
hypertrophy with the same exercise (Wakahara, 2012;
Wakahara, 2013). Since the quantification of muscle
activity using MRI and EMG is very closely correlated
(Adams, 1992; Dickx, 2010), we can probably assume
that greater muscle activity is beneficial for increased
hypertrophy, at least within muscles. Whether a
threshold effect exists is unclear.
Copyright Strength and Conditioning Research Limited, 2015
Page 2
What do these findings imply?

Why is fatigue a problem?
As explained above, the close and broadly linear
relationship between EMG activity and muscle force is
seen in studies involving low-to-moderate levels of
force production and under conditions with no fatigue.
Fatigue changes the way in which motor units are
recruited in at least two key ways. Firstly, it appears
that the recruitment threshold of higher threshold
motor units is decreased under conditions of greater
fatigue (Adam, 2003), which means that Henneman's
size principle is respected. This has been interpreted
by some researchers to mean that training with low
loads to muscular failure can be equated with training
with high loads, as both involve increasing motor unit
recruitment. As explained above, this fails to take into
account the fact that motor unit recruitment is not the
whole picture when it comes to stimulating a muscle
fiber. Muscle activity involves two elements: motor
unit recruitment and motor unit firing frequency and
motor unit firing frequency is the factor that is more
responsible for increases in force at higher levels of
force. Additionally, since it is likely that muscle tension
is the key driving factor for stimulating increases in
muscular adaptations, probably via sensory receptors
within the extracellular matrix (ECM) (see review by
Kjaer, 2004) motor unit firing frequency may be the
more important factor of the two. Secondly, fatigue
also changes the way in which motor units are
recruited insofar as motor unit cycling or rotation
seems to occur in order to reduce the detrimental
effects of fatigue (Westad, 2003; Bawa, 2006). This
complex arrangement means that the total number of
motor units that are simultaneously recruited may be
lower when using low loads than when using high
loads during fatiguing conditions, even though full
motor unit recruitment is reached in both (as defined
by the recruitment of a motor unit at any time during
the exercise). Exactly what this implies for muscular
adaptations is unclear but it seems likely that the
lower force involved would lead to a smaller signal
through the ECM. This signal could lead to greater
muscular adaptations, both in relation to muscle
cross-sectional area and also in relation to the
formation of additional lateral structures within the
ECM, which are believed to be responsible for the
greater specific tension that arises with long-term
resistance training, which partly explains the greater
ratio of strength to size gains (in conjunction with
central factors).
These findings indicate that the overall magnitude of

EMG activity (involving both motor unit recruitment
and motor unit firing frequency) is greater using
heavy loads than when using light loads, which is
most likely a function of greater muscle tension. This
in turn likely means that the signal transmitted to
through the ECM is greater when using heavy loads.
This is as would be expected, insofar as larger
external loads are matched by greater internal muscle
forces.
What else did the studies report?

In addition to these findings, Looney (2015) confirmed
the findings of earlier research insofar as EMG activity
was found to be greater when sets were taken closer
to muscular failure than when they were stopped
further from muscular failure. More importantly,
Jenkins (2015) observed that the mean power
frequency of the EMG signal (a measure that reduces
with elevated levels of fatigue) decreased more and
was lower for the last repetitions with 30% of 1RM
condition than with 80% of 1RM. These additional
findings demonstrate that greater fatigue is incurred
with lighter loads than with the heavy loads. Since
peripheral fatigue is accompanied by increased
metabolic stress and is thought to be a driver of
muscular adaptations in its own right (Schoenfeld,
2013), it may be the case that lighter loads can exert
a key hypertrophic stimulus through this mechanism
to a greater extent than heavy loads.
What are the conclusions?

The above analysis hopefully illustrates several key
points. Firstly, that we should not use the terms
muscle activity and motor unit recruitment without
due care and attention, as they do not refer to the
same concept. Secondly, fatigue makes it very difficult
to determine exactly what is going on when taking
measurements of EMG activity. Thirdly, it could be
argued that muscle force (rather than motor unit
recruitment) is a key driver of muscular adaptations
and that this can be maximized with the use of heavy
loads. Finally, it could also be argued that muscle
fatigue is a second key driver of hypertrophy and new
findings indicate that muscle fatigue could be greater
when using light loads than when using heavy loads,
even when both are taken to muscular failure.
What have recent studies found?

Two studies have recently been carried out, reporting
that heavy loads lead to greater EMG activity than
light loads. Jenkins (2015) explored knee extensions
to muscular failure with both 30% of 1RM and 80% of
1RM. They found that the magnitude of the EMG
activity was greater at 80% of 1RM than at 30% of
1RM across all repetitions and sets. Looney (2015)
explored back squats to muscular failure and not to
failure with 50%, 70% and 90% of 1RM. They also
found that EMG activity was greater with heavier loads
than with lighter loads.
Page 3
Strength coach notes

Relationships Between Field
Tests of Power and Athletic
Performance in Track and
Field Athletes Specializing in
Power Events
The researchers concluded that a number of simple field tests are valuable
predictors of track and field performance at the university level, including
the standing long jump, standing triple jump, and standing quintuple jump.
Influence on strength and

flexibility of a swing phasespecific hamstring eccentric
program in sprinters
general preparation
The researchers concluded that a machine-based hamstring eccentric

training program can increase hamstrings strength, hamstring-toquadriceps strength ratios, and hamstrings flexibility in national-level track
sprinters to a superior extent than a control group only performing
standard compound exercises such as the lunge, squat and deadlift.
Post-exercise cold water

immersion attenuates acute
anabolic signalling and longterm adaptations in muscle
to strength training
Cold water immersion attenuates long-term gains in muscle mass and

strength, possibly through the suppression of satellite cell activity.
Acceleration capability in
elite sprinters and ground
impulse: push more, brake
less?
The researchers concluded that faster sprint running performances were

associated with greater overall horizontal impulse and propulsive horizontal
impulse but braking horizontal impulse was not related to sprint running
times. This may imply that interventions to increase propulsive horizontal
impulse are likely to be more effective in improving sprint running ability
than interventions designed to reduce braking horizontal impulse.
A comparison of gluteus
maximus, biceps femoris,
and vastus lateralis EMG
activity in the back squat
and barbell hip thrust
exercises
The researchers concluded that the barbell hip thrust activates the upper
and lower regions of the gluteus maximus and biceps femoris to a greater
extent than the back squat when using similar relative loads.
A comparison of gluteus
maximus, biceps femoris,
and vastus lateralis EMG
amplitude in the parallel,
full, and front squat
variations in resistance
trained females
The researchers concluded that squat variation does not affect upper and
lower gluteus maximus muscle activity, vastus lateralis muscle activity or
biceps femoris muscle activity.
An investigation into the

relationship between
maximum isometric
strength and vertical jump
performance
The researchers concluded that there are no good correlations between

measures of maximum isometric mid-thigh pull strength and either squat
jump or countermovement jump heights, which implies that other factors
are involved, such as jumping skill.
Page 4
Sports medicine notes

Exercise-induced
rhabdomyolysis
mechanisms and
prevention: a literature
review
The researchers concluded that increased calcium ions levels in muscle cells
leading to degradation of the cell membrane might be the pathophysiology
of exercise-induced rhabdomyolysis. Exercise-induced rhabdomyolysis
might be caused by performing very high repetitions of high-velocity or
high-load exercises with eccentric components and may be exacerbated by
exercising in high temperatures, in electrolyte imbalance, and with high
carbohydrate, creatine and/or alcohol intakes.
The neuromechanical
adaptations to Achilles
tendinosis
The researchers concluded that Achilles tendinopathy is associated with less

stiff Achilles tendons but elevated spinal and supraspinal excitability.
Proximal muscle
rehabilitation is effective for
patellofemoral pain: a
systematic review with
meta-analysis
The researchers concluded that in the short term, there is strong evidence
that combined hip and knee muscle exercise is better at pain reduction
than knee exercise alone; there is moderate evidence that hip muscle
exercise is better at improving pain than knee muscle exercise, and there is
very limited evidence that hip muscle exercise reduces pain compared to a
non-training control.
The immediate effects of

doming of the diaphragm
technique in subjects with
short hamstring syndrome:
a randomized controlled
trial
The researchers concluded that the doming of the diaphragm technique

leads to immediate increases in both hamstrings flexibility and spine
mobility.
Acute effects of stretching

on passive properties of
human gastrocnemius
muscletendon unit:
analysis of differences
between holdrelax static
stretching
The researchers found that both hold-relax stretching and static stretching
techniques increase flexibility, decrease muscle-tendon stiffness, and
increase stretch tolerance. They found that hold-relax stretches lead to
greater increases in stretch tolerance while static stretching leads to
greater reductions in muscle-tendon stiffness.
Electromyography activation
levels of the 3 gluteus
medius subdivisions during
manual strength testing
The researchers concluded that the side-lying-with-hip-neutral and sidelying-with-hip-internal-rotation positions were the testing positions that
show the highest activations for all subdivisions of the gluteus medius.
Meta-analysis melatonin
for the treatment of primary
sleep disorders
The researchers concluded that in a meta-analysis of 19 trials, melatonin

was found to decrease sleep onset latency (by around 7 minutes), increase
total sleep time (by around 8 minutes), and improve overall sleep quality.
Page 5
Strength and Conditioning Research
CONTENTS
The Muscle Activity Edition............................................................................................................................................... 2
CONTENTS.........................................................................................................................................................................5
1. STRENGTH & CONDITIONING, POWER AND HYPERTROPHY........................................................................................... 8
1.
The training process: planning for strengthpower training in track and field. Part 1, by DeWeese, Hornsby, Stone, & Stone, in Journal
of Sport and Health Science (2015)................................................................................................................................................................9
2.
The training process: planning for strengthpower training in track and field. Part 2 by DeWeese, Hornsby, Stone, & Stone, in Journal
of Sport and Health Science (2015)..............................................................................................................................................................10
3.
Relationships Between Field Tests of Power and Athletic Performance in Track and Field Athletes Specializing in Power Events, by Aoki,
Kohmura, Sakuma, Koshikawa and Naito, in International Journal of Sports Science & Coaching (2015) ..................................................11
4.
Influence on strength and flexibility of a swing phase-specific hamstring eccentric program in sprinters general preparation, by Guex,
Lugrin, Borloz, Millet, & de Beaumont, in Journal of Strength & Conditioning Research (2015) ................................................................ 12
5.
The effect of resisted sprint training on maximum sprint kinetics and kinematics in youth, by Rumpf, Cronin, Mohamad, Mohamad,
Oliver, & Hughes, in European Journal of Sport Science (2015)...................................................................................................................13
6.
Intramuscular anabolic signaling and endocrine response following high volume and high intensity resistance exercise protocols in
trained men, by Gonzalez, Hoffman, Townsend, Jajtner, Boone, Beyer, & Stout, in Physiological Reports (2015) ......................................14
7.
High-volume resistance training reduces postprandial lipaemia in postmenopausal women, by Correa, Teixeira, Cobos, Macedo, Kruger,
Carteri, & Reischak-Oliveira, in Journal of Sports Sciences (2015) ...............................................................................................................15
8.
Acute response to cluster sets in trained and untrained men, by Oliver, Kreutzer, Jenke, Phillips, Mitchell, & Jones, in European Journal
of Applied Physiology (2015)........................................................................................................................................................................16
9.
Selective hypertrophy of the quadriceps musculature after 14 weeks of isokinetic and conventional resistance training, by Matta,
Nascimento, Trajano, Simo, Willardson, & Oliveira, in Clinical physiology and functional imaging (2015) ..............................................17
10. Efficacy of manual versus free-weight training to improve maximal strength and performance for microgravity conditions, by
Behringer, Schren, McCourt, & Mester, in Journal of Sports Sciences (2015) ............................................................................................ 18
11. Plyometric training effects on athletic performance in youth soccer athletes a systematic review, by Bedoya, Miltenberger, & Lopez, in
Journal of Strength & Conditioning Research (2015)...................................................................................................................................19
12. Effect of plyometrics on the energy cost of running and MHC and titin isoforms, by Pellegrino, Ruby, & Dumke, in Medicine & Science in
Sports & Exercise (2015)...............................................................................................................................................................................20
13. Effects of 6-weeks resistance training combined with plyometric and speed exercises on physical performance of pre-peak height
velocity soccer players, by Rodriguez-Rosell, Franco-Mrquez, Pareja-Blanco, Mora-Custodio, Yez-Garca, Gonzlez-Surez, &
Gonzlez-Badillo, in International journal of sports physiology and performance (2015) .......................................................................... 21
14. Determinant factors of pull up performance in trained athletes, by Snchez-Moreno, Pareja-Blanco, Daz-Cueli, & Gonzlez-Badillo, in
The Journal of Sports Medicine and Physical Fitness (2015)........................................................................................................................22
15. Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training, by
Roberts, Raastad, Markworth, Figueiredo, Egner, Shield, & Peake, in The Journal of Physiology (2015) ................................................... 23
2. BIOMECHANICS AND MOTOR CONTROL.......................................................................................................................24

16. Acceleration capability in elite sprinters and ground impulse: push more, brake less? By Morin, Slawinski, Dorel, Couturier, Samozino,
Brughelli, & Rabita, in Journal of Biomechanics (2015)...............................................................................................................................25
17. A comparison of gluteus maximus, biceps femoris, and vastus lateralis EMG activity in the back squat and barbell hip thrust exercises,
by Contreras, Vigotsky, Schoenfeld, Beardsley, & Cronin, in Journal of Applied Biomechanics (2015) ....................................................... 26
18. A comparison of gluteus maximus, biceps femoris, and vastus lateralis EMG amplitude in the parallel, full, and front squat variations in
resistance trained females, by by Contreras, Vigotsky, Schoenfeld, Beardsley, & Cronin, in Journal of Applied Biomechanics (2015) ......27
19. Spatial EMG potential distribution of biceps brachii muscle during resistance training and detraining, by Watanabe, Kouzaki, &
Moritani, in European Journal of Applied Physiology (2015).......................................................................................................................28
20. Muscle activation during three sets to failure at 80 vs. 30% of 1RM resistance exercise, by Jenkins, Housh, Bergstrom, Cochrane, Hill,
Smith, & Cramer, in European Journal of Applied Physiology (2015).......................................................................................................... 29
21. Electromyographical and Perceptual Responses to Different Resistance Intensities in a Squat Protocol: Does Performing Sets to Failure
With Light Loads Recruit More Motor Units? By Looney, Kraemer, Joseph, Comstock, Denegar, Flanagan, Newton, Szivak, DuPont,
Hooper, Hakkinen, and Maresh, in Journal of Strength & Conditioning Research (2015) ........................................................................... 30
22. Electromyography activation levels of the 3 gluteus medius subdivisions during manual strength testing, by Otten, Tol, Holmich, &
Whiteley, in Journal of Sport Rehabilitation (2015)..................................................................................................................................... 31
23. Relationships between lower body muscle structure and maximal power clean performance, by McMahon, Turner, & Comfort, in
Journal of Trainology (2015)........................................................................................................................................................................ 32
24. An investigation into the relationship between maximum isometric strength and vertical jump performance, by Thomas, Jones,
Rothwell, Chiang, & Comfort, in Journal of Strength & Conditioning Research (2015)............................................................................... 33
25. Overhead shoulder press in front of the head or behind the head? By McKean & Burkett, in Journal of Sport and Health Science (2015)
......................................................................................................................................................................................................................34
26. Repeated bout effect in muscle-specific exercise variations, by Zourdos, Henning, Jo, Khamoui, Lee, Park, & Kim, in Journal of Strength
& Conditioning Research (2015).................................................................................................................................................................. 35
27. Extracellular matrix remodeling and its contribution to protective adaptation following lengthening contractions in human muscle, by
Hyldahl, Nelson, Xin, Welling, Groscost, Hubal, & Parcell, in FASEB Journal (2015)....................................................................................36
28. Post-activation potentiation: the neural effects of postactivation depression, by Xenofondos, Patikas, Koceja, Behdad, Bassa, Kellis, &
Kotzamanidis, in Muscle & Nerve (2014)..................................................................................................................................................... 37
3. ANATOMY, PHYSIOLOGY, AND NUTRITION................................................................................................................... 38

29. Skeletal muscle hypertrophy adaptations predominate in the early stages of resistance exercise training, matching deuterium oxidederived measures of muscle protein synthesis and mechanistic target of rapamycin complex 1 signaling, by Brook, Wilkinson, Mitchell,
Lund, Szewczyk, Greenhaff, & Atherton, in FASEB Journal (2015)............................................................................................................... 39
30. Muscle hypertrophy induced by myostatin inhibition accelerates degeneration in dysferlinopathy, by Lee, Lehar, Sebald, Liu, Swaggart,
Talbot, & Lee, in Human Molecular Genetics (2015)................................................................................................................................... 40
31. Higher protein intake is associated with higher lean mass and quadriceps muscle strength in adult men and women, by Sahni,
Mangano, Hannan, Kiel, & McLean in The Journal of Nutrition (2015).......................................................................................................41
32. Effect of resistance training and various sources of protein supplementation on body fat mass and metabolic profile in sarcopenic
overweight elderly men: a pilot study, by Maltais, Perreault, Courchesne-Loyer, Lagac, Barsalani, & Dionne, in International Journal of
Sport Nutrition and Exercise Metabolism (2015)......................................................................................................................................... 42
33. Leucine does not affect mechanistic target of rapamycin complex 1 assembly but is required for maximal ribosomal protein s6 kinase 1
activity in human skeletal muscle following resistance exercise, by Apr, Moberg, Hamilton, Ekblom, Rooyackers, Holmberg, &
Blomstrand, in FASEB Journal (2015)........................................................................................................................................................... 43
34. The skeletal muscle anabolic response to plant- versus animal-based protein consumption, by Van Vliet, Burd, & Van Loon, in The
Journal of Nutrition (2015)...........................................................................................................................................................................44
35. Contractile properties and sarcoplasmic reticulum calcium content in type I and type II skeletal muscle fibres in active aged humans, by
Lamboley, Wyckelsma, Dutka, McKenna, Murphy, & Lamb, in The Journal of Physiology (2015)...............................................................45
36. Meta-analysis melatonin for the treatment of primary sleep disorders, by Ferracioli-Oda, Qawasmi, & Bloch, in FOCUS (2014) .........46
37. Effects of oral contraceptive use on the salivary testosterone and cortisol responses to training sessions and competitions in elite
women athletes, by Crewther, Hamilton, Casto, Kilduff, & Cook, in Physiology & Behavior (2015)............................................................47
38. Metabolic effects of non-nutritive sweeteners, by Pepino, in Physiology & Behavior (2015)......................................................................48
39. The biology of appetite control: do resting metabolic rate and fat-free mass drive energy intake? By Blundell, Finlayson, Gibbons,
Caudwell, & Hopkins, in Physiology & Behavior (2015)............................................................................................................................... 49
40. Obesity and the neurocognitive basis of food reward and the control of intake, by Ziauddeen, Alonso-Alonso, Hill, Kelley, & Khan, in
Advances in Nutrition: An International Review Journal (2015).................................................................................................................. 50
41. Associations of sedentary time with fat distribution in a high-risk population, by Henson, Edwardson, Morgan, Horsfield, Bodicoat,
Biddle, & Yates, in Medicine & Science in Sports & Exercise (2014).............................................................................................................51
4. PHYSICAL THERAPY AND REHABILITATION................................................................................................................... 52

42. Exercise-induced rhabdomyolysis mechanisms and prevention: a literature review, by Kim, Lee, Kim, Ryu, Cha, & Sung, in Journal of
Sport and Health Science (2015).................................................................................................................................................................. 53
43. Gluteus maximus inhibition in proximal hamstring tendinopathy, by De Jesus, Bryk, Moreira, Nakaoka, Dos Reis, & Lucar, in Medical
Express (2015).............................................................................................................................................................................................. 54
44. The neuromechanical adaptations to Achilles tendinosis, by Chang, & Kulig, in The Journal of Physiology (2015) ................................... 55
45. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis, by Lack, Barton, Sohan,
Crossley, & Morrissey, in British Journal of Sports Medicine (2015)............................................................................................................ 56
46. Is there a difference in the electromyographic activity of the pelvic floor muscles across the phases of the menstrual cycle? By Micussi,
Freitas, Angelo, Soares, Lemos, & Maranho, in Journal of Physical Therapy Science (2015) .................................................................... 57
47. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing, by Park &
Han, in Journal of Physical Therapy Science (2015)..................................................................................................................................... 58
48. Comparison of psoas major muscle thickness measured by sonography during active straight leg raising in subjects with and without
uncontrolled lumbopelvic rotation, by Jeon, Kwon, Weon, Choung, & Hwang, in Manual Therapy (2015)................................................59
49. The immediate effects of doming of the diaphragm technique in subjects with short hamstring syndrome: a randomized controlled
trial, by Valenza, Cabrera-Martos, Torres-Snchez, Garcs, Mateos-Toset, & Valenza-Demet, in Journal of Sport Rehabilitation (2015) .60
50. Acute effects of stretching on passive properties of human gastrocnemius muscletendon unit: analysis of differences between hold
relax static stretching, by Nakamura, Ikezoe, Tokugawa, & Ichihashi, in Journal of Sport Rehabilitation (2015) .......................................61
1. STRENGTH & CONDITIONING, POWER AND

HYPERTROPHY
The training process: planning for strengthpower

training in track and field. Part 1, by DeWeese,
Hornsby, Stone, & Stone, in Journal of Sport and
Health Science (2015)
Background
Track and field is a collection of competitive physical
events that fits within a larger body of events called
athletics. Track and field is contested both outdoor and
indoor and the events incorporated under its umbrella
comprise those that require skill in running, jumping
and throwing. Track events are those that involve
running while field events are those that involve either
jumping or throwing. The running events comprise the
sprint, middle and long distances and range from 60m
to 10,000m. Sprint distances are those ranging from
60m to 400m. Middle distances are those ranging
from 800m to 1500m (or perhaps also the 3,000m)
and long distance are those ranging from 3,000m to
10,000m. Running events can be contested either with
or without hurdles but the distances differ depending
on whether hurdles are present. Running events can
also be contested in teams of athletes, as relays.
Jumping events include bilateral and unilateral jumps
in horizontal and vertical directions both with and
without implements and are contested as the long
jump, triple jump, high jump and pole vault. Throwing
events differ predominantly depending on the weight
of the implement being thrown but also on the
throwing technique and are contested as the shot put,
javelin, discus and hammer. Combinations of these
events are organized into separate competitions for
athletes who excel as all-rounders, which include the
decathlon, heptathlon and pentathlon. The decathlon
comprises the 100m sprint, the long jump, the shot
put, the high jump, the 400m sprint on a single day of
competition, followed by the 110m hurdles, the
discus, the pole vault, the javelin, and the 1500m run
on a second day. The heptathlon comprises the 100m
hurdles, the high jump, the shot put, the 200m sprint
on a single day of competition, followed by the long
jump, the javelin, and the 800m run on a second day.
The pentathlon is contested on a single day and
comprises the 100m high hurdles, long jump, shot
put, high jump, and 800m run. In general, except for
the middle and long distance running events, most
track and field events require a considerable amount
of strength and power in order to excel at a high level
and therefore most training programs for the track
and field events will include resistance training,
ballistic resistance training, and/or plyometrics in
order to develop athletes to their full potential. In
addition, many athletes will continue to perform a
great deal of skill practice and drills intended to
improve the efficiency of movements.
OBJECTIVE: To discuss the concepts underlying the

use of block periodization for strength-power training
in track and field.
What happened?
The annual plan
The reviewers explain that before setting out a
periodized program, it is essential to prepare the
annual plan for an athlete, including their upcoming
competitions and any testing dates. They note that
within this plan, it is important to manage the key
principles of overload, variation, specificity, and
reversibility. Overload is the stimulus for adaptation
but comes with an associated cost, which is the
creation of fatigue. Overload can be achieved by
altering aspects of an exercise to make it harder,
increasing the range of motion, increasing the relative
load, increasing workout frequency, increasing overall
workout volume, and reducing rest period duration.
Variation is used to manage the accumulation of
fatigue and help achieve continued progression. The
reviewers note that more advanced athletes may need
more variation than beginners. Specificity refers to the
transfer of training effect, which is how much an
increase in a type of training or an exercise transfers
to the sport performance. Transfer can be calculated
from long-term data using a metric known as a
Transfer Effect Correlation (TEC) as: result gain (effect
size) in the sport performance measure / result gain
(effect size) in the exercise. In practice, most coaches
discuss transfer in theoretical terms based on either
the kinetic (force-related) or kinematic (movementrelated) variables of an exercise in relation to the
sport performance. Reversibility refers to the loss of
fitness that was accumulated earlier in the program,
either because of detraining or fatigue.
Block periodization
Block periodization is the form of periodization in
which a distinct quality (e.g. strength, hypertrophy, or
power) is trained in one block before moving onto the
next. It has been proposed as a practical approach for
coaches working with athletes, as it appears to fit well
with the annual plan and does not force athletes to
attempt to develop multiple characteristics at the
same time. In addition, the reviewers performed a
review of the literature and identified 11 studies
performed in both strength-power and endurance
athletes competing in a range of different sports. They
noted that most studies found superior aerobic and
strength-power outcomes in the block periodization
groups compared to other types of periodization, such
as linear (traditional) and non-linear (daily undulating)
periodization.
What did the researchers conclude?

The reviewers concluded that block periodization is the
optimal periodization approach for track and field.
Limitations
The review was limited by being a narrative review
based upon the opinions of the authors.
Page 10
The training process: planning for strengthpower

training in track and field. Part 2 by DeWeese,
Hornsby, Stone, & Stone, in Journal of Sport and
Health Science (2015)
Background
athletics. For a detailed introduction to track and field,
see the preceding study review.
OBJECTIVE: To discuss some of the practical aspects

of block periodization in order to help coaches
maximize the strength and power qualities of their
track and field athletes.
What happened?
Concentrated loads
The reviewers explain that a key concept underlying
block periodization is that it emphasizes individual
qualities in each training block (e.g. hypertrophy,
strength, power). In order to achieve this, it does not
focus all training sessions on the single quality but
uses the concept of concentrated loads whereby the
main characteristic is emphasized while the others are
deprioritized but still present.
Sequenced training
The reviewers explain that an added benefit of using
concentrated loads as prescribed in block periodization
is that each quality can be developed in such a way as
to potentiate the ability to improve the next block. For
example, focusing on an increase in muscular size in
the first block can aid in improving muscular strength
in the second block, as cross-sectional area is a key
determinant of strength. They note that the placement
of blocks in a beneficial order is called sequenced
training and commonly follows the hypertrophystrength-power sequence. This is so that the gains in
size permit greater gains in strength, which then allow
improved speeds (because of the force-velocity
relationship) and therefore greater power outputs and
thus each phase potentiates the next one.
Movement transfer
The reviewers note that in the absence of hard data
correlating improvements in actual sports performance
with long-term improvements in specific exercises (as
can be done between back squats and short sprints),
it is necessary to consider the actual biomechanics of
exercises used with training programs. Specifically,
they suggest that sports performances should be
assessed in order to determine what types of muscle
action are critical (i.e. concentric, eccentric, stretchshortening cycle), whether multi-joint or single-joint
actions are involved, which muscles are key drivers of
the movements, which ranges of motion require peak
force production, and the loading of the movement
and its subsequent velocity. These factors can help
determine which exercises are most likely to be
beneficial at face value, although clearly it is beneficial
to collect data on whether improving performance in
such exercises does actually lead to improved ability in
the sports performance in question.

The reviewers concluded that block periodization
makes use of the concepts of concentrated load and
sequenced training to enhance the development of
athletes.
Limitations
The review was limited by being a narrative review
based upon the opinions of the authors.
Page 11
Relationships Between Field Tests of Power and

Athletic Performance in Track and Field Athletes
Specializing in Power Events, by Aoki, Kohmura,
Sakuma, Koshikawa and Naito, in International
Journal of Sports Science & Coaching (2015)
Background
athletics. For a detailed introduction to track and field,
see the preceding but one study review.
OBJECTIVE: To explore the association between field

tests of power (standing long jump, standing triple
jump, standing quintuple jump, backward overhead
medicine ball throw, forward overhead medicine ball
throw, maximum leg press power, maximum cycle
ergometer power in 10 seconds, and 1RM power clean
from the hang position) and event scores on the
International Association of Athletics Federation (IAAF)
scoring table.
POPULATION: 74 males in a university track and
field team (sprinters, jumpers and throwers), aged
20.0 1.1 years.
What happened?
Descriptive statistics
The researchers reported that the subjects displayed a
standing long jump of 2.69 0.16m, a standing triple
jump of 8.09 0.56m, a standing quintuple jump of
13.80 0.98m, a forward medicine ball throw of
13.44 1.40m, a backward medicine ball throw of
14.09 1.85m, leg press power of 33.00 5.48W per
kg, cycle ergometer power of 15.7 2.2W per kg, and
1RM power clean from the hang position of 93.9
20.0kg. The jumpers had a greater standing triple
jump than throwers and both the jumpers and
sprinters had a greater standing quintuple jump than
throwers. In contrast, the throwers had a greater
forward medicine ball throw, backward medicine ball
throw, leg press power and 1RM power clean from the
hang position than both the jumpers and sprinters. In
terms of the cycle ergometer power, this differed
depending on whether absolute measurements or
values relative to bodyweight were taken. Throwers
had greater absolute measurements but jumpers and
sprinters had greater relative values.
Correlations
The researchers found that in sprinters, standing triple
jump (r = 0.40), standing quintuple jump (r = 0.49),
and backward medicine ball throw (r = 0.35) were all
correlated with the IAAF scores. In throwers, forward
medicine ball throw (r = 0.48), backward medicine
ball throw (r = 0.54), and 1RM power clean from the
hang position (r = 0.55) were significantly correlated
with the IAAF score. There were no significant
correlations between field test scores and IAAF scores
in jumpers. Across all athletes, standing long jump (r
= 0.29), standing triple jump (r = 0.43), standing
quintuple jump (r = 0.51) and cycle ergometer power
(r = 0.35) were correlated with IAAF scores.

The researchers concluded that a number of simple
field tests are valuable predictors of track and field
performance at the university level, including the
standing long jump, standing triple jump, and
standing quintuple jump.
Limitations
The study was limited in that it is unclear whether
such measures could also predict changes in track and
field performance longitudinally or in elite groups.
Page 12
Influence on strength and flexibility of a swing phasespecific hamstring eccentric program in sprinters
general preparation, by Guex, Lugrin, Borloz, Millet, &
de Beaumont, in Journal of Strength & Conditioning
Research (2015)
Background
Sprint running is a key athletic quality that is
contested in its own right in track and field, as well as
being critical for success in many team sports, such as
soccer, rugby, and both Australian Rules and American
Football. Consequently, many researchers have
performed extensive work into sprint running, both
overall and in respect of certain specific aspects,
including kinematics (joint angles) kinetics (forces and
moments), stiffness, electromyographic (EMG)
activity, and the transfer of training to sprint running.
As a result, there is a large body of knowledge in
respect of the features that are characteristic of elite
sprinters and also of the training methods that may
lead to best results. Sprint running performance is
determined by the combination of stride length and
stride frequency. Observational research indicates that
some athletes rely on stride length for increased
speed while others rely more on stride frequency for
increased speed. Analysis of biomechanics suggests
that for improving stride length, hopping, bounding
and stepping drills may be able to develop different
aspects of force production during the sprint running
gait cycle. Analysis of experimental trials suggests
that sprint training, resistance training, plyometrics
and resisted sprint training all produce significant
improvements in stride length. The effectiveness of
plyometrics may be related to observations that the
storage of elastic energy is important for sprint
running performance. Indeed, researchers have found
that this elastic energy storage becomes more
important with increasing sprinting speed. This
indicates that drop jumps and other vertical
plyometric exercises might be among the most
effective training tools. Indeed, since biomechanical
analysis suggests that the main role of the knee
extensors is one of shock absorption and increased
joint stiffness upon ground contact, this further
supports a role for reactive plyometric training that
stresses this muscle group, such as drop jumps.
Related to this idea are the results of musculoskeletal
modeling research, which has reported that the
limiting factor for sprint running performance is
muscle contraction velocity. This suggests that training
rate of force development for the key running muscles
may be the single most important factor in developing
sprint running performance. This probably requires a
mix of training involving low loads with high velocities
(which can be achieved using plyometrics) and high
loads with low velocities. For improving stride
frequency, both experimental trials and biomechanical
analysis indicate that combined heavy and explosive
training along with overspeed running, using either a
downhill slope or towing are all effective.
OBJECTIVE: To assess whether additional swing

phase-specific hamstring eccentric training in welltrained sprinters can improve strength (as measured
by isokinetic concentric knee flexion torques at 60 and
240 degrees/s and isokinetic eccentric knee flexion
torques at 30 and 120 degree/s), the conventional
hamstrings-to-quadriceps torque ratio (i.e. concentric
knee flexion to concentric knee extension), the
functional hamstrings-to-quadriceps torque ratio (i.e.
eccentric knee flexion to concentric knee extension),
and flexibility (using the passive knee extension test)
compared to a similar training program without the
hamstring eccentric exercises.
POPULATION: 20 national-level sprinters (7 males,
13 females), randomly allocated to either an eccentric
(10 subjects) or a control group (10 subjects) with no
recent history of hamstring strain injury.
INTERVENTION: All subjects performed usual track
and field training, which included basic resistance
training with compound movements (squat, lunge,
standing calf raise, deadlift, clean, bench press). The
sprinters in the eccentric group also performed an
additional 6-week hamstring eccentric program, which
was specific to the swing phase of the running cycle.
This program involved two exercises: a unilateral
eccentric knee extension exercise (using a traditional
hamstring curl machine) and a unilateral eccentric hip
flexion exercise (using a hip trainer machine).
What happened?
Strength
The researchers reported that the eccentric group
significantly increased concentric hamstring torque at
60 and 240 degrees/s by 16% and 10%, respectively,
and eccentric hamstring torque at 30 and 120
degrees/s by 20% and 22%, respectively. In contrast,
the control group significantly increased only eccentric
hamstring torque at 30 and 120 degrees by 6% and
6%, respectively. The researchers reported that the
eccentric group increased the conventional and
functional ratios of both hamstring-to-quadriceps
torques by 12% and 12%, respectively.
Flexibility
The researchers reported that the eccentric group
significantly increased flexibility by 4% while the
control group did not improve flexibility.

The researchers concluded that a machine-based
hamstring eccentric training program can increase
hamstrings strength, hamstring-to-quadriceps
strength ratios, and hamstrings flexibility in nationallevel track sprinters to a superior extent than a control
group only performing standard compound exercises
such as the lunge, squat and deadlift.
Limitations
The study was limited in that it neither measured
sprint running performance nor injury outcomes.
Page 13
The effect of resisted sprint training on maximum

sprint kinetics and kinematics in youth, by Rumpf,
Cronin, Mohamad, Mohamad, Oliver, & Hughes, in
European Journal of Sport Science (2015)
Background
Sprint running is a key athletic quality that is
contested in its own right in track and field, as well as
being critical for success in many team sports, such as
soccer, rugby, and both Australian Rules and American
Football. For a detailed introduction to sprint running,
see the previous study review.
OBJECTIVE: To examine the effects of resisted sled

towing training on sprint running performance on a
non-motorized Woodway treadmill (as measured by
treadmill belt velocity), vertical and horizontal forces
(as measured by an embedded force plate within the
instrumented treadmill), various movement-related
variables (stride length, stride frequency, ground
contact time, and flight time), and leg and vertical
stiffnesses, in youths of different maturation statuses.
POPULATION: 32 children, of whom 18 were prepeak height velocity (pre-PHV) and 14 were mid- or
post-peak height velocity (post-PHV).
INTERVENTION: All subjects performed 6 weeks of
resisted sprint training comprising 12 14 training
sessions of sled towing. Each session comprised 8
10 sprints of 15 30m with an added load of 2.5, 5,
7.5 or 10% of body mass.
What happened?
Sprint running performance
The researchers found that the pre-PHV group did not
improve sprint performance, while the post-PHV
participants had significant reductions in sprint time.
Movement-related variables
improve stride frequency, while the post-PHV group
significantly increased stride frequency. Neither of the
groups improved stride length, ground contact time,
or flight time.
Force-related variables
improve either peak horizontal force or average
relative vertical force, while the post-PHV group
significantly increased both of these variables. Neither
of the groups improved average horizontal force or
peak relative vertical force.
Stiffnesses
improve either vertical or leg stiffness, while the postPHV group improved both of these measures.

The researchers concluded that youths in the pre-PHV
group did not respond beneficially to the resisted
sprint running training, while the youths in the postPHV group responded similarly to adults, based on the
findings of other trials.
Limitations
The study was limited in that it did not directly
compare the effects of this training program in youths
with a similar program in adults.
Page 14
Intramuscular anabolic signaling and endocrine

response following high volume and high intensity
resistance exercise protocols in trained men, by
Gonzalez, Hoffman, Townsend, Jajtner, Boone, Beyer,
& Stout, in Physiological Reports (2015)
Background
Introduction
The optimal structure of a resistance training program
is unclear. Many variables can be altered, including
relative load, volume, frequency, proximity to
muscular failure, rest period duration, muscle action
and repetition speed. Researchers have studied the
effect of volume on gains in strength and size more
than any other single training variable.
Effect of volume on strength gains (read more)
A number of long-term trials have assessed the effects
of different volumes on strength gains in various
populations. At our last count, at least 22 studies have
compared the effects of high and low volumes on
strength gains over long-term interventions in
untrained subjects (where low is usually a single set
and high is usually multiple sets, most commonly 3
sets). This research is relatively clear that high
volumes are superior to low volumes for strength
gains, as 13 of these 22 trials found that high volumes
led to significantly greater strength gains than low
volumes and many of the remaining studies reported
non-significant trends in the same direction. For
trained subjects, there is much less research available.
At our last count, at least 6 studies had been
performed, of which 3 found a significant benefit of
using higher volumes. In addition, several metaanalyses have been performed of the underlying data,
across both trained and untrained subjects. Thus, it
seems completely appropriate that current guidelines
recommend progressive, higher volume resistance
training in order to achieve optimal strength gains.
Effect of volume on hypertrophy (read more)
A number of long-term trials have assessed the effects
of different volumes on size gains in various
populations. At our last count, at least 14 studies have
compared the effects of high and low volumes on size
gains over long-term interventions in untrained
subjects (where low is usually a single set and high is
usually multiple sets, most commonly 3 sets). This
research is relatively clear that high volumes are
superior to low volumes for size gains, as 6 of these
14 trials found that high volumes led to significantly
greater size gains than low volumes and many of the
remaining studies reported non-significant trends in
the same direction. For trained subjects, there is much
less research available. At our last count, only 2
studies had been performed and neither found a
significant benefit of using higher volumes. However,
meta-analyses of the underlying data, across both
trained and untrained subjects, indicate that higher
volumes are superior. Thus, it seems appropriate that
current guidelines recommend progressive, higher
volume resistance training in order to achieve optimal
hypertrophy.
OBJECTIVE: To compare the acute effects of high

volume and high relative load resistance training
protocols on vastus lateralis muscle activity (as
measured by surface electromyography [EMG] during
the back squat and leg press), hormonal responses
and mTORC1 signaling activity (as measured by taking
blood samples immediately before a resistance
training workout and immediately after, as well as
after 30 minutes, 1 hour, 2 hours and 5 hours).
POPULATION: 10 resistance-trained males, aged
24.7 3.4 years, with 6.7 4.6 years of resistance
training experience and a 1RM barbell back squat of
172.7 25.2kg. The subjects performed resistance
training workouts in a randomized, counterbalanced
order.
INTERVENTION: The high volume workout was
performed with a relative load of 70% of 1RM for sets
of 10 12 repetitions with a 1 minute inter-set rest
period duration. The high relative load workout was
performed with a relative load of 90% of 1RM for sets
of 3 5 repetitions with a 3 minute inter-set rest
period duration. Both groups performed 4 6 sets of
barbell back squats, bilateral leg press, bilateral
hamstring curls, bilateral knee extensions, and seated
calf raises.
What happened?
Muscle activity
There was no difference in muscle activity between
the protocols during either the barbell back squat or
leg press exercises.
Hormonal responses
The researchers observed that the myoglobin and
lactate dehydrogenase levels were significantly greater
following the high relative load workout compared to
the high volume workout but the reverse was the case
for lactate levels, growth hormone, and cortisol. There
were no significant differences between workouts for
insulin-like-growth-factor-1 (IGF-1) or testosterone.
mTORC1 responses
The researchers observed that the phosphorylation
status of the signaling proteins within the mTORC1
pathway, including mTOR, p70S6k, and RPS6, were
not significantly different between workouts.

The researchers noted that both workouts appeared to
elicit similar mTORC1 activation in resistance-trained
men. Given that previous long-term trials have found
that higher volumes are more closely associated with
greater muscular adaptations, this calls into question
the sensitivity of mTORC1 signaling for detecting the
hypertrophic potential of a workout.
Limitations
The study was an acute trial and may not reflect the
results of long-term trials.
Page 15
High-volume resistance training reduces postprandial

lipaemia in postmenopausal women, by Correa,
Teixeira, Cobos, Macedo, Kruger, Carteri, & ReischakOliveira, in Journal of Sports Sciences (2015)
Background
than any other single training variable. For a detailed
introduction to volume, see the preceding study
review.
OBJECTIVE: To compare the effects of low-volume

and high-volume resistance training on maximal
aerobic capacity (as measured by a progressive cycleergometer test), muscle strength (as measured by
1RM knee extension strength), hypertrophy (as
measured by changes in quadriceps muscle thickness
with B-mode ultrasound), and plasma triglycerides
response to fat intake in post-menopausal women.
POPULATION: 36 healthy, untrained postmenopausal
females, aged 58.9 5.8 years, randomly allocated
into either a high-volume, a low-volume, or a control
group.
INTERVENTION: All subjects in the training groups
took part in resistance training 3 times per week for
11 weeks. The 8 exercises were performed for 15
repetitions to muscular failure (bench press, biceps
curl, triceps kick back, one arm row, leg press, knee
extension, knee flexion, and abdominal crunch). The
low-volume group performed 1 set of each exercise
and the high-volume group performed 3 sets.
What happened?
Maximal aerobic capacity
The researchers observed that maximal aerobic
capacity did not change in either the high-volume
(from 18.8 1.6 to 18.9 2.0ml/kg/min) or the lowvolume (from 18.4 1.7 to 18.6 2.0ml/kg/min)
groups. This was slightly surprising as several
previous studies have often reported increases in
aerobic fitness post-resistance training in untrained
subjects.
Muscle strength and size
The researchers observed that strength, as measured
by the 1RM knee extension, increased to a greater
extent in the high-volume group (from 27.0 4.4 to
37.1 3.6kg) compared with the low-volume group
(from 26.6 2.8 to 34.9 5.3kg). Additionally, they
found that quadriceps muscle thickness increased in
both training groups in relation to the control group
but there were no differences between groups.
Plasma triglycerides response to fat intake
The researchers observed that the high-volume group
displayed a superior decrease in baseline triglycerides
and total serum triglycerides response after fat intake
compared to the low-volume group.

The researchers concluded that high-volume programs
of resistance training are more effective than lowvolume programs for increasing muscular strength and
size, and may also be beneficial for enhancing health
measures, such as triglycerides levels, as well as the
triglycerides response to fat intake.
Limitations
The study was limited in that the exact relationship
between health outcomes and either triglycerides or
triglycerides response to fat intake is unclear.
Page 16
Acute response to cluster sets in trained and

untrained men, by Oliver, Kreutzer, Jenke, Phillips,
Mitchell, & Jones, in European Journal of Applied
Physiology (2015)
Background
than any other single training variable. For a detailed
introduction to volume, see the preceding but one
study review.
OBJECTIVE: To compare the acute mechanical (as

measured by a combination of a force plate and a set
of linear transducers), and both metabolic and
hormonal responses (as measured by taking blood
samples) between resistance training workouts
performed in a traditional style (with no rest between
repetitions) and in a cluster format (with intra-set
rests).
POPULATION: 12 resistance-trained males, aged 25
1 years and 11 untrained males, aged 25 1 years.
INTERVENTION: All subjects performed both a
traditional resistance training workout (4 sets of 10
repetitions with 2 minutes inter-set rest) and a cluster
format resistance training workout (4 sets of (2 bouts
of 5 repetitions) with a 1.5 minute rest between sets
and a 30 second rest between clusters). In both cases,
the workout involved a back squat performed using
70% of 1RM.
What happened?
Mechanical variables
The researchers observed that there was a greater
total volume load (sets repetitions load) during
the cluster format (3,266.6 100.7kg) compared to
the traditional format (3,237.6 100.3kg) because a
greater load could be managed in this format. The
cluster format also generally allowed a greater power
output across many of the repetitions. Conversely,
repetition duration was lower in the cluster format in
many of the repetitions compared to the traditional
format.
Metabolic and hormone variables
The researchers noted that blood lactate, growth
hormone, and cortisol levels post-exercise were all
greater in the traditional condition than in the cluster
condition. Testosterone levels returned to baseline
earlier in the cluster condition than in the traditional
condition.

The researchers concluded that the cluster format
allowed the performance of greater volume load and
higher average power output, which likely implies a
larger mechanical stress. In contrast, they concluded
that the traditional format displayed a higher level of
metabolic stress (higher blood lactate) and a stronger
hormonal response (growth hormone, testosterone,
and cortisol) than the cluster format.
Limitations
The study was an acute trial and the differences in
long-term outcomes between the two conditions are
unclear.
Page 17
Selective hypertrophy of the quadriceps musculature

after 14 weeks of isokinetic and conventional
resistance training, by Matta, Nascimento, Trajano,
Simo, Willardson, & Oliveira, in Clinical physiology
and functional imaging (2015)
Background
Introduction
relative load, volume, frequency, the proximity to
and repetition speed. During resistance training, the
type of external load can be changed but this has only
rarely been explored. In general, the type of external
load can be divided into types where the load remains
the same throughout the movement (isoinertial) and
types where the load varies during the movement
(variable). Variable types of resistance can be further
subdivided into types were the load changes in order
to maintain a constant velocity during the exercise
(isokinetic) and those in which the load is altered to
follow the force-angle curve more generally (strictly
variable, but sometimes also called accommodating
resistance).
Effects of variable resistance on strength gains
Various researchers have investigated the differences
in effects on strength gains during long-term periods
of resistance training using either constant load or
variable load resistance types, while training with
barbells. In such cases, the variable loads are created
by the use of either bands or chains. To date, at least
5 studies have been performed in resistance-trained
subjects. However, among these studies, only 1 has
reported a superior benefit on strength gains of using
variable resistance types compared to using constant
load resistance. The use of variable resistance or
constant loads may therefore make little difference to
strength gains in trained subjects. Similarly, to date,
only 1 study has been carried out assessing the
difference in the effect on strength gains between
constant load or variable load resistance types, while
training with barbells in untrained subjects. In this
study, there was no difference between the variable
and the constant load resistance type. Therefore,
despite the huge popularity of variable resistance, the
addition of bands and chains may not be superior to
constant loads for resistance trained and untrained
populations. Whether benefits might be observed in
elite powerlifters, however, is unclear.
OBJECTIVE: To compare the long-term effects of

resistance training using either constant load or
variable (isokinetic) resistance on muscular strength
(as measured by maximum isometric knee extension
torque, with an isokinetic dynamometer) and changes
in quadriceps muscle size (as measured by changes in
muscle thickness with ultrasound).
POPULATION: 35 males, randomly assigned to one
of three groups: constant load resistance training (12
subjects, aged 19.3 0.9 years), variable load
(isokinetic) resistance training (12 subjects, aged 19.1
0.3 years), and a control group (11 subjects, aged
19.6 1.3 years).
INTERVENTION: Both of the resistance training
groups performed 3 sets of unilateral knee extension
exercise in each workout, 2 times per week for 14
weeks.
What happened?
Muscular strength
The researchers found that both external loading
types produced significant increases in strength. In
the constant load group, maximum isometric knee
extension torque increased by 22 5%, while in the
variable load group it increased by 29 6%, with no
significant differences between groups.
Muscular size
The researchers found non-uniform changes in muscle
thickness between muscles. In both groups, there
were significantly greater increases in rectus femoris
thickness compared to the other quadriceps muscles.
However, there was no significant difference between
the two groups.

The researchers concluded that constant load and
variable resistance knee extension training lead to
similar increases in muscular strength and size.
However, knee extension resistance training leads to
greater increases in rectus femoris size than in the
other quadriceps muscles.
Limitations
other quadriceps exercises would also lead to
preferential development of the rectus femoris over
long-term periods.
Page 18
Efficacy of manual versus free-weight training to

improve maximal strength and performance for
microgravity conditions, by Behringer, Schren,
McCourt, & Mester, in Journal of Sports Sciences
(2015)
Background
During resistance training, the type of external load
can be changed but this has only rarely been
explored. In general, the type of external load can be
divided into types where the load remains the same
throughout the movement (isoinertial) and types
where the load varies during the movement (variable).
Variable types of resistance can be further subdivided
into types were the load changes in order to maintain
a constant velocity during the exercise (isokinetic) and
those in which the load is altered to follow the forceangle curve more generally (strictly variable, but
sometimes called accommodating resistance). For a
detailed introduction to external resistance, see the
previous study review.
OBJECTIVE: To compare the effects on muscular

strength (as measured by maximal isometric force of
trunk flexion, back extension, chest press and wide
grip row using an isometric dynamometer and 1RM
back squat in a Smith machine) and jumping height
between training using a device designed for manual
resistance training in space (the Self-Powered Rope
Trainer Duo [SPoRT Duo]) with standard free weight
resistance training. The SPoRT Duo involves two
individuals training together by passing cables through
ground-based pulleys. While using this device, one
individual provides resistance for the other while they
perform the exercise.
POPULATION: 24 recreationally trained males, aged
20.8 2.1 years, were randomly assigned either to a
manual resistance group (12 subjects) or to a freeweight group (12 subjects)
INTERVENTION: All subjects performed 8 exercises
(3 sets of 8 12 repetitions) either with free weights
or with the SPoRT Duo, 2 times per week for 6 weeks.
The 8 exercises were: deadlifts, squats, bent-over
rows, pectoral fly, triceps extensions, biceps curls, calf
raises and crunches.
What happened?
Muscular strength
The researchers reported that maximal isometric force
in trunk flexion, back extension and chest press
increased significantly in both groups but there was no
significant difference between groups. Neither group
increased maximum isometric force in the wide grip
row. Both groups significantly increased 1RM back
squat in the Smith machine.
Squat jump height
The researchers found that the free-weight group
significantly increased jump height (by 9.8%
13.2%) but the manual resistance group did not
(2.0% 8.5%).

The researchers concluded that the manual resistance
device was similarly effective for improving a range of
upper and lower body strength measures as standard
free weights. However, the device was not as effective
for increasing squat jump height, which may mean
that it is less effective for athletic development.
Limitations
The study was limited in that it was carried out in
recreationally trained males and different results
might be observed in other populations, such as the
elderly.
Page 19
Plyometric training effects on athletic performance in

youth soccer athletes a systematic review, by
Bedoya, Miltenberger, & Lopez, in Journal of Strength
& Conditioning Research (2015)
Background
The term plyometrics was first popularized with the
Soviet jumping coach, Verkoshansky. Verkoshansky
wanted to explore ways to develop the jumping ability
of athletes who had already attained significant gains
using standard methods at the time, which mainly
comprised jumping practice and resistance training.
Verkoshansky reasoned that since there seemed to be
a correlation between short ground contact times and
better performances in triple jumpers, this could imply
that a greater stiffness (or a superior ability to store
and release elastic energy) could be the key to
improved jumping ability. Thus, he started using depth
jumps with his athletes in order to increase their
ability to switch from eccentric muscle actions to
concentric muscle actions more quickly, thereby
reducing ground contact times. While many coaches
still think of plyometrics in these terms, the usage in
the modern literature has changed substantially.
Today, the term plyometrics refers to explosive,
compound upper- or lower-body movements involving
the stretch-shortening cycle. When considering the
lower-body, various different types of jumps are
included within this definition and for the upper-body,
medicine ball throws are a frequent example. There is
therefore a difference between the earliest popular
usage of the term by Verkoshansky and his later
disciples and the modern sports science literature,
which seems to use the term as a subset of ballistic
resistance training exercises, being those using very
low-loads or no-load and which involve the stretchshortening cycle. Moreover, it is often stated that such
plyometrics are the key to bridging the qualities of
strength and power. Thus, there is also a difference
between the intended purpose of plyometrics between
the early popular usage and usage in modern sports
science, as Verkoshansky intended the training
modality to improve jumping performance, while
modern literature expressly refers to increases in
muscular power. If Verkoshanksy was correct and the
means by which plyometrics improves jumping
performance is by increasing stiffness, then we might
not necessarily expect to see substantial changes in
power, or at least we might see smaller changes than
by other training modalities. Unfortunately, there are
very few long-term trials comparing the use of
plyometrics to other training modalities in relation to
improving muscular power output. However, there are
a great many long-term trials demonstrating that
plyometrics do consistently increase both muscular
power and vertical jumping ability. Additionally,
plyometrics appears to lead to increases in muscle size
as well as enhancements in neural drive, despite
assertions to the contrary by coaches lacking in
knowledge of the literature.
OBJECTIVE: To perform a systematic review to

assess the effectiveness of plyometric training on
athletic performance in youth soccer athletes.
STUDY SELECTION: Studies were included that
assessed the long-term effects of plyometric training
programs on athletic performance in preadolescent to
17 year old soccer athletes, published between 2000
and the end of 2013.
What happened?
Study selection and quality
The researchers identified 7 studies that met the
inclusion criteria. The studies displayed a range of
PEDro quality scores of 4 6 points, with a mean
score of 5 points.
Plyometric programs
The plyometric training programs ranged from 6 12
weeks, with workouts being performed 1 3 days per
week. In general, the researchers noted that common
plyometric exercises included: forward and backward
hops, lateral hops, power skips, forward hops over 6inch cone, lateral hops, single leg hops (both legs), on
and off box jumps (12-inch), lateral hops over 10-inch
hurdles, power skips, toe taps on soccer ball, on and
off box jumps (12 and 18 inch), box drop jumps for
height, single leg hops over agility cone (both legs),
and high knees over 10-inch hurdles.
Performance tests
Various tests were used to assess athletic and soccerspecific performance improvements, including kicking
tests, short distance sprints (20 40m), the multiple
5-bound test, countermovement jump, depth jump,
agility tests, sprint cycling, and a modified version of
the Loughborough Intermittent Shuttle Test (LIST).

The researchers found that the currently available
studies confirm that youth soccer athletes generally
improve across a range of soccer-specific and athletic
performance measures after plyometric training.
Limitations
The systematic review was limited by the lack of
quantitative analysis and by the large degree of
heterogeneity between studies in respect of the
performance measures assessed and the programs
carried out.
Page 20
Effect of plyometrics on the energy cost of running

and MHC and titin isoforms, by Pellegrino, Ruby, &
Dumke, in Medicine & Science in Sports & Exercise
(2015)
Background
The term plyometrics was first popularized with the
Soviet jumping coach, Verkoshansky. Verkoshansky
wanted to explore ways to develop the jumping ability
of athletes who had already attained significant gains
using standard methods at the time, which mainly
comprised jumping practice and resistance training.
Today, the term plyometrics refers to explosive,
compound upper- or lower-body movements involving
the stretch-shortening cycle. For a more detailed
introduction to plyometrics, see the previous study
review.
OBJECTIVE: To explore the effects of plyometric

training on body composition (as measured using
hydrostatic weighing), vertical jump height, flexibility
(as measured by the sit-and-reach test), aerobic
capacity (as measured by an incremental treadmill
running test for VO2-max using a metabolic cart),
running economy (measured by oxygen consumption
at a range of running speeds), endurance running
performance (as measured by 3km time trial time),
and changes in both titin and muscle fiber type in
muscle biopsies taken from vastus lateralis (measured
by reference to myosin heavy chain (MHC) isoforms).
POPULATION: 22 experienced recreational runners
from local running clubs (14 males, 8 females).
INTERVENTION: The plyometric training program
was progressive and comprised 15 sessions over 6
weeks. The total contacts per session was increased
from 60 to 228 and the intensity of the jumps was
also increased over the 6 weeks.
What happened?
Performance tests and physiological changes
The researchers found that the plyometrics program
led to a significantly improved time trial performance
compared to the control (2.6% vs. 1.6%), which was
accompanied by a significant improvement in maximal
aerobic capacity that was not displayed by the control
group (5.2% vs. 3.1%). Vertical jump height reduced
significantly in the control group but did not change in
the plyometrics group (-6.8% vs. -0.7%). Energy cost
of running decreased significantly in the plyometrics
group at several velocities and increased in the control
group.
Changes in muscle fiber type
The researchers found no significant changes in any of
the MHC isoforms analyzed. There was a trend for an
increase in MHCI fiber type percentage in both the
plyometric (3.3%) and control (15.4%) groups and a
trend for a decrease in MHCII fiber type percentage in
both the plyometric (-5.0%) and control (-14.9%)
groups. The trends seemed larger in the control group
than in the plyometric group. Interestingly, MHCIIa
proportion was positively and moderately correlated
with vertical jump height (r = 0.59) and vertical jump
height was also positively and moderately correlated
with time trial running performance (r = 0.55).

The researchers concluded that a short-term program
of plyometric training improved endurance running
performance and the energy cost of running despite
there being no clear, measurable changes in muscle
fiber type. Correlations showed that greater jumping
heights seem to be related to greater type IIa muscle
fiber proportion and better endurance running ability.
Limitations
The study was limited in that there were evident
trends in the muscle fiber type changes, which may
have been type II error because of a lack of power.
Page 21
Effects of 6-weeks resistance training combined with

ply ometric a nd s peed ex erc is es on phy s ic a l
performance of pre-peak height velocity soccer
players, by Rodriguez-Rosell, Franco-Mrquez, ParejaBlanco, Mora-Custodio, Yez-Garca, GonzlezSurez, & Gonzlez-Badillo, in International journal of
sports physiology and performance (2015)
Background
Soccer or Association Football is the world's most
popular team sport and is played by more than 250
million people in over 200 separate countries. Through
this incredible popularity, it is known simply as
football in most parts of the world, despite the
existence of many other football codes, including
American Football, Australian Rules Football, Gaelic
Football, and Rugby. Soccer is played in teams of 11
players in two halves of 45 minutes in length with a
15-minute break between the two halves. Play runs
continuously within halves, such that the clock is not
stopped while the ball is out of play. Every four years,
the World Cup is held, in which around 200 national
teams compete in qualifying tournaments in the hope
of becoming one of the 32 national teams that
compete in the 4-week competition. The most recent
World Cup was held in Brazil and was the twentieth
such competition. Germany beat Argentina 10 in the
final to take their fourth title. Training for soccer
requires a focus on many different aspects, including
physical qualities, technical skills, and tactical abilities.
There are many different physical qualities that are
important for soccer, including aerobic endurance,
anaerobic endurance, strength, power and flexibility.
Traditionally, soccer teams placed the most emphasis
on aerobic endurance, noting that players needed to
be able to run long distances during games. Indeed,
there is a basic agreement that soccer players travel
around 9 14km in a single 90-minute match,
although the exact distance depends on the position
played. Training methods for improving aerobic
capacity include interval training, small-sided games,
game simulations, soccer-specific circuits, repeated
sprints, and agility drills. More recently, soccer teams
have begun to focus more on sprint running ability,
which appears to be crucial in allowing soccer athletes
to dominate situations during play. This change in
focus came out of the realization that the nature of
the activity performed by soccer players during a
game comprises long periods of low-intensity walking
or jogging, interspersed by short periods of maximal
or near-maximal effort, including accelerating sprints.
Some studies have found that players perform many
such accelerating sprints per match, for a total
distance of around 200m. Sprint running ability can be
improved by various training methods, including
sprinting, heavy load resistance training, ballistic
resistance training, plyometrics, and assisted and
resisted sprinting. There is currently no strong
consensus around which type of training is best,
although a recent meta-analysis concluded that novice
athletes benefit most from sprint running practice and
more advanced athletes benefit more from a varied
program.
OBJECTIVE: To assess the effects of low-load, highvelocity resistance training combined with plyometrics
on short distance sprint running ability (as measured
by photocell timing gates over both 10m and 20m)
and countermovement jump height (as measured by
an infrared timing system) in pre-peak height velocity
(pre-PHV) soccer players.
POPULATION: 30 pre-PHV soccer players, aged 13
1 years from the same academy, randomly allocated
to either a training group (15 players) or a control
group (15 players).
INTERVENTION: Training comprised full squats with
low loads (45 58% of 1RM) and low volumes (4 8
repetitions per set) in addition to jumps and both
straight-line and change-of-direction sprints, 2 times
per week for 6 weeks. Each session lasted only 35
minutes.
What happened?
Sprint running
The researchers reported that the training group
significantly reduced 10m (by 2.7%) and 20m (by
2.7%) and flying 10m (by 3.5%) sprint times while
the control group did not improve sprint running times
at all.
Countermovement jump height
The researchers reported that the training group
significantly increased countermovement jump height
(by 12.2%) while the control group did not improve.

The researchers concluded that a combination of full
squat resistance training with low volume and low
loads and plyometrics can improve both short distance
sprint running and countermovement jump
performances in pre-PHV soccer players.
Limitations
similar results would be observed in older players, or
in players with some resistance training experience.
Page 22
Determinant factors of pull up performance in trained

athletes, by Snchez-Moreno, Pareja-Blanco, DazCueli, & Gonzlez-Badillo, in The Journal of Sports
Medicine and Physical Fitness (2015)
Background
Although lat-pull downs, pull-ups and chin-ups are
common exercises that appear in most resistance
training programs for both athletes and bodybuilders
for developing the latissimus dorsi and other middle
back muscles, they have not been widely studied by
researchers. What research has been performed has
largely investigated the hand-position, grip width and
head position of either pull-ups or lat pull-downs. Grip
width (wide vs. narrow), hand position (pronated vs.
supinated) and head position (behind the head vs. in
front of the head) all appear to affect the muscle
activity of some of the back and arm muscles during
both pull-ups and lat pull-downs. In terms of the
latissimus dorsi, it has been found that latissimus
dorsi muscle activity is greater in wide grip lat pulldowns than in narrow grip pull-downs, even though
the load that can be lifted is lower in wide grip lat pulldowns than in narrow grip lat pull-downs. However, it
seems that latissimus dorsi muscle activity is similar
between behind the head and in front of the head
positions. Also, using a pronated grip leads to greater
latissimus dorsi muscle activity than a supinated grip,
although the reverse is the case for biceps brachii
muscle activity. In addition, although they appear very
similar exercises, there are some differences in muscle
activity between the lat-pulldown and the pull-up or
chin-up exercises. Although the two exercises display
similar latissimus dorsi muscle activity, the biceps
brachii and erector spinae muscles seem to involve
greater muscle activity during chin-ups than during
the lat pull-down. The reasons for these differences
are unclear but may relate to the relative stability of
the two exercises.
OBJECTIVE: To evaluate the relationships between

pull up and lat pull-down performances at various
loads, by reference to the maximum number of pull
ups, the 1RM lat pull-down, the maximum number of
lat pull-down repetitions with 80% of 1RM, the
maximum number of lat pull-down repetitions with
body mass, and to explore whether pull up or lat pulldown performances are explained by any individual
anthropometric variables (body height, body mass,
body composition as estimated by skinfold analysis).
POPULATION: 25 trained males (either firefighters or
policeman candidates), aged 26.8 6.3 years.
INTERVENTION: All subjects performed both pull up
and lat pull-down tests, including maximum number of
pull ups (rep-BW-PU), the 1RM lat pull-down (1RMLP), the maximum number of lat pull-down repetitions
with 80% of 1RM (rep-80%-LP), and the maximum
number of lat pull-down repetitions with body mass
(rep-BW-LP).
What happened?
Relationship between pull ups and lat pull-downs
The researchers reported the presence of significant
relationships between rep-BW-PU and rep-BW-LP (r =
0.62) and between rep-BW-PU and 1RM-LP relative to
bodyweight (r = 0.59) but not between rep-BW-PU
and rep-80%-LP (r = 0.14) or between rep-BW-PU
and 1RM-LP (r = 0.09). Unsurprisingly, 1RM-LP and
rep-80%-LP were significantly associated (r = 0.55).
Anthropometrics
The researchers found that rep-BW-PU was negatively
associated with bodyweight (r = -0.55), fat mass (r =
=-0.55), and lean body mass (r = -0.50) but there
was no association between rep-BW-PU and percent
body fat or percent lean mass. In turn, 1RM-LP was
positively associated with body mass (0.55) and lean
body mass (r = 0.55).
Predictive equations
Based on these data, the researchers produced an
equation to predict pull ups from 1RM-LP performance
and bodyweight (BW), as follows: rep-BW-PU = 0.34 x
BW + 0.72 x 1RM-LP + 29.37kg. However, this
equation only explained 52% of the variance in
maximum pull up repetitions.

The researchers concluded rep-BW-PU is significantly
associated with 1RM-LP relative to bodyweight but not
with absolute 1RM-LP. They noted that increasing
bodyweight seems to be advantageous for 1RM-LP but
disadvantageous for rep-BW-PU.
Limitations
The study was limited in that the predictive equations
were not able to explain the majority of the variance
in the variables being connected.
Page 23
Post-exercise cold water immersion attenuates acute

anabolic signalling and long-term adaptations in
muscle to strength training, by Roberts, Raastad,
Markworth, Figueiredo, Egner, Shield, & Peake, in The
Journal of Physiology (2015)
Background
Recovery from training and competition is very
important for athletes. Until they are fully recovered,
athletes cannot function again at their previous high
level of performance. However, recovery is difficult to
define precisely. It is often defined as the rate at
which the fatigue induced by a prior training bout or
competition is dispersed, relative to the magnitude of
that fatigue. But since fatigue is also difficult to pin
down and measure precisely, even this broad
definition is problematic. Additionally, recovery is often
measured over multiple different time periods. In
general, there are three main types of recovery
referred to in the literature: immediate recovery,
short-term recovery, and training recovery. Immediate
recovery refers to the recovery that is allowed during
performance, between muscular contractions. For
example, a certain amount of recovery for the leg
muscles occurs during the flight phase of running
between ground contact phases. Short-term recovery
occurs between sets of intervals or between multiple
sets of resistance training exercises. Training recovery
refers to the period of adaptation between sequential
workouts or between competitions. The definition of
the time periods still does not address the problem of
what is being measured, however. Therefore, in order
to bring some measure of precision to the study of
recovery, researchers have settled on various indirect
measures of recovery, including glycogen re-synthesis,
electrolyte replacement and rehydration, performance
measures (e.g. maximal strength, repetition strength,
muscular power or anaerobic power output),
biomarkers of muscle damage such as creatine kinase
(CK), changes in heart rate variability (HRV), and selfperception of delayed onset muscle soreness (DOMS).
The individual performance measures are clearly able
to provide a concrete understanding of how much
fatigue has affected the athlete and how long such
performance took to return. However, the exact speed
at which performance returns is affected by any
super-compensation that might occur in response to
the training bout. The biomarkers of muscle damage
can appear to be slightly more scientific measures to
some people, as can HRV measurements. However,
the extent to which these measures (and others) are
good measures of overall fatigue is open to debate. A
number of different interventions have been tested for
reducing improving recovery and reducing DOMS.
There is some evidence to support the use of massage
and limited evidence to support the use of selfmyofascial release with a foam roller for reducing
DOMS, in particular. However, the mechanisms by
which such modalities might be effective for reducing
DOMS are not well-understood.
OBJECTIVE: Two studies were performed, an acute

study and a chronic study. In the acute study, the
purpose was to assess the effects of post-exercise cold
water immersion on satellite cell response (by taking
muscle biopsies). In the chronic study, the purpose
was to explore the effects of post-exercise cold water
immersion on long-term changes in muscular strength
(as measured by isokinetic dynamometry and various
1RM lower body strength exercises), quadriceps size
(as measured by magnetic resonance imaging [MRI]
scans), and muscle fiber type area (as measured by
immunohistochemistry).
POPULATION: Acute study: 9 physically active
males. Chronic study: 21 physically active males.
INTERVENTION: Acute study: a single bout of lowerbody strength exercises. Chronic study: All subjects
trained 2 days per week for 12 weeks, with either 10
minutes of cold water immersion or active recovery
post-exercise. Training comprised resistance training
exercises, including the 45-degree leg press, knee
extension, knee flexion, and walking lunges, and
plyometrics exercises, comprising drop jumps, slow
eccentric squat jumps, split lunge jumps, and box
jumps. Cold water immersion therapy involved sitting
in water at 10.1 0.3 degrees C with both legs
immersed to the waist. Active recovery comprised low
intensity stationary cycle ergometer exercise.
What happened?
Acute study
The researchers observed that the number of satellite
cells expressing neural cell adhesion molecule (NCAM)
and paired box protein (Pax7) increased 24 48 hours
post-exercise in both groups but the increase was
greater after active recovery than after cold water
immersion.
Chronic study
Isoinertial and isometric strength measures increased
more in the active recovery group than in the cold
water immersion group. Similarly, quadriceps muscle
mass increased more in the active recovery group
than in the cold water immersion group (309 73g
vs. 103 71g). Type II fiber area increased in the
active recovery group (17.1 5.1%) but not in the
cold water immersion group. The number of myonuclei
per type II fiber increased significantly after training in
the active recovery group (26.1 4.2%) and the total
number of myonuclei increased significantly after
training in the active recovery group (17.0 4.4%)
but neither of these increased in the cold water
immersion group, suggesting reduced satellite cell
activity as in the acute study.

Cold water immersion attenuates long-term gains in
muscle mass and strength, possibly through the
suppression of satellite cell activity.
Limitations
The study was limited in that it is unclear whether the
same results would be observed in other populations.
Page 24
2. BIOMECHANICS AND MOTOR CONTROL
Page 25
Acceleration capability in elite sprinters and ground

impulse: push more, brake less? By Morin, Slawinski,
Dorel, Couturier, Samozino, Brughelli, & Rabita, in
Journal of Biomechanics (2015)
Background
One of the most fierce debates in all of strength and
conditioning rages between those coaches and
researchers who believe in the importance of vertical
ground reaction forces and those who believe in the
importance of horizontal ground reaction forces for
sprint running speed. Ground reaction forces are
usually measured using force plates. The force plate
records the force exerted by the ground back onto the
athletes foot as they step onto it, hence: ground
reaction force. In accordance with Newtons Third Law,
this force must be equal and opposite to the force
exerted by the athlete in each direction. Since during
running the athlete is moving upward and forward, the
forces will be both vertical and horizontal. During
vertical jumping, on the other hand, horizontal forces
are minimal. In line with basic physical principles, it is
generally accepted that both stride length and stride
frequency during running are increased as a result of
greater ground reaction forces. However, as noted
above, there is disagreement regarding whether it is
vertical ground reaction forces or horizontal ground
reaction forces that are more important for increasing
running speeds. Care is needed here to understand
what is being said this debate does not refer to
accelerating to faster running speeds but to constant
running speeds following a period of acceleration. In
brief, the researchers who support the view that
vertical ground reaction forces are more important for
faster running speeds have suggested this is because
the vertical ground reaction forces are much larger
than the horizontal ground reaction forces. They note
there is little horizontal resistance to overcome. They
suggest that the requirement for horizontal propulsive
forces at constant speeds need only be sufficient to
counteract the braking forces. Therefore, they propose
that vertical forces are more important. Based on this
conclusion, they believe that exercises that stress the
musculature in an axial direction (e.g. squats) are
more important than exercises that stress the
musculature in an anteroposterior direction (e.g. hip
thrusts). On the other hand, researchers who support
the opposing view have suggested that horizontal
forces are more important than vertical ground
reaction forces because research clearly shows that
the extent to which horizontal forces increase with
increasing running speed is far greater than the extent
to which vertical ground reaction forces increase.
Based on this conclusion, they believe that exercises
that stress the muscles in an anteroposterior direction
are more important than exercises that stress the
musculature in an axial direction. Until long-term trials
are performed comparing the effects of exercises in
each category, however, it is unlikely that there will be
a resolution to the debate.
OBJECTIVE: To assess whether elite sprinters display

a greater propulsive horizontal impulse component
(IMPH+) or a smaller braking horizontal impulse
component (IMPH-) of the overall horizontal impulse
(IMPH), or both, by measuring ground reaction forces
during repeated short sprints over a 6.6m force plate.
POPULATION: 9 international level or national level
sprinters, with a mean 100m personal best time of
10.37 0.27s (range = 9.95 10.60s).
INTERVENTION: All sprinters performed a total of 7
sprints (2 sets of 10m, 2 sets of 15m, 1 set each of
20m, 30m and 40m) on an indoor track.
What happened?
The researchers found that both IMPH and IMPH+
were significantly correlated with 40m sprint running
speed (r = 0.868 and 0.802, respectively) but vertical
impulse and IMPH- were not.

The researchers concluded that faster sprint running
performances were associated with greater IMPH and
IMPH+ but IMPH- was not related to sprint running
times. This may imply that interventions to increase
IMPH+ are likely to be more effective in improving
sprint running ability than interventions designed to
reduce IMPH-.
Limitations
The study was cross-sectional and therefore it is
unclear whether changes in IMPH or IMPH+ would
occur with changing sprint running performance over a
long-term period of time. Also, it is unclear what
training methods are optimal for improving IMPH and
IMPH+ in athletes.
Page 26
A comparison of gluteus maximus, biceps femoris, and

vastus lateralis EMG activity in the back squat and
barbell hip thrust exercises, by Contreras, Vigotsky,
Schoenfeld, Beardsley, & Cronin, in Journal of Applied
Biomechanics (2015)
Background
The squat is a key exercise in training programs and
can be classified in different ways (including barbell
placement, technique, stance width or foot placement,
and fixed or free weight). Test-re-test reliability of
back squat 1RM testing is nearly perfect, although a
familiarization effect has been observed. Prime movers
in the back squat are the quadriceps, gluteus
maximus and erector spinae. The hamstrings are
antagonist co-contractors. The roles of the adductors,
calves and abdominals are unclear. In the back squat,
using a wider stance and knee wraps increase gluteus
maximus muscle activity, while using running shoes
rather than no footwear increases quadriceps muscle
activity. Most squat variations appear to lead to similar
quadriceps, gluteus maximus and erector spinae
muscle activity, but the back squat displays greater
quadriceps muscle activity than the split squat and
overhead squat. No other exercise has been found to
involve greater quadriceps muscle activity than the
back squat but the barbell hip thrust involves greater
gluteus maximus activity and the deadlift involves
greater erector spinae muscle activity. Heavier loads
are lifted during partial rather than parallel squats by
individuals with greater levels of resistance training
experience, and by athletes using a powerlifting-style
of squat compared to an Olympic weightlifting-style of
squat. Ground reaction forces are primarily a function
of the absolute loads used. The optimal load for power
during back squats is unclear. Supportive equipment
(knee wraps and weightlifting belts) increases power
output, most likely by increasing velocity as a result of
stored elastic energy in the lowering phase. Greater
trunk angles in the back squat are observed in
subjects wearing no footwear rather than running
shoes and when using cues to restrict the movement
of the knees over the toes. The effect of cues to
prevent knee movement over the toes on peak hip
angle is unclear but cues to look downwards rather
than upwards lead to more acute peak hip angles,
while increasing fatigue leads to less acute peak hip
angles. Increasing load and wearing running shoes
rather than no footwear lead to more acute peak knee
angles, while using cues to prevent forward knee
movement over the toes and fatigue lead to less acute
peak knee angles. Weightlifting shoes and running
shoes both lead to more acute peak ankle angles than
using no footwear, while cues to prevent the knee
from moving forward over the toes lead to less acute
peak ankle angles. Hip extensor moments in the back
squat increase with increasing relative load, squat
depth, trunk lean and with cues to prevent forward
movement of the knees over the toes. They are
greater using a powerlifting-style squat than a
standard squat. In the Smith machine, hip extensor
moments are greater with a foot position that is more
forward of the barbell or with a backward inclination.
OBJECTIVE: To compare the muscle activity (using

surface electromyography [EMG]) activity of the upper
and lower regions of the gluteus maximus, biceps
femoris, and vastus lateralis during the back squat
and barbell hip thrust exercises with the same relative
loads, in trained females.
POPULATION: 13 trained females, aged 28.9 5.11
years, with 7.00 5.80 years of resistance training
experience, with a 10RM of 53.2 17.0kg back squat
and a 10RM of 87.4 19.3kg barbell hip thrust.
INTERVENTION: Subjects performed 10 repetitions
with their estimated 10RM back squat and 10RM
barbell hip thrust exercises, calculated by reference to
maximum repetition testing as 75% of estimated 1RM.
What happened?
Upper and lower gluteus maximus muscle activity
The researchers reported that the barbell hip thrust
displayed significantly greater mean upper gluteus
maximus muscle activity (69.5% vs. 29.4%), peak
upper gluteus maximus muscle activity (172% vs.
84.9%) mean lower gluteus maximus muscle activity
(86.8% vs. 45.4%) and peak lower gluteus maximus
muscle activity (216% vs. 130%) compared to the
back squat, with the same relative load.
Hamstrings and quadriceps muscle activity
The researchers reported that the barbell hip thrust
displayed significantly greater mean biceps femoris
muscle activity (40.8% vs. 14.9%) and peak biceps
femoris muscle activity (86.9% vs. 37.5%) compared
to the back squat, with the same relative load. They
did not detect any significant differences in mean
vastus lateralis muscle activity (99.5% vs. 110%) or
peak vastus lateralis muscle activity (216 vs. 244%)
between the two exercises.

The researchers concluded that the barbell hip thrust
activates the upper and lower regions of the gluteus
maximus and biceps femoris to a greater extent than
the back squat when using similar relative loads.
Limitations
The study was limited in that trained females were
tested and different results might have been found in
other populations. In addition, a small sample size
was used and the small differences in vastus lateralis
muscle activity between exercises (in favor of the back
squat) that were not statistically significant might
have been type II error.
Page 27
A comparison of gluteus maximus, biceps femoris, and

vastus lateralis EMG amplitude in the parallel, full, and
front squat variations in resistance trained females, by
by Contreras, Vigotsky, Schoenfeld, Beardsley, &
Cronin, in Journal of Applied Biomechanics (2015)
Background
The barbell squat is a fundamental exercise in training
programs and can be classified in different ways
(including barbell placement, technique, stance width
or foot placement, and fixed or free weight). For a
detailed review of the barbell squat, see the previous
study review.
OBJECTIVE: To compare the muscle activity (using

surface electromyography [EMG]) activity of the upper
and lower regions of the gluteus maximus, biceps
femoris, and vastus lateralis during front squats, full
back squats, and parallel back squats.
POPULATION: 13 healthy, trained females, aged
28.9 5.1 years, with 7.00 5.8 years of resistance
training experience and an estimated 10RM of 39.2kg,
46.7kg, and 53.1kg in the front squat, full back squat
and parallel back squat, respectively.
INTERVENTION: Subjects performed 10 repetitions
with their estimated 10RM front squat, full back squat
and parallel back squat, respectively. 10RM was
calculated in each case by reference to maximum
repetition testing as 75% of estimated 1RM.
What happened?
Upper and lower gluteus maximus
There were no differences in mean upper gluteus
maximus muscle activity between front squats, full
back squats, and parallel back squats (29.15
14.35%, 29.58 16.26%, 29.35 16.45%). Similar
results were found for peak upper gluteus maximus
muscle activity. There were no differences in mean
lower gluteus maximus muscle activity between front
squats, full back squats, and parallel back squats
(43.89 20.75%, 42.24 21.51%, 45.29 23.54%)
and similar results were found for peak lower gluteus
maximus muscle activity.
Vastus lateralis and biceps femoris muscle activity
There were no differences in mean vastus lateralis
muscle activity between front squats, full back squats,
and parallel back squats (124.22 72.96%, 123.82
67.42%, 110.35 47.24), although there was a trend
for greater muscle activity in front squats and full
squats compared to parallel back squats. Similarly,
there were no differences in peak vastus lateralis
muscle activity between front squats, full back squats,
and parallel back squats (302.61 191.80%, 280.54
166.16%, 243.92 121.63%), although there was
a trend for greater muscle activity in front squats and
full squats compared to parallel back squats. There
were no differences in mean or peak biceps femoris
muscle activity between squat variations.

The researchers concluded that squat variation does
not affect upper and lower gluteus maximus muscle
activity, vastus lateralis muscle activity or biceps
femoris muscle activity.
Limitations
The study was limited in that trained females were
tested and different results might have been found in
other populations. In addition, a small sample size
was used and the small differences in vastus lateralis
muscle activity between exercise variations (in favor
of deeper squats) that were not statistically significant
might have been type II error.
Page 28
Spatial EMG potential distribution of biceps brachii

muscle during resistance training and detraining, by
Watanabe, Kouzaki, & Moritani, in European Journal of
Applied Physiology (2015)
Background
Electromyography (EMG) is a commonly-used method
that helps researchers understand how strongly a
muscle is contracting. EMG is performed using an
electromyograph in order to produce an output known
as an electromyogram. An electromyograph detects
electrophysiological activation of a muscle during the
production of mechanical force. EMG is an important
method as it is not possible with current technology to
measure forces inside a muscle. Musculoskeletal
modeling can provide an estimate of these forces but
such values are based upon a variety of assumptions
and are indirect and not direct measurements.
Measuring EMG activity using an electromyograph
involves placing electrodes either on or in a muscle.
Electrodes can be placed either upon the skin (surface
EMG) or directly into the muscle itself (fine wire EMG).
While fine wire EMG is thought to provide a more
accurate picture of the EMG activity in a very specific
part of a muscle, it is invasive and so surface EMG is
more commonly used. Signals from surface EMG
electrodes are less reliable than signals from fine wire
electrodes because they can experience interference
from neighboring muscles and they can slip or move
during muscle actions, particularly where concentric or
eccentric muscle actions are being performed (and not
isometric muscle actions). The electrophysiological
signal detected by electrodes starts when a muscle
fiber or group of muscle fibers is activated by the
central nervous system (CNS) via a motor nerve. The
activation starts with the electrophysiological
depolarization cell membranes, leading to the release
of Ca2+ ions within the muscle cells, and the
subsequent activation of actin/myosin filaments to
produce a shortening of each sarcomere. Thus, EMG
activity and mechanical force are closely related. Since
mechanical loading is thought to be the primary driver
for muscular hypertrophy, it is therefore unsurprising
that exercises that display high EMG levels in certain
muscle groups are thought to be those that are most
effective for developing those parts of the body.
However, the interpretation of EMG activity is not a
simple matter and the signal requires processing and
normalization before it can be properly compared with
other signals. Normalization is most commonly
performed relative to the signal recorded during a
maximum voluntary isometric contraction in a position
thought to lead to the greatest possible EMG activity
of the muscle in question. Such positions are not
always known for all muscles, however. Additionally,
normalization can also be performed relative to a nonmaximal, reference contraction. Additionally, the
nature of the EMG measurement taken can differ
between studies, depending on whether average EMG
activity is taken across the whole of a given muscle
action, or whether the peak EMG activity during a
given muscle action is recorded.
OBJECTIVE: To explore the effects of resistance

training and detraining on muscular strength (as
measured by 1RM biceps curl and maximum voluntary
isometric contraction (MVIC) elbow flexion torque),
muscular size (as measured by muscle thickness of
the biceps brachii using B-mode ultrasound), and
changes in muscle activity (as measured by the
magnitude and spatial distribution patterns of surface
electromyography [EMG]) in the biceps brachii.
POPULATION: 10 male subjects, aged 22.1 2.8
years.
INTERVENTION: All subjects performed 6 weeks of
resistance training, 3 times a week. Each training
session comprised 3 sets of 10 unilateral dumbbell
biceps curls with 70% of 1RM, with 2 minutes of
inter-set rest between sets. All subjects subsequently
performed 8 weeks of detraining.
What happened?
Muscular adaptations
The researchers reported that 1RM biceps curl, MVIC
elbow flexion torque, and muscle thickness of the
trained arm were significantly greater than those of
the untrained arm after the 6 weeks of resistance
training. These differences all disappeared after the 8
weeks of detraining.
Muscle activity changes
The researchers reported that the magnitude of
muscle activity in the trained arm was significantly
greater than that in the untrained arm after the 6
weeks of resistance training. This difference then
disappeared after the 8 weeks of detraining. On the
other hand, they reported no significant differences in
the spatial distribution pattern of muscle activity
between arms either after the 6-week period of
resistance training or following the 8-week detraining
period.

The researchers concluded that although resistance
training induces increases in muscular strength, size
and neural drive, it does not change the spatial
distribution pattern of muscle activity in the muscle.
Limitations
differences in spatial distribution pattern of muscle
activity would occur following two different programs
of resistance training, particularly those that lead to
different regional hypertrophy outcomes.
Page 29
Muscle activation during three sets to failure at 80 vs.

30% of 1RM resistance exercise, by Jenkins, Housh,
Bergstrom, Cochrane, Hill, Smith, & Cramer, in
European Journal of Applied Physiology (2015)
Background
Muscle activation is most commonly measured by
electromyography or EMG. For a detailed introduction
to EMG, see the previous study review.
OBJECTIVE: To compare the muscle activity (as

measured by the surface electromyography [EMG]
amplitude and mean power frequency), changes in
quadriceps muscle cross-sectional area (as measured
by ultrasound), and volume load (as measured by
repetitions multiplied by weight lifted) during 3 sets of
resistance exercise to muscular failure at 80% and
30% of 1RM resistance exercise.
POPULATION: 9 males, aged 21.0 2.4 years, and
9 females, aged 22.8 3.8 years.
INTERVENTION: All subjects performed 3 sets of
knee extensions to muscular failure at 80% of 1RM
and at 30% of 1RM.
What happened?
Muscle activity
The researchers noted that EMG amplitude remained
greater at 80% of 1RM than at 30% of 1RM across all
repetitions and sets. They observed that EMG mean
power frequency decreased more and was lower for
the last repetitions during the 30% of 1RM condition
than during the 80% of 1RM condition, possibly as a
result of greater metabolic byproduct accumulation
and/or greater reductions in intramuscular pH.
Muscle cross-sectional area
The researchers found that muscle cross-sectional
area increased to a greater degree after the 30% of
1RM condition than after the 80% of 1RM condition,
most likely because of exercise-induced cell hydration
and/or cell swelling.
Volume load
The researchers found volume was significantly
greater for 30% of 1RM than for 80% of 1RM during
all sets. This was because the number of repetitions
was much greater for the 30% of 1RM condition (e.g.
set 1 = 45.6 14.3 vs. 8.9 2.7 repetitions).

The researchers concluded that EMG amplitude was
greater when using 80% of 1RM than when using a
30% of 1RM load. On the other hand, EMG mean
power frequency displayed a greater reduction over
the course of the workout when using 30% of 1RM
than when using 80% of 1RM. They concluded that
total volume load was greater when using 30% of 1RM
than when using 80% of 1RM and that acute changes
in muscle cross-sectional area, possibly caused by cell
swelling, were greater in the 30% of 1RM condition.
Limitations
The study was limited in that it was an acute trial and
longitudinal studies are necessary to understand how
individual training variables affect long-term gains in
muscular strength and size.
Page 30
Electromyographical and Perceptual Responses to

Different Resistance Intensities in a Squat Protocol:
Does Performing Sets to Failure With Light Loads
Recruit More Motor Units? By Looney, Kraemer,
Joseph, Comstock, Denegar, Flanagan, Newton,
Szivak, DuPont, Hooper, Hakkinen, and Maresh, in
Journal of Strength & Conditioning Research (2015)
Background
Muscle activation is most commonly measured by
electromyography or EMG. For a detailed introduction
to EMG, see the previous but one study review.
OBJECTIVE: To compare the muscle activity of the

vastus lateralis and vastus medialis (as measured
using surface electromyography [EMG]) across several
different conditions. Firstly, to compare muscle activity
during sets of back squats with either maximal or submaximal numbers of repetitions with 50% of 1RM.
Secondly, to compare muscle activity between relative
loads (50% of 1RM vs. 90% of 1RM) performed with
maximal numbers of repetitions. Thirdly, to compare
muscle activity during sets with 50% of 1RM between
rested and pre-fatigued conditions (during a drop set).
In addition, rating of perceived exertion (RPE) was
measured (using the Borg 010 category-ratio scale).
POPULATION: 10 resistance-trained males, aged 23
3 years, with a 1RM back squat of 141 28kg.
INTERVENTION: Subjects performed sub-maximal
sets of 10 repetitions with 50% of 1RM and sets of 7
repetitions with 70% of 1RM. They performed a
maximal set of 50% of 1RM to muscular failure and a
maximal set of 90% of 1RM to muscular failure. In a
drop set, the subjects performed 3 consecutive sets
with 90% of 1RM, 70% of 1RM and 50% of 1RM.
What happened?
Muscle activity
The researchers observed that EMG amplitude in both
vastus lateralis and vastus medialis was significantly
greater in the 90% of 1RM set to muscular failure
compared to the 50% of 1RM set to muscular failure.
Also, EMG amplitude in the 50% of 1RM set to
muscular failure was greater than in the 50% of 1RM
set of sub-maximal repetitions. However, pre-fatigue
using a drop set format did not increase muscle
activity above the levels seen during muscular failure.
RPE
The researchers found that RPE did not differ with
relative load when sets were performed to muscular
failure. However, RPE was lower in the sub-maximal
sets than in the maximal sets.

The researchers concluded that muscle activity, as
measured by EMG amplitude, is greater with higher
relative loads (90% of 1RM) than with lower relative
loads (50% of 1RM) even when both sets are take to
muscular failure. They also found that RPE was similar
during sets taken to muscular failure, although sets
taken to muscular failure display greater RPE than
sets of sub-maximal numbers of repetitions.
Limitations
The main limitation of this study is that muscle
activity, as measured by EMG amplitude, is not
identical to motor unit recruitment. EMG amplitude is
comprised of at least two key factors: motor unit
recruitment and motor unit firing frequency. In
addition, it can be altered during fatiguing conditions
by a range of other circumstances.
Page 31
Electromyography activation levels of the 3 gluteus

medius subdivisions during manual strength testing,
by Otten, Tol, Holmich, & Whiteley, in Journal of Sport
Rehabilitation (2015)
Background
The gluteus medius is a much smaller and less
complex muscle than the gluteus maximus, albeit no
less important for rehabilitation professionals. In
terms of size, it seems to be around half the size of
the gluteus maximus, which is the largest muscle in
the human body. But despite the large differences in
volume and weight, the physiological cross-sectional
area of the gluteus medius and the gluteus maximus
are similar and it is the difference in length that leads
to the difference in size. The muscle architecture of
the gluteus medius is fairly straightforward. It has a
characteristically short fascicle length, a large
pennation angle, and a large physiological crosssectional area. Thus, it is very well-suited to very
forceful contractions over short excursions and
consequently can easily perform a very important
stabilizing role at the hip and pelvis. The gluteus
medius has its origin on the external iliac surface and
inserts on the greater trochanter of the femur, most
likely on the lateral surface, although not all
authorities agree on this location. In terms of muscle
moment arms, the posterior, middle and anterior
fibers of the gluteus medius all have very large hip
abduction moment arms and quite small hip extension
moment arms. However, the posterior fibers have
moderate hip external rotation moment arms while
the anterior fibers have large hip internal rotation
moment arms. Biomechanically, therefore, the
predominant role of the gluteus medius is hip
abduction, although the posterior fibers assist with hip
external rotation and the anterior fibers may perform
hip internal rotation. Studies that have explored how
gluteus medius electromyographic (EMG) activity is
affected by hip flexion and pelvic angles have reported
conflicting results. One study found that reclining the
pelvis leads to reduced gluteus medius EMG activity
compared to a neutral pelvic angle while greater hip
flexion leads to greater gluteus medius EMG activity
compared to lesser hip flexion. However, other studies
have reported that hip flexion angle does not affect
gluteus medius EMG activity. However, studies have
reported more consistent results regarding the effect
of hip internal-external rotation angle on gluteus
medius EMG activity. The side-lying hip abduction with
external rotation typically leads to lower gluteus
medius EMG activity than the side-lying hip abduction
in internal rotation. This may be because the large,
anterior fibers are more involved when the hip is in
internal rotation. Alternatively, it may be that the
gluteus maximus is less involved when the hip is less
externally-rotated.
OBJECTIVE: To compare different strength-testing

positions for the highest levels of muscle activity (as
measured by using surface electromyography [EMG])
in the three main compartments of the gluteus medius
muscle, and to assess the differences between the
primary tested and contralateral legs.
POPULATION: 20 healthy and physically active male
subjects, aged 37 5 years.
INTERVENTION: All subjects performed maximum
isometric voluntary contractions (MVIC) in 8 different
strength-testing positions. The positions were as
follows: (1) supine with straight legs (SSL), (2) supine
with the contralateral leg flexed (SCLF), (3) side-lying
with the hip joints in neutral position (SL0), (4) sidelying with the tested leg in 20 degrees of abduction
(SL20), (5) side-lying with the hip of the tested leg
maximally internally rotated (SLIR), (6) side-lying
with the hip of the tested leg maximally externally
rotated (SLER), (7) side-lying with the tested leg in
full extension and external rotation (SLEXT+ER), and
(8) side-lying in the clam position (SLCLAM).
What happened?
Differences between strength-testing positions
The researchers found that 5 of the 8 positions
displayed high levels of activity (>75%) in the anterior
part of the gluteus medius (SSL, SCFL, SL0, SLER, and
SLEXT+ER). Only 2 of the 8 positions displayed high
levels of activity for the middle and posterior parts of
the gluteus medius (SL0 and SLIR).
Differences between legs
The researchers noted that the ipsilateral leg displayed
greater muscle activity than the contralateral leg in all
strength-testing positions for the anterior portion of
the gluteus medius. For the middle portion, this was
only the case for 4 out of 8 positions (SL0, SL20,
SLIR, and SLCLAM) and for the posterior portion, this
was only the case in 5 out of 8 positions (SSL, SL0,
SL20, SLIR, and SLCLAM).

The researchers concluded that the SL0 and SLIR
positions were the testing positions that show the
highest activations for all subdivisions of the gluteus
medius.
Limitations
The study was limited in that it lacked the necessary
power to determine which of the strength-testing
positions was best for each subdivision.
Page 32
Relationships between lower body muscle structure

and maximal power clean performance, by McMahon,
Turner, & Comfort, in Journal of Trainology (2015)
Background
Olympic weightlifting is an individual sport in which
two lifts, the snatch and the clean and jerk, are
contested in weight classes. The snatch involves the
barbell being lifted from the floor to overhead in a
single motion. The clean and jerk involves the barbell
being lifted from the floor to the shoulders and then
from the shoulders to overhead in two separate
motions. In some respects, the sport of Olympic
weightlifting as very similar to powerlifting, in that the
maximal load lifted is the goal. Previous studies have
found that muscular strength is very strongly
correlated with Olympic weightlifting performance,
although it is most often considered to be a primary
developer of the ability to develop a high velocity in
combination with heavy loads and consequently
muscular power. Indeed, in many respects, the sport
of Olympic weightlifting is more similar to the
throwing events in track and field, albeit with greater
loads. Olympic weightlifting is commonly used for
increasing lower-body muscular power even though
there are few long-term studies to support its use for
this purpose. The main evidence for the use of
Olympic lifts and their variations (including the power
variations and the hang variations) in power-based
resistance training programs comes from studies
reported high acute power outputs. Indeed, an early
influential review compared the acute power outputs
during the Olympic lifts and the powerlifts. In a series
of calculations, it was found that acute power outputs
in an elite-level Olympic clean for a heavyweight lifter
could be estimated at 4,200W while a deadlift
performed by a similar caliber powerlifter in a
comparable weight class would be around 1,300W.
However, later studies found that when sub-maximal
loads were used, power outputs during deadlifts are in
fact around the same value (4,200W). In fact, it
seems that bar speed is more important than the type
of exercise when it comes to the acute power output
produced during resistance training. Additionally, longterm trials have found that the size of an acute power
output is not a good predictor of long-term
adaptations following programs of either heavy
resistance training or ballistic resistance training.
Thus, comparisons of acute power outputs between
Olympic weightlifting exercises and their variations
may not be hugely valuable. Nevertheless, as
expected, long-term trials indicate that using the
Olympic lifts does lead to increases in muscular
strength and muscular power output, although the
evidence base is still very small in comparison with
heavy resistance training and it is unclear what
training variables within an Olympic weightlifting
program lead to the greatest gains in strength or
power.
OBJECTIVE: To examine the reliability of lower body

muscle architecture measurements (using ultrasound
imaging scans of the vastus lateralis and medial
gastrocnemius) and 1RM power clean tests (using
intraclass correlation coefficients [ICCs]) and to assess
the relationships between variables (with Pearson's r).
POPULATION: 15 resistance-trained athletes, aged
23.2 3.21 years (13 males and 2 females) from a
range of sports.
INTERVENTION: All subjects performed 1RM power
cleans on 2 separate occasions.
What happened?
Reliability
The researchers found that the reliability of ultrasound
measurements of muscle thickness was nearly perfect
for the vastus lateralis (ICC = 0.90 0.99) and medial
gastrocnemius (ICC = 0.92 0.99). The reliability of
the medial gastrocnemius pennation angle was also
very high or nearly perfect (ICC = 0.81 0.99). The
researchers found that test-re-test reliability of the
1RM power clean was nearly perfect (ICC = 0.96) and
the mean 1RM power clean was 86 19kg. From
these data, the Standard Error of Measurement (SEM)
and Minimum Difference to be considered real (MD)
can be estimated as 4kg (4.4%) and 11kg (12.2%).
Relationships
The researchers found that there were moderately
strong relationships between the muscle thickness of
the vastus lateralis and 1RM power clean relative to
body weight (r = 0.506), between the muscle
thickness of the medial gastrocnemius and 1RM power
clean ( = 0.476) and between medial gastrocnemius
pennation angle and 1RM power clean relative to body
weight ( = 0.543).

The researchers concluded that there exist moderately
strong relationships between the muscle thickness of
the vastus lateralis, the muscle thickness of the
medial gastrocnemius, and medial gastrocnemius
pennation angle and 1RM power clean ability.
Limitations
same or stronger relationships would be observed
between the 1RM power clean and the muscle
architecture of other muscles (such as the gluteus
maximus or rectus femoris) and whether the same or
stronger relationships would be observed in more
highly-skilled weightlifters.
Page 33
An investigation into the relationship between

maximum isometric strength and vertical jump
performance, by Thomas, Jones, Rothwell, Chiang, &
Comfort, in Journal of Strength & Conditioning
Research (2015)
Background
Vertical jumping ability is a key athletic quality. Thus,
researchers have assessed both the biomechanics of
vertical jumping and also the transfer of training to
vertical jumping performance from several types of
commonly-used training methods. Studies have
reported beneficial effects on vertical jump height
from several training methods, including unilateral
plyometrics, bilateral plyometrics, loaded jumps,
unilateral conventional strength training, conventional
strength and/or power training, isometric strength
training, Olympic lifting programs, kettlebell training,
complex and contrast training, assisted and resisted
jumps, and multiple combined methods. Studies
exploring the biomechanics of vertical jumping have
attempted to identify the key factors that contribute to
increased jumping performance. In this respect,
previous studies have identified that co-ordination,
strength, rate of force development and elastic energy
storage through the stretch-shortening cycle can all
influence vertical jump performance to some degree.
Since vertical jumping ability is a key athletic quality
like horizontal jumping ability, sprint running ability
and agility, a number of studies have assessed the
correlations between each of these different qualities,
with varying results, although generally with positive
correlations in all cases.
OBJECTIVE: To assess the reliability of measures of

isometric peak force (PF), maximum rate of force
development (RFD), and impulse during the mid-thigh
pull and performances in the squat jump (SJ) and
countermovement jump (CMJ), as measured by jump
heights (with intraclass correlation coefficients [ICCs])
and to assess the relationships between variables
(using Pearson's r).
POPULATION: 22 male collegiate athletes, aged 21.3
2.9 years, who were active in the sports of cricket,
judo, rugby, and soccer.
INTERVENTION: All subjects performed several
isometric mid-thigh pulls as well as sets of both SJ
and CMJ.
What happened?
Reliability
During the mid-thigh pull, the researchers found that
the reliability of PF and impulse were both nearly
perfect (ICC = 0.95 0.97) but the measures of RFD
were only very high (ICC = 0.81 0.87). The
researchers found that the reliability of the SJ height
was very high (ICC = 0.86) but the reliability of the
countermovement jump was nearly perfect (ICC =
0.91). The mean SJ was 0.30 0.05m and the mean
CMJ height was 0.35 0.05m. From these data, the
Standard Error of Measurement (SEM) and Minimum
Difference to be considered real (MD) can be
estimated as 4kg (4.4%) and 11kg (12.2%).
Relationships
Interestingly, neither the CMJ nor the SJ heights were
significantly correlated with any of the isometric midthigh pull force-related variables with ICC <0.33 in all
cases. The researchers reported that RFD during the
mid-thigh pull was moderately correlated with PF (ICC
= 0.70) but not impulse (ICC = 0.29 0.43).

The researchers concluded that there are no good
correlations between measures of maximum isometric
mid-thigh pull strength and either SJ or CMJ heights.
Limitations
different results would have been obtained if the
isometric strength measure had been a squat pattern
or if the study had been performed in track and field
jumping athletes.
Page 34
Overhead shoulder press in front of the head or

behind the head? By McKean & Burkett, in Journal of
Sport and Health Science (2015)
Background
The deltoids (anterior, middle, posterior) have a
relatively large physiological cross-sectional area
compared to other muscles in the upper body. The
anterior deltoid appears to be shortest in fascicle
length and largest in pennation angle. In the sagittal
plane, the anterior deltoid is a primary shoulder flexor
and displays its greatest force with the arm above
horizontal. The middle deltoid is not a major
contributor in the sagittal plane. The posterior deltoid
functions as a primary shoulder extensor throughout
the range of motion with the greatest contribution
with the arms below horizontal. In the frontal plane,
the posterior deltoid performs shoulder adduction
while the anterior and middle deltoid perform shoulder
abduction. The middle deltoid has the greatest
moment arm in this plane. Peak moment arms lengths
for the anterior, middle and posterior deltoids are
overhead, arms out to the sides, and arms by the
sides, respectively. When performing horizontal
movements, the anterior deltoid performs horizontal
adduction (moving the hands together), with its
greatest moment arm length with the arms out to the
sides. In contrast, the middle and posterior deltoids
perform horizontal abduction (moving the hands
apart), with their greatest moment arm lengths in the
middle of the joint range of motion. The muscle fiber
type of the deltoids is unclear but may be mixed in
proportion. This may imply that both higher and lower
speeds, and heavier and moderate loads are beneficial
for this muscle. The deltoids are highly active during
resistance exercises that include pressing-type
movements such as the bench press and shoulder
press. No single exercise is best for the deltoids. Multijoint exercises preferentially target either the anterior
or posterior deltoids, while the middle deltoid is
moderately active during both. The dumbbell shoulder
press and seated row appear to be reliable options,
but the barbell shoulder press, bench press, upright
row and incline lat pull-down are good alternatives.
Muscle activity in the three deltoids during multi-joint
exercises can be affected by the pressing angle and
grip width. Steeper pressing angles seem to increase
the anterior deltoid muscle activity, as well as wider
grip width during incline pressing. A wider grip width
also increases the muscle activity of the three
segments during the upright row, while a narrower
grip during lat pull-downs increases the posterior
deltoid muscle activity. Using dumbbells during the
standing shoulder press appears to increase the
muscle activity in the anterior and middle deltoids.
Single-joint exercises can be used to target the three
deltoid segments. Lateral raise-type exercises appear
to produce superior middle deltoid muscle activity,
while horizontal abduction exercises produce high
levels of posterior deltoid muscle activity.
OBJECTIVE: To assess the differences in passive

shoulder range of motion (ROM) (using a goniometer
to measure shoulder flexion, abduction, external
rotation, and horizontal abduction) and spine posture
(using motion analysis recording the movements of
sensors attached to the shoulder girdle, spine, neck
and head) between the overhead press performed
behind the head (BNP) or in front of the head (OP).
POPULATION: 33 individuals (18 males, aged 28.6
4.8 years; and 15 females, aged 25.0 4.1 years).
INTERVENTION: All subjects performed the OP and
BNP with a 3RM load from a seated position on a
standard free weight bench with no back support
using an Olympic bar.
What happened?
Relative loads
The researchers found that the 3RM loads for the OP
and BNP for males were 50.7 4.9 and 49.8 5.2kg
and for females were 28.0 4.4 and 27.4 4.2kg.
These were not significantly different between exercise
variations.
Spine movements
The researchers reported that the BNP technique
involved a starting position in which the cervical spine
was placed in forward flexion (e.g. males = +23.9
degrees). In contrast, they noted that the OP allowed
cervical lordosis (e.g. males = -8.5 degrees). The
finishing position was also different in that the BNP
technique involved a more forward position (e.g.
males +54.4 degrees) than the OP technique (e.g.
males = +8.5 degrees). The total ROM was greater in
the BNP technique (e.g. males 42.5 vs. 18.7 degrees).
There was also a difference in starting position in
thoracic flexion, with the BNP displaying less flexion
than the OP (e.g. females = -3.3 vs. -14.0 degrees)
and this difference was maintained at the end position
(e.g. females = -1.9 vs. -12.7 degrees). Despite the
similar starting and ending positions, the ROM was still
greater in the BNP than in the OP (e.g. females = 14.6
vs. 11.9 degrees). A similar finding was made for
lumbar extension but the ROM was not different
between conditions.

The researchers concluded that there are substantial
differences in spine movements (starting and ending
positions and total ROM) at the cervical, thoracic and
lumbar spine between the BNP and OP. In particular,
the BNP involves greater ROM at the cervical and
thoracic spines and starts in a position of greater
cervical flexion, lower thoracic extension, and lower
lumbar flexion.
Limitations
The study was limited in that it is unclear how these
different spine joint angle measures relate to injury
risk or performance enhancement.
Page 35
Repeated bout effect in muscle-specific exercise

variations, by Zourdos, Henning, Jo, Khamoui, Lee,
Park, & Kim, in Journal of Strength & Conditioning
Research (2015)
Background
Delayed onset muscle soreness (DOMS) is frequently
experienced by athletes and recreational trainees
when exposed to either novel resistance training
workouts or a large volume of eccentric muscle
actions. Symptoms include soreness, tenderness upon
palpation, and stiffness during movement. DOMS
appears to occur reliably between 12 24 hours postworkout, with soreness peaking around 48 hours postworkout. There is a lack of consensus regarding the
underlying mechanisms that cause DOMS. Some
researchers consider DOMS to be caused entirely by
exercise-induced muscle damage (EIMD). EIMD is
similarly characterized by muscle soreness, muscle
swelling, an increase in intramuscular protein and
passive muscle tension, and also involves a reduction
in muscular strength and range-of-motion. In this
model, EIMD causes various disruptive changes,
including sarcomere damage, calcium accumulation,
protein degradation, and increased osmotic pressure.
These changes lead to the sensitization of nociceptors
and other pain receptors, which leads to the sensation
of DOMS being experienced. A number of different
interventions have been tested for reducing both EIMD
and DOMS. There is some evidence to support the use
of massage and limited evidence to support the use of
self-myofascial release with a foam roller. The
mechanisms by which massage or self-massage might
be effective for reducing DOMS are not wellunderstood and various possibilities are currently
being explored by researchers. One interesting feature
of DOMS is that it is dramatically reduced when the
muscle has been exposed to a similar stimulus on a
recent, previous occasion. This is known as the
repeated bout effect and indicates that central
factors may well be involved in addition to local ones.
OBJECTIVE: To identify whether the type of exercise

performed affects the magnitude of the repeated bout
effect on DOMS by reference to changes in maximal
voluntary isometric (MVIC) elbow flexion torque and
isokinetic elbow flexion torque, elbow extension range
of motion (ROM), muscle soreness (using a visual
analog scale (VAS) and serum creatine kinase levels
before, immediately after, and 24, 48, 72, and 96
hours after each exercise session.
POPULATION: 20 untrained males, aged 21 2
years, randomly allocated to 1 of 2 groups, a group
who performed the same exercise on 2 occasions
(SAME) or a group who performed a different exercise
for the same muscle group on 2 occasions (DIFF).
INTERVENTION: The subjects in SAME performed 2
sessions of incline curls. The subjects in DIFF
performed 1 session of incline curls followed by 1
session of preacher curls.
What happened?
Effect of first training session
The researchers found that both groups displayed
changes in MVIC elbow flexion, isokinetic elbow
flexion, ROM, and DOMS (measured using VAS) from
session 1 to 2, with the recovery following session 2
being much faster than the recovery following session
1. There were no changes in creatine kinase levels
after either session.
Effects of exercise variation
The researchers found no differences between groups
for any of the measures taken (MVIC elbow flexion,
isokinetic elbow flexion, ROM, and DOMS), indicating
that the repeated bout effect is not exercise specific
but rather muscle specific.

The researchers concluded that the repeated bout
effect is not exercise specific but rather only muscle
specific.
Limitations
The study was limited in that no cross-over effect was
investigated and it is possible that training the
ipsilateral arm may have had an effect on the contralateral arm. Therefore, it is unclear to what extent the
effects observed in this study were central and to
what extent they were peripheral.
Page 36
Extracellular matrix remodeling and its contribution to

protective adaptation following lengthening
contractions in human muscle, by Hyldahl, Nelson,
Xin, Welling, Groscost, Hubal, & Parcell, in FASEB
Journal (2015)
Background
While the focus of research into muscle adaptations
following resistance training has been primarily on
increases in muscle size (hypertrophy) and secondarily
on changes in muscle architecture, such as increases
in fiber length or pennation angle, other adaptations in
muscles do occur. Indeed, although changes in specific
tension are thought to account for a large proportion
of the difference between gains in strength and size
following a long-term resistance training program, the
underlying causes for these increases in specific
tension are not well-understood. It is thought that
increases in specific tension are partly caused by
increases in myofibrillar packing density (which is
indicated by the ratio of strength-to-size in a single in
vitro muscle fiber) and partly by shifts in the degree to
which extracellular lateral force transmission occurs,
which is believed to occur through sarcomeres
attaching to the extracellular matrix. The extracellular
matrix is the structure that connects individual muscle
fibers to allow force transmission within the whole
muscle. Signaling within the TGF- superfamily
pathway appears to be important for activating the
proteolytic systems within muscle fibers and for
regulating the synthesis and remodeling of the
extracellular matrix after it has been damaged,
particularly subsequent to eccentric exercise. When
the extracellular matrix is damaged, this allows an
influx of calcium ions, which activates proteases that
proteolyse titin and dismantle the damaged chains of
sarcomeres. This process also liberates myostatin
bound at the sarcomere, which consequently becomes
free to participate in signaling cascades. Myostatin
may then bind to its receptors and bring about
necessary proteolysis within muscle fibers, which is
important for recycling existing damaged proteins
following damage caused during resistance training
exercise.
OBJECTIVE: To assess whether extracellular matrix

(ECM) remodeling (as measured by reference to ECM
gene expression at the mRNA transcript level and
TGF- signaling in muscle biopsies) contributes to the
repeated bout effect.
POPULATION: 14 healthy adults (7 males, aged 23.3
2.1 years and 7 females, aged 25.6 2.5 years.
INTERVENTION: All subjects performed 2 bouts of
unilateral eccentric leg curls for the knee extensors
with the same randomized leg, separated by 28 days.
What happened?
ECM-related gene expression
The researchers found that the expression of ECMrelated proteins CO- L1A1, COL3A1, and COL4A1
mRNA was not changed in the 2 days following the
first bout of exercise. However, expression of all of
these proteins increased by 5.7 2.5, 3.2 0.9, and
2.1 0.4 times, respectively, after 27 days. There
was no similar increase after the second bout of
exercise.
TGF- signaling
The researchers observed that TGF- signaling was
was not increased significantly at 2 days following the
first bout but was increased significantly (by 60%) at
27 days following the first bout and also 2 days after
the second bout (by 111%).

The researchers concluded that there appears to be a
connection between ECM remodeling after eccentric
exercise, as there are differences in the responses of
collagen transcripts and in TGF- signaling between
the first and second bouts. The lack of increase at 2
days after the first bout and the increase after 27 days
may imply that a relatively long period is required to
remodel the ECM.
Limitations
The study was limited in that it is still unclear precisely
how the remodeling of the ECM is related to the
repeated bout effect and whether the two are in fact
quantitatively associated.
Page 37
Post-activation potentiation: the neural effects of post

activation depression, by Xenofondos, Patikas,
Koceja, Behdad, Bassa, Kellis, & Kotzamanidis, in
Muscle & Nerve (2014)
Background
The post-activation potentiation (PAP) effect is the
well-known phenomenon in which performance in a
given muscle action is increased when it is carried out
after another muscle action, known as the
conditioning contraction. Many studies have been
performed exploring the PAP effect. Above all, a large
amount of inter-individual variability has been
reported, with great differences being observed from
one person to the next in respect of their responses to
any given PAP. Additionally, there is some evidence
that trained individuals display greater PAP effects
than untrained people. The PAP effect is most
normally studied using heavy resistance exercises but
many studies have found that performance can also
be enhanced following plyometrics, ballistic exercises
and isometric contractions. Indeed, most early studies
tended to use maximum voluntary isometric
contractions (MVICs) in combination with single-joint
exercises, most often the dynamic knee extension,
because it is easier to standardize more variables
when using this modality. However, later research has
tended to move towards using heavy resistance
exercise protocols, as they appeared most effective. In
general, it has been found that the PAP effect can be
maximized by using multiple sets at moderate relative
loads (60 84% of 1RM) with moderate rest period
lengths (7 10 minutes), using both isometric and
dynamic protocols as conditioning contractions.
However, these are only general outlines and specific
circumstances often lead to substantial variation in the
outcomes. Moreover, the exact mechanism by which
the PAP effect occurs is unclear. Researchers have
proposed various mechanisms by which PAP might
work. Three such mechanisms that have been
proposed are as follows: (1) increased regulatory light
chain phosphorylation as a result of an elevation in
Ca2+ release from the sarcoplasmic reticulum, which
increases the sensitivity of the actin-myosin
interaction, altering the structure of the myosin head
and resulting in a higher force-generation state of the
cross-bridges; (2) increased recruitment of motor
units because of an increased excitation potential
following the previous muscular contractions; and (3)
favorable alterations in muscle fiber pennation angle.
It seems that most researchers tend to lean towards a
neurological explanation, such as enhanced motor unit
activation. Indeed, recent research found no changes
in muscle architecture following a PAP protocol.
OBJECTIVE: To assess the effects of the PAP effect

(created by a 10-second maximum voluntary isometric
contraction [MVIC] for plantar flexion in an isokinetic
dynamometer) on maximum involuntary twitch torque
and H-reflex amplitude over the 20 minutes following
the PAP stimulus.
POPULATION: 14 healthy, recreationally active males
and females, aged 23.8 5.9 years.
INTERVENTION: All subjects performed 10-second
MVICs of plantar flexion before a series of tests.
What happened?
Maximum involuntary twitch torque
The researchers found that peak twitch torque was
significantly higher than the pre-PAP values in the
third (19.2 3.7%), fourth (111.3 3.7%), fifth
(110.0 3.4%), and sixth (18.5 3.2%) minutes
post-PAP.
H-reflex
The researchers reported that soleus H-reflex was
depressed in the first minute post-PAP (by 25.2
5.7%), although this was only apparent when the
muscle was relaxed and was not apparent when the
muscle was contracting. Similar results were observed
for the lateral gastrocnemius and for the H/M ratio for
both muscles.

The researchers found that a 10-second MVIC protocol
potentiated involuntary muscle force for 3 6 minutes
immediately after its performance. However, contrary
to expectation, there was a reduction in H-reflex and
H/M ratio 1 minute after the MVIC protocol that
quickly returned to normal thereafter.
Limitations
The study was limited in that the mechanisms that
underpin the change in H-reflex immediately after the
MVIC are unclear.
Page 38
3. ANATOMY, PHYSIOLOGY, AND NUTRITION
Page 39
Skeletal muscle hypertrophy adaptations predominate

in the early stages of resistance exercise training,
matching deuterium oxide-derived measures of
muscle protein synthesis and mechanistic target of
rapamycin complex 1 signaling, by Brook, Wilkinson,
Mitchell, Lund, Szewczyk, Greenhaff, & Atherton, in
FASEB Journal (2015)
Background
Muscle hypertrophy occurs in response to resistance
training (and consumption of protein post-workout). It
is thought that this process occurs by way of an
alteration in the balance between muscle protein
synthesis and muscle protein breakdown over a
sustained period of time. In support of this, previous
studies have found that muscle protein synthesis is
elevated post-workout. It is thought that such
increases are important contributors to long-term
gains in muscle mass, although investigations have
found no association between acute increases in levels
of muscle protein synthesis and hypertrophy over a
long-term period. Nevertheless, assuming that there is
a connection between elevations in muscle protein
synthesis post-workout, the activity in various
molecular signaling pathways has been suggested to
explain how the acute rise in muscle protein synthesis
might be triggered by a resistance training workout.
Indeed, it is well-known that the primary regulator of
muscle protein synthesis is the mammalian-target of
rapamycin (mTOR) pathway. mTOR phosphorylates its
targets, the downstream effectors 4E binding protein 1
(4EBP1) and the 70-kDa ribosomal protein S6 kinase
(p70S6K). Importantly, unlike muscle protein
synthesis itself, the phosphorylation of these two key
effectors in human muscle is significantly associated
with long-term gains in muscle mass during resistance
training. The mitogen-activated protein kinase (MAPK)
pathway may be another, different signaling pathway
that may also have an important role in regulating
muscle protein synthesis. There appears to be crosstalk between these pathways, however, with
components of the MAPK pathway being able to
phosphorylate signaling proteins both upstream and
downstream of mTOR itself.
OBJECTIVE: To explore the relationship between

long-term muscle protein synthesis (as measured by
newly-developed deuterium oxide tracer techniques
involving muscle biopsies for estimating fractional
synthetic rates) and increases in knee extension
strength (using 1RM knee extension and maximum
voluntary isometric contraction (MVIC) knee extension
torque), vastus lateralis muscle architecture and size
(by reference to ultrasound imaging scans), and lean
body mass (by dualenergy Xray absorptiometry
[DEXA]).
POPULATION: 10 males, aged 23 1 years.
INTERVENTION: All subjects performed unilateral
knee extension resistance training for 6 sets of 8
repetitions with 75% of 1RM, 3 times per week for 6
weeks. The contralateral leg was not trained.
What happened?
Muscle strength and size
The researchers reported that there were gains in
both 1RM knee extension and in MVIC knee extension
torque for the trained leg over the 6 weeks. They
noted that there were increases in the muscle
thickness, pennation angle, and fascicle length of the
vastus lateralis, as measured by ultrasound.
Muscle protein synthesis
The researchers found that muscle protein synthesis
fractional synthetic rate stayed unchanged in the
untrained leg (1.35 0.08%, 1.32 0.07%, and 1.33
0.06% per day at 0 3, 3 6, and 0 6 weeks,
respectively. In the trained leg, they found that
muscle protein synthesis fractional synthetic rate was
elevated at 0 3 weeks (1.6 0.01% per day) but
not at 3 6 weeks (1.29 0.11% per day). Also, in
the trained leg, muscle protein synthesis fractional
synthetic rate was significantly correlated with muscle
thickness at 3 weeks (R-squared = 0.52) but this
relationship was not present in the untrained leg (Rsquared = 0.03).

The researchers concluded that novel deuterium oxide
tracer techniques making use of muscle biopsies for
estimating fractional synthetic rates show tha t
elevated muscle protein synthesis rates accompany
the early increases in muscle size that occur during
periods of resistance training. They concluded that
these elevations in muscle protein synthesis appear to
reduce over time.
Limitations
The study was limited in that it was unclear whether
the estimate for muscle protein synthesis fractional
synthetic rate used in this study would explain the
changes in lean body mass over the course of the
study and, if not, then what other factors might be
involved.
Page 40
Muscle hypertrophy induced by myostatin inhibition

accelerates degeneration in dysferlinopathy, by Lee,
Lehar, Sebald, Liu, Swaggart, Talbot, & Lee, in Human
Molecular Genetics (2015)
Background
Muscle hypertrophy occurs in response to resistance
training (and consumption of protein post-workout). It
is thought that this process occurs by way of an
alteration in the balance between muscle protein
synthesis and muscle protein breakdown over a
sustained period of time. For a detailed introduction to
hypertrophy, see the previous study review.
OBJECTIVE: To examine the effects of blocking the

myostatin pathway in dysferlin-deficient mice, in
whom membrane repair is compromised, both by
transgenic expression of follistatin in skeletal muscle
and by systemic administration of the soluble form of
the activin type IIB receptor. The purpose was to find
out whether myostatin-induced increases in muscle
mass actually lead to detrimental effects in mammals
with muscular dystrophies because of the possibly
adverse effects on membrane repair caused by the
treatment.
POPULATION: Dysferlin-deficient mice, which are
used as a model for some muscular dystrophies.
INTERVENTION: Both genetic and pharmacological
approaches were used. In the genetic approach,
follistatin was over-expressed in F66 transgenic mice.
Follistatin is a secreted protein that binds and inhibits
members of the TGF- superfamily, including
myostatin. F66 transgenic mice display dramatically
more muscle mass throughout the whole body. The
researchers tested the effects of crossing the F66 mice
with dysferlin-deficient mice. Also, the researchers
tested the effects of blocking myostatin signaling
pharmacologically by administering a myostatin
inhibitor (the soluble form of the activin type IIB
receptor) to dysferlin-deficient mice.
What happened?
Transgenic expression of follistatin
The researchers found that myostatin inhibition by
follistatin transgene expression in dysferlin-deficient
mice leads to improvements early on in the condition
but later speeds the muscle degeneration.
Systemic administration of activin type IIB receptor
The researchers found that myostatin inhibition by
pharmacological means lead to significant increases in
muscle mass in dysferlin-deficient mice. On the other
hand, there were increases in serum creatine kinase
levels in some of the mice, indicating possible muscle
damage. However, the accelerated degeneration was
not as severe as in the transgenic experiment.

The researchers concluded that these findings indicate
that inducing muscle hypertrophy by myostatin
blockade may have certain detrimental effects.
Limitations
The study was limited in that it was a mouse model
and it is unclear whether similar results would be
observed in humans.
Page 41
Higher protein intake is associated with higher lean

mass and quadriceps muscle strength in adult men
and women, by Sahni, Mangano, Hannan, Kiel, &
McLean in The Journal of Nutrition (2015)
Background
The global consumer market for dietary supplements
in 2011 was estimated at ~$30 billion. Protein
supplements are among the most popular items
purchased. Protein supplements are available in both
liquid and solid forms, although the liquid form is the
most common. Additionally, while various types of
protein are available, whey is the most commonly
used in commercially-available supplement formulas.
Protein supplements are primarily intended to increase
muscular strength and size when consumed in
combination with periods of resistance training, largely
by increasing total daily protein intake. Research
indicates that consuming a protein supplement may
increase total protein intake but other dietary factors
may be modifying factors, including whether
individuals are engaged in caloric restriction or not.
Nevertheless, a substantial body of acute research has
found that dietary protein consumption immediately
post-resistance training exercise leads to an increase
in muscle protein synthesis and a reduction in muscle
protein breakdown. Increases or decreases in
muscular size (hypertrophy or atrophy) are thought to
occur through a sustained imbalance between muscle
protein synthesis and muscle protein breakdown.
Since increases in muscle protein synthesis are
believed to be important contributors to long-term
gains in muscle mass, this is often taken as evidence
that protein supplementation can be used to enhance
gains in muscular strength and size. However, not all
long-term trials have supported this claim and we
should be cautious about drawing strong inferences
about hypertrophy from the behavior of muscle
protein synthesis and the balance between muscle
protein synthesis and muscle protein breakdown in
acute trials, as some studies have found no correlation
between these acute responses and long-term gains in
muscle mass. It is fortunate that meta-analyses of
trials of resistance training programs of >6 weeks
have reported that protein supplementation does lead
to superior gains in strength and size in both young
and old adult subjects. Protein supplementation may
be provided from several different sources and some
researchers have suggested that the use of either
whey, casein or essential amino acids may lead to
different effects, most likely by altering the rate of
muscle protein synthesis or muscle protein breakdown
post-exercise. Indeed, essential amino acids such as
the branched-chain amino acids (BCAA) can increase
muscle protein synthesis and reduce muscle protein
breakdown. Additionally, the essential amino acid
leucine could be an important modulator insofar as it
seems to lead to an increase in the activity of
important signaling proteins.
OBJECTIVE: To assess the associations between total

protein intake, animal protein intake, and plant
protein intake (as measured by the semiquantitative
126-item Willett food frequency questionnaire) and
both lean leg mass (as measured by dualenergy X
ray absorptiometry [DEXA]) and maximum voluntary
isometric contraction (MVIC) knee extension force
(using a handheld dynamometer).
POPULATION: 1,166 males and 1,509 females from
the Framingham Offspring Cohort in Massachusetts,
with a mean age of 59 9 years (range: 29 86
years).
What happened?
Protein intake and lean leg mass
The researchers observed that leg lean mass was
higher in both males and females who were in the
highest quartiles of total protein and animal protein
intake compared with those in the lowest quartiles of
intake but plant protein intake was not associated with
leg lean mass.
Protein intake and knee extension force
The researchers observed that knee extension force
was higher in both males and females who were in the
highest quartile of plant protein intake compared with
those in the lowest quartile and there were nonsignificant trends for animal and total protein intakes.

The researchers concluded that there are associations
between protein intake and both lean mass and
muscle strength in adults. Therefore, it may be
beneficial to maintain adequate protein intake with
increasing age to help preserve muscle mass and
strength.
Limitations
The study was limited in that it was a cross-sectional
trial and it is unclear whether changing protein intakes
would lead to altered muscle mass or strength in a
population.
Page 42
Effect of resistance training and various sources of

protein supplementation on body fat mass and
metabolic profile in sarcopenic overweight elderly
men: a pilot study, by Maltais, Perreault, CourchesneLoyer, Lagac, Barsalani, & Dionne, in International
Journal of Sport Nutrition and Exercise Metabolism
(2015)
Background
Previous research has indicated a beneficial effect of
protein consumption on body composition, often
through supplementation. For a detailed introduction
to the effects of protein supplementation, see the
previous study review.
OBJECTIVE: To establish if dairy supplementation

during a long-term period of resistance training could
affect changes in fat mass (measured by dual X-Ray
absorptiometry [DEXA]) as well as resting energy
expenditure (as measured by indirect calorimetry),
inflammatory profile and blood lipid profile (measured
by blood samples) in overweight sarcopenic males,
who lack normal levels of muscle mass.
POPULATION: 26 overweight sarcopenic males 65
5 years, where sarcopenia was defined as having an
appendicular lean mass index lower than 10.75 kg/m2.
INTERVENTION: All subjects performed a range of
resistance training exercises for the whole body
comprising both free weights (shoulder press, sit ups
and biceps curls) and machines (leg press, bench
press, leg extension, rowing extensions, and leg curls)
for 3 sets of 8 repetitions with 80% of 1RM, 3 times
per week for 16 weeks. The subjects were randomly
allocated into 3 groups who all received isocaloric
post-workout shakes that were flavored with chocolate
syrup so that all mixtures tasted similar (control [rice
milk], dairy [cow's milk] and non-dairy [soy])
comprising 375ml of fluid at around 280 calories per
shake. The dairy and non-dairy mixtures contained
the same amount of protein but the control mixture
contained almost no protein.
What happened?
Body composition
The researchers reported that lean body increased
significantly in all groups independently of which type
of supplementation was used (1.9kg non-dairy, 1.7kg
dairy, and 1.4kg control). However, they found that
only the dairy group significantly decreased fat mass
(+0.1kg non-dairy, -1.1kg dairy, -0.9kg control) and
only the dairy group significantly increased the muscle
mass to fat mass ratio (+0.6) while bodyweight
increased significantly only in the non-dairy group
(1.9kg).
Resting energy expenditure
The researchers found no changes in resting energy
expenditure in any of the groups as a result of the 16week period of resistance training, nor did they
observe any differences between groups.
Inflammatory profile and blood lipid profile
The researchers found no changes as a result of the
16-week period of resistance training in any of the
inflammatory markers (e.g. IL-6) or in any of the
cardio-metabolic health markers including low density
lipoprotein cholesterol (LDL), high density lipoprotein
cholesterol (HDL), and triglycerides.

The researchers concluded that dairy supplementation
aided the loss of fat during a resistance training
program in overweight sarcopenic elderly men.
Limitations
The study was limited as the mechanisms underlying
the change in fat mass could not be discerned.
Page 43
Leucine does not affect mechanistic target of

rapamycin complex 1 assembly but is required for
maximal ribosomal protein s6 kinase 1 activity in
human skeletal muscle following resistance exercise,
by Apr, Moberg, Hamilton, Ekblom, Rooyackers,
Holmberg, & Blomstrand, in FASEB Journal (2015)
Background
through supplementation. Leucine is believed to be a
key element of most protein supplements. For a
detailed introduction to protein supplementation, see
the preceding but one study review.
OBJECTIVE: To assess if the post-exercise effects of

consuming the essential amino acid (EAA) leucine on
mechanistic target of rapamycin complex 1 (mTORC1)
pathway are altered by the presence or absence of the
other EAAs, by taking muscle biopsies 60 minutes
before and 90 minutes after resistance exercise.
POPULATION: 9 resistance-trained males (>12
months of resistance training experience), aged 26
1 years.
INTERVENTION: All subjects performed a resistance
training workout on 4 different occasions. The workout
comprised 5 sets of 6 leg press repetitions at 90% of
1RM, followed by 5 sets of 10 leg press repetitions at
75% of 1RM, with 5 minutes of rest between each set.
At each occasion, they were randomly supplied with
EAAs with leucine (EAA-LEU), EAAs without leucine
(EAA-NO-LEU), leucine alone (LEU), or flavored water
placebo control (CONTROL).
What happened?
Molecular signaling
The researchers reported that the phosphorylation of
Akt (at Ser473) was significantly increased postexercise but there was no significant difference
between conditions. The researchers also noted that
the phosphorylation of mTOR (at Ser 2448) w a s
significantly increased post-exercise and the increase
in the EAA-LEU was greater than the CONTROL or
EAA-NO-LEU conditions. The researchers found that
phosphorylation of 4EBP1 (at Thr37/46) was significantly
increased post-exercise but there was no significant
difference between conditions. The researchers saw
increases in S6K1 phosphorylation (at Thr 389) residue
post-exercise except in the EAA-NO-LEU trial in which
S6K1 phosphorylation was unchanged.
Muscle protein synthesis
The rate of muscle protein synthesis during recovery
from exercise was similar in the LEU and EAA-LEU
trials (0.091 0.007% per hour in both) as well as in
CONTROL and EAA-NO-LEU trials (0.075 0.011%
and 0.073 0.008% per hour). The difference
between the LEU/EAA-LEU and CONTROL/EAA-NO-LEU
conditions did not reach significance.

The researchers concluded that leucine seems to
possess a unique ability to stimulate the mTORC1
signaling pathway (and possibly also muscle protein
synthesis) in human muscle, although a combination
of all EAAs is superior to leucine alone.
Limitations
The study was limited in that it was an acute trial and
it is unclear whether long-term trials comparing
protein supplements with and without leucine would
identify any meaningful differences between EAA-LEU
and EEA-NO-LEU.
Page 44
The skeletal muscle anabolic response to plant- versus

animal-based protein consumption, by Van Vliet,
Burd, & Van Loon, in The Journal of Nutrition (2015)
Background
through supplementation although also via changing
the type of foods that are consumed. Whether the
origin of the protein is important, however, is less
clear. For a detailed introduction to the effects of
protein supplementation, see the earlier study review.
OBJECTIVE: To perform a review of the literature in

order to evaluate whether the consumption of plantbased protein sources can stimulate muscle protein
synthesis and thereby assist with the increase of
muscle mass following resistance training.
What happened?
Immediate effects
The researchers note that several studies have now
established that soy protein consumption leads to
lower immediate rates of muscle protein synthesis
than the consumption of animal-based proteins,
including beef, whey and milk. Such measurements
have been taken both at rest and post-exercise.
Long-term effects
The only truly reliable way of comparing the effects of
plant-based and animal-based protein consumption on
supporting hypertrophy during resistance training is to
perform longitudinal trials, where several groups of
subjects perform resistance training interventions
while eating different protein sources. Although very
few studies have been carried out in this area, the
researchers note that when the same amount of
protein is consumed in plant-based and animal-based
diets, the animal-based diet group tends to display
greater improvements in muscle mass. However, there
are some trials in which larger amounts of protein
were consumed (in both plant-based and animalbased protein groups) that did not display any such
differences. It may therefore be the case that where
sufficient protein is eaten in the plant-based group, it
is perfectly feasible to achieve optimum protein needs
albeit with a greater absolute number of grams of
protein from that source.

The researchers concluded that there is little research
directly comparing plant-based and animal-based
protein sources in respect of their immediate effects
on muscle protein synthesis and their long-term
effects on enhancing hypertrophy following resistance
training. They concluded that soy appears to produce
a lower increase in immediate rates of muscle protein
synthesis and smaller long-term gains in muscle mass
than either dairy or meat-based proteins.
Limitations
This review was limited as it was a narrative review
based on the opinions of the authors.
Page 45
Contractile properties and sarcoplasmic reticulum

calcium content in type I and type II skeletal muscle
fibres in active aged humans, by Lamboley,
Wyckelsma, Dutka, McKenna, Murphy, & Lamb, in The
Journal of Physiology (2015)
Background
Muscle fibers can be classified in various ways and
using different methods. Firstly, the method of
measurement can differ and involve either ATPase
histochemistry, immunohistochemistry, or (much less
commonly) metabolic enzymes. Secondly, either the
proportion of muscle fibers (also variously referred to
as the percentage or composition) or the crosssectional area of the muscle fibers can be measured
for each muscle fiber type. Since the cross-sectional
area of the individual muscle fibers differs between
muscle fiber types, each of these measurements
produces different results and describes different
underlying phenomena. Changes in the proportion of
muscle fibers is thought to reflect a conversion of one
type of muscle fiber (usually a hybrid type) to another
(usually a pure type I, IIA or IIX). Changes in fiber
cross-sectional area reflect a combination of both
changes in individual fiber cross-sectional area and
conversions of one type of muscle fiber to another.
Thirdly, results can be presented in absolute terms or
in proportional terms relative to the other muscle fiber
type areas, with each muscle fiber type area being
expressed as a percentage of the whole. Presenting
changes in cross-sectional area in absolute terms
generally shows that all muscle fiber type areas
change (because they all increase). Presenting
changes in cross-sectional area in proportional terms
generally shows that no muscle fiber type areas
change (because they all increase more or less to the
same extent. Muscle fiber type is thought to be
important for several reasons. Firstly, muscle fiber
type is thought to influence the strength-to-size ratio
of individual muscles (also called specific tension).
Type II muscle fibers are generally believed to display
a higher force than type I muscle fibers, although the
literature is actually conflicting in this regard.
Secondly, muscle fiber type is thought to affect muscle
contraction velocity. Indeed, it has consistently been
found by many investigators that type II muscle fibers
display a faster muscle contraction velocity than type I
muscle fibers. Knowledge of how training affects type
I and type II muscle fibers may therefore be important
for strength coaches and athletes, as a higher
proportion of type II muscle fibers is likely beneficial
for performance in strength and power sports. Thirdly,
muscle fiber type may be important for hypertrophy
programming. It has traditionally been accepted that
type II muscle fibers tend to increase to a greater
extent in cross-sectional area than type I muscle
fibers following a program of resistance training.
However, it has been suggested that observations of
greater hypertrophy in type II muscle fibers could
potentially be more a function of the type of resistance
training programs that are conventionally used to
study increases in cross-sectional area than of the
responsiveness of this particular muscle fiber type.
OBJECTIVE: To compare the single fiber specific

tension (by reference to measurements taken with a
force transducer of skinned muscle fibers sourced
during muscle biopsies), the contractile apparatus
properties (using calcium ion buffered solutions), and
the muscle fiber type (using immunohistochemistry
from samples taken during muscle biopsies of the
vastus lateralis) between young and old individuals, in
order to find out whether changes in single muscle
fiber properties or muscle fiber type contribute to
reduced muscular strength in old age.
POPULATION: 20 old (aged 70 4 years) and 16
young (aged 22 3 years) individuals.
What happened?
Single fiber specific tension
The researchers found that there was no difference in
the single fiber specific tension of skinned muscle
fibers of type I muscle fibers between the young and
old subjects. However, the single fiber specific tension
of type II muscle fibers was significantly lower (by
17%) in the old subjects than in the young subjects.
Calcium ion sensitivity and content
The researchers found that there was no difference in
the calcium sensitivity of skinned muscle fibers of type
I muscle fibers between the young and old subjects.
However, the calcium sensitivity of type II muscle
fibers was significantly lower in the old subjects than
in the young subjects. They also found that the
endogenous and maximal calcium ion contents in
muscle fibers of old subjects were significantly lower
than the values in young subjects and moreover these
contents were not released following treatments
designed to produce full release, suggesting that the
amount of calcium ions that the old subjects can
release from the sarcoplasmic reticulum was lower
than that observed in young subjects.
Muscle fiber type
The researchers identified that the old subjects
displayed a greater proportion of type I muscle fibers
(by 24%) than the young subjects and a similarly
smaller proportion of type II muscle fibers (by 38%).

The researchers concluded that old subjects display a
smaller proportion of type II muscle fibers and a lower
specific tension and calcium sensitivity in those muscle
fibers. Additionally, they concluded that the amounts
of calcium ions that were stored and that could be
released from the sarcoplasmic reticulum were lower
in old subjects than in young subjects, which may also
be important for function.
Limitations
The study was limited in that it is unclear exactly what
the relevance of the calcium sensitivity and calcium
ion storage and release is for muscle function.
Page 46
Meta-analysis melatonin for the treatment of

primary sleep disorders, by Ferracioli-Oda, Qawasmi,
& Bloch, in FOCUS (2014)
Background
Sleep is essential for humans. Sleep deprivation leads
to severe reductions in both cognitive and physical
performance and ultimately endangers health. Current
guidelines for health recommend that adults achieve
between 7 9 hours of sleep each night. However,
several epidemiological studies have revealed that
achieving inadequate sleep is a common problem for
many adults of all ages in modern society, as well as
children. In this regard, many researchers have made
suggestions regarding potentially contributory factors
to the failure to attain sufficient sleep in modern
society, including caffeine consumption, smoking,
exposure to electronic media, exposure to bright lights
during dark night hours, sleep timing, jet lag and shift
work, all of which may disrupt our natural circadian
rhythms and thereby alter sleep. The relatively high
prevalence of short sleep duration among adults in
modern society has also been associated with the rise
in obesity and overweight. Indeed, a number of crosssectional studies have identified an association
between shorter sleep durations and conditions of
either obesity or overweight. Whether this implies that
sleeping for shorter sleep durations leads to increased
appetite or food consumption, or whether being obese
or overweight leads to sleeping for shorter durations,
is unclear. Interestingly, intermittent sleep has also
been connected to greater risk of being overweight or
obese, and a single randomized controlled trial has
found that placing a sleep management component
into a 12-week weight-loss intervention program led
to significantly more weight loss in adults than a
standard treatment, as well as greater coping and
self-efficacy measures. These factors suggest that
short sleep duration might lead to overweight or
obesity rather than the other way around. Researchers
who have investigated the impact of interventions on
sleep have suggested that effective measures for
improving sleep duration and quality include: keeping
consistent bedtimes and consistent waking times,
engaging in regular physical activity and exercise,
reducing consumption of caffeine (notably post-lunch),
reducing exposure to television programs and video
games immediately before bedtime, turning off all
electronic displays 2 hours prior to bedtime, dimming
overhead lights later in the evening, making use of hot
baths, soothing drinks, meditation, massage, deep
breathing, reading calming material, minimizing the
impact of distracting noise (either by reducing all
noise or by implementing white noise generators such
as electric fans), and ensuring that the bedroom is at
a suitable temperature and the bed is comfortable.
OBJECTIVE: To perform a meta-analysis in order to

investigate the efficacy of melatonin compared to a
placebo for improving outcomes related to sleep
quality in patients with primary sleep disorders and to
quantify the dose-response effect (by using metaregression).
STUDY SELECTION: Studies were included that were
randomized, placebo-controlled trials investigating the
effects of melatonin on either sleep onset latency,
sleep quality, or total sleep time in subjects with
primary sleep disorders. Sleep quality was assessed
either objectively (by reference to polysomnography
or actigraphy) or subjectively (by reference to scales,
questionnaires, or sleep logs). Trials were included
where they involved >10 subjects for parallel group
designs or >5 subjects in crossover designs.
What happened?
The researchers identified 19 studies including a total
of 1,683 subjects. No quality assessment of these
studies was performed.
Effects of melatonin
The researchers found that melatonin was significantly
better than a placebo for sleep onset latency (by 7.1
minutes) for total sleep time (by 8.3 minutes) and
produced greater sleep quality (effect size = 0.22).
For sleep onset latency and total sleep time, there was
substantial heterogeneity between trials (I-squared =
56% and 44%) but there was no heterogeneity
between trials for sleep quality (I-squared = 0%),
despite the various different objective and subjective
tests used. The Eggers Test displayed no evidence of
publication bias in any measure. Meta-regression
revealed that those trials with longer duration and
those trials using higher doses of melatonin displayed
greater effects on both sleep onset latency and total
sleep time compared to shorter durations and smaller
doses of melatonin. However, there was no effect of
either trial duration or melatonin dosage on measures
of sleep quality.

The researchers concluded that this meta-analysis of
19 trials shows that melatonin decreases sleep onset
latency (by around 7 minutes), increases total sleep
time (by around 8 minutes) and improves overall
sleep quality.
Limitations
The meta-analysis was limited in that the researchers
did not report sub-group analysis of the metaanalyses in which substantial levels of heterogeneity
were observed. Thus, it is unclear whether other
factors contributed to the heterogeneity or whether
the trial duration and melatonin dosage were the only
factors that caused this variability between trials.
Page 47
Effects of oral contraceptive use on the salivary

testosterone and cortisol responses to training
sessions and competitions in elite women athletes, by
Crewther, Hamilton, Casto, Kilduff, & Cook, in
Physiology & Behavior (2015)
Background
Oral contraceptives are hormone-based interventions
that alter the normal functions of the menstrual cycle.
The menstrual cycle is a repetitive sequence of
physiological changes that occurs in the uterus and
ovary of fertile female humans in order to produce
eggs for the purposes of sexual reproduction. Cycling
is regulated by a complex interaction of the levels of
endogenous hormones and lasts from menarche until
menopause. The length of each individual cycle is
counted from the first day of menstrual bleeding and
can vary between 21 35 days. It can be divided into
three sequential ovarian phases: follicular, ovulatory,
and luteal. The ovulatory and luteal phases of the
cycle are thought to be fairly standardized at a length
of around 14 days while the length of the follicular
phase can vary substantially between cycles and
between individuals. During the follicular phase, there
is a rise in follicle stimulating hormone, which
stimulates a small number of ovarian follicles to
mature, one of which proceeds and prepares to
release an egg. In the ovulatory phase, there is a
spike in luteinizing hormone from the anterior pituitary
gland, which causes the mature egg to be released
into the oviduct from the ovarian follicle. Finally, in the
luteal phase, there is a rise in progesterone levels,
which in turn causes the production of estrogen. The
subsequent fall in progesterone is the factor that
causes menstruation and this signals the start of the
following cycle. In sports science research, several
investigations have explored the effects of the
menstrual cycle on the risk of non-contact Anterior
Cruciate Ligament (ACL) injury, leading to the general
consensus that ACL risk is not constant during all
phases but is greater in the follicular phase than in the
luteal phase. The exact mechanisms for this increased
risk are unclear but may relate to differences in joint
laxity or changes in joint stiffness as a result of
neuromuscular alterations, some of which may be
mediated by hormone levels.
OBJECTIVE: To compare the salivary testosterone

and cortisol responses of elite female hockey players
across 4 activities (light training, heavy training, club
and international competitions) between those taking
oral contraceptives and those not taking any oral
contraceptives.
POPULATION: 29 elite women hockey players, aged
25.3 2.1 years, comprising 10 players in an oral
contraceptive group (OC group) and 19 players in a
non-oral contraceptive group (NOC group) who all
reported having regular menstrual cycles.
What happened?
Differences between groups
The researchers found that the NOC group had higher
levels of testosterone (by 47 52%) across light and
heavy training. The researchers also found that the
NOC group had higher levels of testosterone (by 31
41%) across club and international competitions.
Differences between activity types
The researchers found that testosterone increased
following heavy training (by 45%), club competitions
(by 62%) and international competitions (by 40%) but
not after light training. They also found that cortisol
reduced after light training (-52%) but increased after
heavy training (by 46%), club competitions (by 80%)
and international competitions (by 27%).

The researchers concluded that individuals taking oral
contraceptives display reduced testosterone levels and
there are different changes in testosterone and
cortisol levels following training and competition in
both individuals taking oral contraceptives and those
not taking oral contraceptives.
Limitations
The study was limited in that the exact implications of
post-exercise testosterone and cortisol responses have
yet to be determined.
Page 48
Metabolic effects of non-nutritive sweeteners, by

Pepino, in Physiology & Behavior (2015)
Background
Non-nutritive sweeteners are used in processed foods
as sugar substitutes because they produce a sweet
taste by means of substances that do not contain any
calories. At present, there are six non-nutritive
sweeteners that have been approved as a sweetener
in food by the US Food and Drug Administration (FDA)
(aspartame, acesulfame potassium, advantame,
saccharin, sucralose, and neotame) and two additional
non-nutritive sweeteners that have been approved as
safe (steviol glycosides, Luo han guo extract). In order
to provide these approvals for use, clinical studies
were performed to ensure that they were generally
safe. Nevertheless, there are some indications that a
paradoxical effect is observed, in that epidemiological
studies have reported associations between the
consumption of non-nutritive sweeteners and weight
gain, risk of developing the metabolic syndrome, and
risk of developing type II diabetes. To explain this
apparent paradox, at least two hypotheses have been
suggested. Firstly, it has been proposed that the
individuals who consume non-nutritive sweeteners
tend to be those who are already at greater risk of
weight gain, developing metabolic syndrome, and
developing type II diabetes. Secondly, it has been
suggested that there are some biological processes
that involve non-nutritive sweeteners that increase the
risk of these conditions in ways other than the direct
excess consumption of calories, perhaps through the
elevation of appetite.
OBJECTIVE: To perform a review of the literature

regarding the potential mechanisms by which nonnutritive sweeteners might bring about metabolic
dysregulation.
What happened?
Interference with learned responses
The researchers explain that one hypothesis that
might explain the adverse effects of non-nutritive
sweeteners is that they could affect the learned
response connecting sweet tastes and energy intake,
which could in turn alter the autonomic and endocrine
responses that normally occur within the digestive
tract during the ingestion of food. Rodent models that
have been devised to test this hypothesis have shown
that rats who have become accustomed to eating
things with a sweet taste that do not contain calories
display several dysregulated features, including more
adipose tissue, a reduced ability to compensate for
pre-meal snacks, and a reduced thermic effect of food.
Interference with gut microbiota
The researchers explain that another hypothesis that
might explain the adverse effects of non-nutritive
sweeteners is that since they clearly reduce the risk of
dental cavities (by being resistant to fermentation by
oral bacteria and also through bacteriostatic effects),
they might also have antibacterial effects within the
gut. Indeed, rodent models have found that exposure
to non-nutritive sweeteners does cause changes in gut
microbiota that are associated with weight gain.
Interactions with digestive system taste receptors
The researchers note that a recent exciting discovery
in the field has been the realization that there are
taste receptors in the gut. They explain that another
hypothesis for explaining the role of non-nutritive
sweeteners in weight gain concerns these intestinal
sweet taste receptors. Rodent models have revealed
that active intestinal glucose absorption and passive
intestinal glucose absorption are altered under certain
conditions of non-nutritive sweetener consumption,
leading to insulin resistance.

The researchers concluded that there are a number of
potential mechanisms, by which the consumption of
non-nutritive sweeteners could lead to the metabolic
disorders observed in several cross-sectional studies,
including interference with learned responses that
connect sweet tastes and calories, alterations in gut
microbiota, and interactions with the sweet taste
receptors in the gut, which influence insulin secretion.
Limitations
The study was a narrative review and the views put
forward by this group of researchers may not be
shared by all other researchers working in the same
field.
Page 49
The biology of appetite control: do resting metabolic

rate and fat-free mass drive energy intake? By
Blundell, Finlayson, Gibbons, Caudwell, & Hopkins, in
Physiology & Behavior (2015)
Background
Resting metabolic rate accounts for the largest
proportion of daily total energy requirements in
humans. It is calculated as energy expended (in kcal)
per unit of bodyweight (in kg) over time (in hours).
Resting metabolic rate is normally defined as the
amount of energy expended by the body while awake
and in a resting (sitting or lying) position. In this
respect, it is very similar to basal metabolic rate,
although this definition is more specific and requires
that the measurement is taken first thing in the
morning after an overnight fast and having performed
no exercise in the previous 24 hours. Previous studies
across groups of different populations have found that
resting metabolic rate differs depending on age, sex,
and body composition. Specifically, resting metabolic
rate is higher for males than for females, is higher in
younger individuals than in older individuals, and is
higher in lean individuals than in overweight or obese
individuals. Indeed, obese individuals have been found
to display the lowest resting metabolic rates. This is
likely because resting metabolic rate is defined relative
to bodyweight rather than lean body mass and fat
mass is not believed to contribute appreciably to
resting energy metabolism.
OBJECTIVE: To perform a narrative review of the

roles of lean body mass and fat mass on RMR, meal
sizes, daily energy intake, and appetite.
What happened?
Relationships between body mass and energy intake
The researchers explain that many studies in humans
that have examined the relationships between lean
body mass, fat mass and both meal sizes and daily
energy intake. They found that there was a positive
relationship between lean body mass and both meal
size and daily energy intake but not between fat mass
and either meal size or daily energy intake. This
picture is not consistent with the idea that how much
adipose tissue an individual possesses regulates how
much food they consume.
Relationships between RMR and energy intake
The researchers explain that the mechanism by which
lean body mass could be related to energy intake is
likely RMR. Previous studies have found that RMR is a
key determinant of both meal size and daily energy
intake in both obese and normal-weight individuals. In
addition, it has recently been demonstrated that RMR
has a robust relationship with lean body mass.
Adipocentric views of obesity
The researchers note that current models of how
people become obese do not tend to involve a key role
for lean body mass and tend to assume that energy
intake is largely determined by the amount of fat
mass (i.e. excess fat mass suppresses energy intake).
These findings suggest that this approach is incorrect
and that fat mass does not exert a large negative
feedback effect on energy intake and that lean body
mass does in fact exert a substantial positive feedback
effect on energy intake. The researchers note that
while mechanistic research shows that fat mass likely
does possess regulatory mechanisms for reducing
energy intake (insulin and leptin), the increases in
leptin and insulin resistance that occur with increasing
fat mass weaken the inhibitory influence of fat mass
on appetite as fat mass increases.

The researchers conclude that lean body mass is
positively associated with meal size and daily energy
intake. They conclude that RMR is associated with
both lean body mass and meal size and daily energy
intake, which may explain how lean body mass is
related to meal size and energy intake. In contrast, fat
mass is not negatively related to meal size and daily
energy intake, which may be explained by insulin and
leptin resistance.
Limitations
Page 50
Obesity and the neurocognitive basis of food reward

and the control of intake, by Ziauddeen, AlonsoAlonso, Hill, Kelley, & Khan, in Advances in Nutrition:
An International Review Journal (2015)
Background
Obesity arises from an individual being in a chronically
positive energy balance (i.e. where energy intake is
greater than energy expenditure). However, the
mechanisms by which this chronically positive energy
balance arises are unclear and it is thought to involve
genetic, environmental and cultural influences and the
rising standard of living in the developed world.
Globally, obesity and overweight is now the main
nutritional problem. Obesity has surpassed
malnutrition and infectious disease as the most
important contributor to mortality and ill health. The
World Health Organization (WHO) have reported that
worldwide obesity has nearly doubled since 1980 and
that as of 2008, >1.4 billion adults aged >20 years
were overweight of which >0.5 billion were obese.
This means that 35% of the world population aged
>20 years were overweight and 11% were obese.
Obesity and overweight are often defined by reference
to Body Mass Index (BMI), where overweight is
defined as a BMI of >25kg/m2 and obesity is defined
as a BMI of >30kg/m2. The WHO have identified that
having a higher BMI puts individuals at increased risk
of a number of non-communicable diseases, including
cardiovascular diseases (mainly heart disease and
stroke), type II diabetes, osteoarthritis, and some
cancers (endometrial, breast, and colon). Additionally,
the risk of incurring these diseases has been found to
increase further as BMI increases. The major risk
factors for obesity are: a high amount of sedentary
behavior and other inactive lifestyle behaviors such as
television watching, ethnicity and socioeconomic
status, and poor nutritional habits. There is therefore
great interest from healthcare organizations,
governments and research bodies in identifying the
best methods for reducing the incidence and
prevalence of obesity and overweight. In the
mainstream media, the most common weight
management methods are dietary interventions and
exercise/lifestyle programs. However, in the medical
environment and particularly for those individuals who
are very or morbidly obese, there are other treatment
options, including bariatric surgery. Nevertheless, a
large and detailed previous body of research has
found that dietary interventions and exercise/lifestyle
programs are indeed beneficial to obese individuals for
improving cardiovascular risk, reducing intra-hepatic
lipids, and decreasing subcutaneous and visceral fat.
Moreover, such studies have also reported that greater
levels of physical activity may benefit weight loss and
minimize the risk of regaining lost weight. In contrast,
bariatric surgery has been associated with excessive
losses in lean body mass, which may lead to
sarcopenia in later life.
OBJECTIVE: To perform a literature review of the

research into the brain reward system in the control of
food intake, as assessed by studies using functional
neuroimaging techniques, including both magnetic
resonance imaging (fMRI) scans and positron emission
tomography (fPET), and by developments in cognitive
psychology.
What happened?
Neuroimaging studies
The researchers explain that neuroimaging studies
exploring the role of the brain reward system in
governing food intake have generally taken two routes
in order to explore the question, using either fMRI or
PET. PET scans use radioactive tracers to monitor the
behavior of regional blood flow and of specific
receptors in the brain. fMRI scans record the changes
in magnetic fields that accompany regional changes in
blood flow changes in the brain. Firstly, researchers
have tried to identify the nature of the reward system
response (as recorded by either fMRI or PET) to
various different food stimuli and to quantify how
predictive this response is of future food intake.
Secondly, they have tried to identify differences in the
reward system response between normal-weight and
obese individuals. Both of these approaches have
found positive preliminary findings but the state of the
research is too early to establish whether people who
have certain patterns of brain reward systems are at a
greater risk of developing obesity than those who do
not.
Differences in cognitive control
Some commentators on the obesity problem assume
that humans are always capable of performing the
actions that lead to their best possible long-term gains
and that they are (in economic terms) rational and
goal-oriented decision makers. Such beliefs lie behind
advice like eat less, move more as such statements
assume that humans do not display traits such as poor
planning, pre-mature or risky actions, and impulsive
choices. And yet, the researchers point out that
inhibitory control and trait impulsivity are among the
most well-studied areas in human psychology (and for
good reason). Indeed, researchers have found that
obese individuals display higher impulsivity that is
associated with greater energy intake, weight gain,
and worse response to weight loss treatments, steeper
delay discounting (lower ability to delay gratification),
and more executive impairment. In contrast, a higher
degree of inhibitory control seems to be protective
against future weight gain.

The researchers concluded that although humans like
to believe that they are rational and capable of making
objective decisions, even in relation to food intake,
this is not supported by research.
Limitations
Page 51
Associations of sedentary time with fat distribution in

a high-risk population, by Henson, Edwardson,
Morgan, Horsfield, Bodicoat, Biddle, & Yates, in
Medicine & Science in Sports & Exercise (2014)
Background
Physical activity is any active movement of the body
that is produced by muscular contractions and that
results in the expenditure of energy. In contrast,
sedentary behavior is simply an absence of physical
activity. Physical activity can be measured in various
ways and with a range of tools. However, the most
common measurement tool is an accelerometer.
Accelerometers have the benefit of being objective in
determining the distance travelled and the duration
over which the activity is performed. The most
commonly-used way to analyze the physical activity
into different categories is on the basis of metabolic
equivalent units (METs). One MET (1.0 MET) is equal
to the energy expenditure required to maintain a
seated position. Thus, more demanding activities can
be related back to how much energy they require in
relation to simply maintaining the seated position.
Therefore, light activity of <3.0 METs includes
behaviors such as strolling at 1 2 mph, easy
swimming, or stretching. Moderate activity of 3.0
6.0 METs includes walking briskly at 3 4mph, cycling
at <10mph, or housework. Vigorous activity or
exercise is anything >6.0 METs. Studies have reported
that children from pre-school to adolescence engage
in moderate-to-vigorous physical activity of anywhere
between 18.9 164 minutes per day, depending on
the country in which they live. The number of minutes
of moderate-to-vigorous physical activity seems to be
smaller in overweight than in normal-weight children
and also seems to reduce with increasing age.
Similarly, research suggests that most adults engage
in moderate-to-vigorous physical activity of between
12 99.4 minutes per day, depending on the
population. Overweight and obese adults seem to
engage in less physical activity than normal-weight
adults but it is unclear whether elderly adults perform
markedly less physical activity than young adults.
Epidemiological studies indicate that physical activity
of any kind reduces all-cause mortality even at low
levels. Being among those undertaking the highest
levels of moderate physical activity seems to be
associated with a reduction in all-cause mortality of
around 30 40%. Additionally, there are bigger
reductions of around 75 80% in all-cause mortality
in populations who undertake more vigorous physical
activity, such as sport.
OBJECTIVE: To investigate the association between

objectively measured sedentary time (by reference to
triaxial accelerometry) regional and whole body fat
(heart, liver, visceral, subcutaneous and total) (as
measured by magnetic resonance imaging [MRI]
scans) in subjects at high risk of type II diabetes.
POPULATION: 66 individuals (33 males and 33
females), aged 47.9 16.2 years. Subjects were
included if they were at high risk of developing type II
diabetes, as measured by reference to impaired
glucose tolerance, impaired fasting glycemia, obesity,
or family history of type II diabetes.
What happened?
The researchers produced a model that accounted for
a number of important covariates, including glycemia,
whole-body fat, and the amount of moderate-tovigorous physical activity performed. In this model,
each additional 30-minute block of sedentary time was
associated with significantly more (by 15.7cm3) heart
fat, significantly more (by 1.2%) liver fat, and
significantly more (by 183.7cm3) visceral fat.

The researchers concluded that objectively measured
sedentary time using accelerometry appears to be
independently associated with heart, liver, and visceral
fat even after controlling for both the total amount of
whole-body fat and the amount of moderate-tovigorous physical activity performed, in individuals at
a high risk of type II diabetes.
Limitations
The study was limited in that it was a cross-sectional
investigation and it is not clear from this study
whether changing levels of sedentary behavior would
have any effect on the levels of heart, liver, and
visceral fat in individuals at a high risk of type II
diabetes.
Page 52
4. PHYSICAL THERAPY AND REHABILITATION
Page 53
Exercise-induced rhabdomyolysis mechanisms and

prevention: a literature review, by Kim, Lee, Kim,
Ryu, Cha, & Sung, in Journal of Sport and Health
Science (2015)
Background
Rhabdomyolysis is severe muscle damage that has
been reported subsequent to extremely vigorous and
unaccustomed exercise, particularly types of training
that involve eccentric muscle actions, and often in
conjunction with accompanying heat stress and/or
dehydration. Rhabdomyolysis is a level of muscle
damage so severe that cell membranes are fractured
and the constituents of the muscle cell, including
myoglobin, are released into the extracellular fluid and
into the circulatory system. Rhabdomyolysis has two
very dangerous implications. Firstly, the myoglobin
that is released from the damaged muscle cells can
precipitate in the kidneys and cause renal failure.
Secondly, the damaged muscle can swell excessively,
leading to compartment syndrome, which is where
pressure builds up within the muscles that leads to
tissue ischemia, pain and weakness. If the pressure is
sufficiently high in compartment syndrome, a surgical
fasciotomy may be required to relieve the pressure.
Rhabdomyolysis is typically diagnosed where dark
reddish-brown urine (myoglobinuria) is recorded along
with severe muscle pain and weakness between 12
36 hours post-exercise. Serum creatine kinase levels
are often also recorded and tracked subsequent to
rhabdomyolysis as proxy markers for myoglobin.
Normal creatine kinase levels are in the region of 50
250U/I but in cases of rhabdomyolysis, levels typically
reach several thousand. Some investigations have
suggested that levels >5,000U/I may be associated
with a greater risk of renal failure. Creatine kinase
levels rise in tandem with the onset of muscle pain
and weakness post-exercise, peak at 24 72 hours
post-exercise, and decline within 5 days post-injury.
Additional features of rhabdomyolysis may include a
general feeling of fatigue, fever, tachycardia, nausea
and vomiting.
OBJECTIVE: To perform a literature review of possible

pathophysiologies of exercise-induced rhabdomyolysis
(EIR) and to make recommendations regarding the
possible preventive strategies based upon these
findings.
What happened?
Pathophysiology of EIR
The researchers note that several studies of EIR have
observed elevated levels of calcium ions (Ca2+) in the
sarcoplasm of muscle cells. Ca2+ ions are normally
discharged into the sarcoplasm during muscle actions.
A substantial reduction in the availability of adenosine
triphosphate (ATP) typically occurs following the needs
of high-intensity anaerobic exercise. This reduction
affects the behavior of the ATP transporters, which
include Na- K+ ATPase and Ca2 + ATPase. Some studies
indicate that changes in the behavior of these ATP
transporters may affect concentrations of the various
ions in the cells, leading to elevated Ca2+ ions in the
sarcoplasm. This excess of Ca2+ ions in the sarcoplasm
has been associated with heightened activity of some
proteases and phospholipase, which may damage the
cell membrane, allowing cell material to escape.
Factors affecting the risk of EIR
The researchers note that previous studies have found
that the exercise experience of participants and the
types of exercises can both affect the risk of EIR.
Specifically, it seems that less experienced individuals
are at greater risk of developing EIR than more
experienced individuals. Although different types of
exercise have not been directly compared for their
ability to produce EIR, the researchers note that the
majority of reports of EIR have been made following
some sort of highly-repetitive resistance training or
plyometrics exercise (e.g. 800 sit-ups and 400 pushups, 250 500 squat jumps, and weight training plus
300 squat jumps). Analyses of these exercises suggest
that high-velocity or high-load exercises with eccentric
components performed for very high repetitions might
be the key elements required for EIR. In addition to
these primary factors, the researchers note that there
is some evidence to suggest that exercising in hot
environments, electrolyte imbalances, very high levels
of carbohydrate intake, creatine intake, and alcohol
consumption may all elevate the risk of EIR in those
individuals already pursuing activities involving highly
repetitive, intense muscle actions.

The researchers concluded that increased calcium ion
levels in muscle cells leading to degradation of the cell
membrane might be the pathophysiology of EIR. EIR
might be caused by performing very high repetitions
of high-velocity or high-load exercises with eccentric
components and may be exacerbated by exercising in
high temperatures, in electrolyte imbalance, and with
high carbohydrate, creatine and/or alcohol intakes.
Limitations
Page 54
Gluteus maximus inhibition in proximal hamstring

tendinopathy, by De Jesus, Bryk, Moreira, Nakaoka,
Dos Reis, & Lucar, in Medical Express (2015)
Background
The gluteus maximus originates on the posterior
quarter of the iliac crest, the posterior surface of the
sacrum and coccyx and the fascia of the lumbar spine.
It inserts on the oblique ridge on the lateral surface of
the greater trochanter of the femur and the iliotibial
band of the fascia latae. In humans, the gluteus
maximus is much larger than in other apes,
partic ularly in res pec t of the upper region.
Additionally, it is attached to the iliac crest as well as
the ischium, which is not the case in other apes. Also,
in other apes, the gluteus maximus is subdivided into
two separate muscles whereas in humans it is a single
muscle, albeit with multiple subdivisions. Indeed, the
gluteus maximus contains 3 divisions from top to
bottom (superior, middle, inferior) and two halves
from side to side (medial and lateral) that can be
shown to perform distinctly different functions in 6
regions, as can be shown by both muscle architecture
and electromyography (EMG) activity. The gluteus
maximus can also be subdivided into superficial, deep
sacral and deep iliac layers. The gluteus maximus is
an extremely important muscle and is the largest and
heaviest of all the muscles in the body. It comprises
around 13 15% of total leg muscle mass by weight
(around 600g in elderly males). It has a physiological
cross-sectional area of ~34cm2 and an anatomical
cross-sectional area of ~ 48.4cm2. The muscle
architecture of the gluteus maximus is extraordinary
in that it has both a long fascicle length and a large
cross-sectional area. It is also strongly pennate, as
might be expected from its large cross-sectional area.
The gluteus maximus is 52 68% percent type I
fibers, making it an evenly mixed slow and fast twitch
muscle. It has its most significant moment arm in the
sagittal plane for hip extension but also has a large
moment arm in the transverse plane for external
rotation. It also has a very small adduction moment
arm in the frontal plane. Our current understanding
based on anatomy, muscle architecture and EMG
studies indicates that the gluteus maximus performs a
number of different hip actions from extension, to
external rotation and abduction/adduction. It also
raises the trunk when the femur is fixed in position,
and posteriorly tilts the pelvis. The gluteus maximus
therefore requires a range of different movements
performed with these actions in mind in order to
target it fully. Various pathologies have been
associated with gluteus maximus weakness. A weak
gluteus maximus has been associated with an
increased risk of lower back pain, excessive anterior
pelvic tilt, sacroiliac joint pain, piriformis syndrome,
anterior femoral hip glide, knee valgus and increased
ACL injury risk and hip internal rotation and
consequent foot pronation.
OBJECTIVE: To identify whether there is loss of hip

extension strength (as measured by reference to
maximum isometric hip extension force production by
using handheld dynamometry) in the ipsilateral
gluteus maximus in cases of proximal hamstring
tendinopathy, by performing 3 case studies of subjects
with proximal hamstring tendinopathy.
POPULATION: 3 recreationally active individuals
(occupation = computer-based work) with proximal
hamstring tendinopathy, being 1 male (aged 48 years,
height 175cm, bodyweight 72kg), 1 male (aged 35
years, height 180cm, bodyweight 88kg) and 1 female
(aged 51 years, height 159cm and bodyweight 65kg).
Subjects were included where they had a diagnosis of
proximal hamstring tendinopathy, and where they had
undergone conservative treatment and yet achieved
poor results, and who displayed a loss of muscle in the
ipsilateral versus the contralateral gluteus maximus
muscle.
What happened?
The researchers found that there was was a reduction
of hip extension force of 34% between the ipsilateral
and the contralateral gluteus maximus muscles, which
was accompanied by a visible loss of muscle on the
ipsilateral side.

The researchers concluded that individuals who
display proximal hamstring tendinopathy can also
present with a loss of hip extension strength and
accompanying loss of gluteus maximus muscle size.
Limitations
The study was limited in that the researchers did not
perform a valid or reliable measurement of voluntary
activation to assess whether the loss of strength was
purely related to a loss of muscle mass or whether
there was a neural component. Also, the researchers
did not perform a measurement of the muscle size of
the two sides of the gluteus maximus. Finally, the
study was a case series and not a cross-sectional
study with a formal study design.
Page 55
The neuromechanical adaptations to Achilles

tendinosis, by Chang, & Kulig, in The Journal of
Physiology (2015)
Background
Tendinopathy is usually taken as a generic term
describing any abnormal tendon condition, although
there is some disagreement about the exact usage of
the nomenclature. Some researchers and clinicians
consider that the term tendinopathy encompasses
both tendinitis and tendinosis. However, others
consider that only long-term structural changes can be
considered tendinopathy and where tendinitis involves
only transitory inflammation, this would not be
classified as tendinopathy. Researchers holding to this
definition suggest that the structural changes
associated with tendinopathy include increased
cellularity, increased vascularity, a tendency for cells
to become more rounded rather than elongated,
greater glycosaminoglycan deposition, calcification
and lipid deposition. Tendinitis is usually defined
purely as the inflammation of a tendon and is thought
to arise from micro-tears following from acute
overloading of the muscle-tendon unit by an
unexpected or excessively large tensile force. On the
other hand, the term tendinosis describes the
degeneration of tendon collagen in response to chronic
overuse. It is thought that tendinosis arises where
chronic damage occurs without the tendon having
time to heal (as occurs in the case of repetitive strain
injury). In any event, tendinopathy, however it is
defined, involves activity-related pain, tenderness,
localized swelling and disability. It is thought to
account for up to half of all sports injuries and is
highly prevalent in athletes who participate in
activities involving repetitive movements. Commonlyoccurring tendinopathies seen by sports medicine
physicians and physiotherapists include patellar,
Achilles, lateral epicondyle of the elbow, and rotator
cuff of the shoulder. Tendinopathy has traditionally
very commonly been treated conservatively with
stretching and now more recently with eccentric
exercise. However, the exact mechanisms by which
such modalities are effective is unclear. Some
researchers have suggested that eccentric exercise
helps stimulate remodeling of the tendon structure by
changing blood and fluid flow but this is far from being
apparent.
OBJECTIVE: To assess whether the presence of

tendinopathy alters the stiffness of Achilles tendons
(by using an ultrasound in combination with an
isokinetic dynamometer), changes aspects of neural
drive (by using surface electromyography [EMG] to
measure the H-reflex, H/M ratio and V/M ratio), and
alters the electromechanical delay [EMD] (by using
evoked contractions with an electrical stimulator while
in the isokinetic dynamometer).
POPULATION: 19 subjects, aged 47 7 years,
allocated into 9 subjects with Achilles tendinopathy
(AT group) who had a history of unilateral Achilles
tendon discomfort (i.e. >1 episode of >2 weeks) but
an absence of Achilles tendon pain during walking or
running at the time of the study and sonographic
evidence of Achilles tendinopathy. The other 10
subjects were healthy controls (CON group) with no
prior major injury or surgery involving the lower
extremity or any medical condition that might alter
tendon composition, (such as diabetes, rheumatoid
arthritis, systemic lupus erythromatosis) or affect the
function of the lower body.
What happened?
Tendon stiffness
The researchers found that tendon stiffness was
significantly greater on the uninjured side than on the
injured side in the AT group (295.39 60.37 vs.
164.82 43.8N/mm). There were no side-on-side
differences in the CON group. The side-on-side
difference was significantly different between groups.
H/M and V/M ratios
The researchers found that H/M ratio was significantly
less on the uninjured side than on the injured side in
the AT group (0.24 0.10 vs. 0.38 0.10). There
were no side-on-side differences in the CON group.
The side-on-side difference was significantly different
between groups. The researchers also found that the
V/M ratio was significantly less on the uninjured side
than on the injured side in the AT group (0.27 0.08
vs. 0.43 0.10). There were no side-on-side
differences in the CON group. The side-on-side
difference was significantly different between groups.
EMD
The researchers found that EMD was significantly less
on the uninjured side than on the injured side in the
AT group (29.44 2.21 vs. 39.44 3.96ms). There
were no side-on-side differences in the CON group.
The side-on-side difference was significantly different
between groups.

The researchers concluded that Achilles tendinopathy
is associated with less stiff Achilles tendons but
elevated spinal and supraspinal excitability.
Limitations
similar results would be observed in other forms of
tendinopathy (e.g. at the shoulder).
Page 56
Proximal muscle rehabilitation is effective for

patellofemoral pain: a systematic review with metaanalysis, by Lack, Barton, Sohan, Crossley, &
Morrissey, in British Journal of Sports Medicine (2015)
Background
Patellofemoral pain syndrome (PFPS) occurs very
frequently in young adult females. It is also the most
common injury affecting recreational endurance
runners. However, despite being so common, its exact
cause remains unclear and diagnosis of PFPS is usually
made once other, more easily diagnosed conditions
have been ruled out. Nevertheless, many researchers
believe that lower-body biomechanics are a key factor
in the development of PFPS. Previous studies have
found that females with the disorder display several
specific features, including: greater lateral patellar
displacement and greater internal femoral rotation at
several knee flexion angles. This is important, as a
larger Q-angle has also been proposed as an
anthropometric feature that predisposes individuals to
PFPS. The existence of the Q-angle means that there
is naturally a lateral pull on the patella. Thus, if certain
biomechanical features increase the size of this lateral
pull, this could increase the risk of greater lateral
tracking of the patella, which may in turn cause knee
pain. The single-leg squat has often been used to
explore the biomechanics of knee movement in the
context of PFPS. Studies have found that individuals
suffering from PFPS display a greater frontal plane
projection angle during the single-leg squat than
asymptomatic individuals. Frontal plane projection
angle is a simple, 2D method of measuring knee
alignment. Angle of hip adduction is closely correlated
with frontal plane projection angle and prospective
cohort studies have reported that this angle is
predictive of the development of PFPS in female
athletes without PFPS at baseline. Additionally,
reviews have found that lower hip external rotator,
abductor, and hip extensor strength are frequently
reported in individuals with PFPS compared to
individuals without PFPS. While such studies do not
establish the extent to which disuse atrophy may play
a role, other prospective studies have made similar
findings. The connection between the various risk
factors may be found in the varied role of the gluteus
maximus, which acts variously as a hip extensor, hip
external rotator and hip abductor. Thus, in controlling
internal rotation, and by implication knee valgus
during single-leg movements, the strength of the
gluteus maximus could be important for PFPS.
OBJECTIVE: To perform a systematic review to

assess the effects of hip and/or lumbopelvic muscle
exercise for improving outcomes associated with PFPS
and to compare the efficacy of hip and/or lumbopelvic
muscle exercise with other types of rehabilitation.
STUDY SELECTION: Randomized clinical trials and
cohort studies were included that assessed the effects
of programs of hip and/or lumbopelvic muscle exercise
for outcomes relating to PFPS in individuals with PFPS
but without other knee pathologies.
What happened?
The researchers identified 14 studies, of which 11
were randomized or comparative control trials and 3
were cohort studies. The quality scores (using the
PEDro scale) ranged between 3 and 10 points. Of the
14 studies, 7 were classed as high quality (>6 points)
and 7 were classed as low quality (<6 points).
Effects of hip muscle exercise
The researchers found very limited evidence (1 low
quality study) to show that open kinetic chain hip
muscle exercise using elastic resistance bands could
reduce pain (visual analog scale [VAS]) and improve
function (Western Ontario and McMaster osteoarthritis
[WOMAC] index) in individuals with PFPS.
Comparison of hip and knee muscle exercise
The researchers found moderate evidence (3 high
quality studies and 1 low quality study) that a greater
reduction in pain occurs immediately after a hip
muscle exercise program than after a knee muscle
exercise program. On the other hand, they found
moderate evidence (3 high quality studies and 1 low
quality study) that there is no difference between the
short-term effects on function between a hip muscle
exercise program and a similar knee muscle exercise
program. The researchers found moderate evidence (3
high quality and 2 low quality studies) that combined
programs of hip and knee muscle exercise lead to
greater short-term pain reduction than knee muscle
exercise only, when using both open and closed chain
exercise. They also found strong evidence (2 high
quality studies and 1 low quality study) that combined
programs of hip and knee muscle exercise lead to
greater short-term improvements in function than
knee muscle exercise only.

The researchers concluded that in the short term,
there is strong evidence that combined hip and knee
muscle exercise is better at pain reduction than knee
exercise alone; there is moderate evidence that hip
muscle exercise is better at improving pain than knee
muscle exercise, and there is very limited evidence
that hip muscle exercise reduces pain compared to a
non-training control.
Limitations
The systematic review was limited by the lack of
literature and by the large heterogeneity in some of
the analyses.
Page 57
Is there a difference in the electromyographic activity

of the pelvic floor muscles across the phases of the
menstrual cycle? By Micussi, Freitas, Angelo, Soares,
Lemos, & Maranho, in Journal of Physical Therapy
Science (2015)
Background
The menstrual cycle is a repetitive sequence of
physiological changes that occurs in the uterus and
ovary of fertile female humans in order to produce
eggs for the purposes of sexual reproduction. Cycling
is regulated by a complex interaction of the levels of
endogenous hormones and lasts from menarche until
menopause. The length of each individual cycle is
counted from the first day of menstrual bleeding and
can vary between 21 35 days. It can be divided into
three sequential ovarian phases: follicular, ovulatory,
and luteal. The ovulatory and luteal phases of the
cycle are thought to be fairly standardized at a length
of around 14 days while the length of the follicular
phase can vary substantially between cycles and
between individuals. During the follicular phase, there
is a rise in follicle stimulating hormone, which
stimulates a small number of ovarian follicles to
mature, one of which proceeds and prepares to
release an egg. In the ovulatory phase, there is a
spike in luteinizing hormone from the anterior pituitary
gland, which causes the mature egg to be released
into the oviduct from the ovarian follicle. Finally, in the
luteal phase, there is a rise in progesterone levels,
which in turn causes the production of estrogen. The
subsequent fall in progesterone is the factor that
causes menstruation and this signals the start of the
following cycle. In sports science research, several
investigations have explored the effects of the
menstrual cycle on the risk of non-contact Anterior
Cruciate Ligament (ACL) injury, leading to the general
consensus that ACL risk is not constant during all
phases but is greater in the follicular phase than in the
luteal phase. The exact mechanisms for this increased
risk are unclear but may relate to differences in joint
laxity or changes in joint stiffness as a result of
neuromuscular alterations, some of which may be
mediated by hormone levels.
OBJECTIVE: To measure the muscle activity (using

intra-cavity electromyography [EMG]) in maximum
voluntary isometric contractions (MVIC) of the pelvic
floor muscle in females during the follicular, ovulatory,
and luteal phases of the menstrual cycle and to assess
the presence of any correlations with estradiol and
total testosterone levels.
POPULATION: 30 healthy females with ovulatory
menstrual cycles, aged 27.2 4.4 years.
What happened?
Muscle activity
The researchers found muscle activity was significantly
lower in the follicular than in the luteal phase (21.1
3.3 vs. 30.4 4.1V) and was also significantly lower
in the ovulatory than in the luteal phase (27.1 5.9
vs. 30.4 4.1V).
Hormone levels
The researchers found that estradiol levels in the
follicular phase displayed a strong positive correlation
with muscle activity (r = 0.9) and with the MVIC force
production (r = 0.8). Similarly, they found that total
testosterone levels in the luteal phase displayed a
strong positive correlation with muscle activity (r =
0.8).

The researchers concluded that females display
differences in pelvic floor muscle activity across the
course of the normal menstrual cycle. They also found
correlations between muscle activity and hormone
levels, which may indicate that hormonal fluctuations
during the menstrual cycle could affect pelvic floor
muscle performance.
Limitations
changes in muscle activity of the pelvic floor muscles
over the course of the menstrual cycle has any effects
on continence.
Page 58
The effect of the correlation between the contraction

of the pelvic floor muscles and diaphragmatic motion
during breathing, by Park & Han, in Journal of Physical
Therapy Science (2015)
Background
The thoracic diaphragm (often called simply the
diaphragm) is a convex sheet of muscle that separates
the thoracic section of the trunk from the abdominal
section of the trunk. The diaphragm is attached to
various internal structures within the trunk both at the
front and at the back, including the ribs and the
vertebrae. Muscular contractions of the diaphragm
cause it to flatten from its convex shape, which
increases in the size of the thoracic section of the
trunk. In turn, this lowers the pressure of the air in
the lungs, causing breathing. Breathing is a key
operation for all mammals and is the process by which
they obtain the oxygen they need in order to perform
oxidative respiration and metabolize substrates such
as glucose to produce energy. In addition to obtaining
oxygen, breathing is also used to remove carbon
dioxide from the body. Both of these processes occur
by means of gas exchange at the pulmonary alveoli by
passive diffusion between the gas in the lungs and the
blood in the lung capillaries.
OBJECTIVE: To assess whether pelvic floor muscle

contractions and diaphragmatic motion (as measured
using radiography to record images of the pelvic floor
and diaphragm while in a supine position both with the
muscles contracted and relaxed) during breathing (as
measured using spirometry to record forced vital
capacity [FVC], forced expiratory volume within one
second [FEV1], maximum voluntary ventilation (MVV),
and peak expiratory flow [PEF]) are correlated with
each other.
POPULATION: 20 healthy female students, aged
22.5 years.
What happened?
The researchers found that when the pelvic floor
muscles were contracted FEV1 significantly decreased,
MVV significantly increased, and diaphragmatic motion
significantly decreased.

The researchers concluded that the pelvic floor
muscles can affect both diaphragmatic motion and
pulmonary function. They suggested that this may
imply that strengthening the pelvic floor muscles is
beneficial for respiratory rehabilitation programs.
Limitations
training the pelvic floor muscles would have any effect
on pulmonary function.
Page 59
Comparison of psoas major muscle thickness

measured by sonography during active straight leg
raising in subjects with and without uncontrolled
lumbopelvic rotation, by Jeon, Kwon, Weon, Choung,
& Hwang, in Manual Therapy (2015)
Background
Core stability has been subject to a large amount of
research, both with a view toward improving athletic
performance and to preventing and treating low back
pain (LBP). However, in the literature, there has been
considerable variety between studies in respect of
what is defined by both the core and by stability.
Moreover, stability requirements may differ under
different loading conditions, particularly as the core
can be subject to indirect forces applied from a variety
of different directions and also in response to forces of
varying durations and magnitudes. Thus, the concept
of core stability is extremely difficult to pin down
accurately. Core stability is thought to be important
for athletes because of the transfer of force from the
upper body segments to the lower body and from the
lower body segments to the upper body in a process
called sequential kinetic linking. Researchers have
previously outlined how the acts of baseball pitching
and batting follow a sequential kinetic chain. This
phenomenon describes motions that follow a proximalto-distal pattern, which are initiated by larger, central
body segments and then proceed outward to the
smaller, more distal segments, such as the arms.
Where optimal proximal-to-distal kinematic sequences
occur in throwing motions, the pelvis is rotated using
the leg and hip muscles. The pelvis initially accelerates
but then quickly decelerates as it transfers energy to
the torso. The same pattern is repeated with the torso
and the arm and then the arm and the hand or bat.
During this sequence, it is thought that the activation
of the core muscles acts to decelerate pelvic rotation
and accelerate rotation of the upper trunk. Not all
researchers have considered the important role of the
trunk muscles in such sequences when attempting to
define core stability for athletes. Many generic
definitions have been proposed defining core stability
as the integrated functioning of the spine and
surrounding muscles to maintain intervertebral range
of motion within a safe limit. Such definitions fall short
not only of taking the role of the trunk in athletic
movement into account but also in that they exclude
the abdominal musculature (with the key ones being
the transverse abdominis, rectus abdominis, external
oblique, and internal oblique), which are also thought
to have a key role in core stability. In possibly the
most important definition of core stability, Kibler et al.
(2006) described it as the ability to control the
position and motion of the trunk over the pelvis to
allow optimum production, transfer and control of
force and motion to the terminal segment in
integrated athletic activities. Nevertheless, it is highly
likely that the current failure to uncover meaningful
findings in this area of research is at least partly
caused by the failure to define terms appropriately.
OBJECTIVE: To compare the thickness of the

contralateral psoas major (by using high-resolution
ultrasound imaging scans) both at rest and during
active straight leg raise (ASLR) in individuals with and
without uncontrolled lumbopelvic rotation and to
measure the extent of lumbopelvic rotation (using an
electromagnetic tracking device). The ASLR requires
both hip flexion and lumbopelvic stability.
POPULATION: 37 male subjects in two groups (18
subjects without uncontrolled lumbopelvic rotation,
aged 24.4 2.2 years, and 19 subjects with
uncontrolled lumbopelvic rotation, aged 23.3 1.2
years).
INTERVENTION: All subjects performed the ASLR to
a 10cm high bar with and without 1kg ankle weights
with the dominant leg, with the arms crossed over the
chests, and the legs 20cm apart.
What happened?
The researchers reported that the resting thickness of
the contralateral psoas major was not significantly
different between the groups of subjects with and
without uncontrolled lumbopelvic rotation (0.64
0.05 vs. 0.64 0.06cm). However, they found that
the thickness of the contralateral psoas major was
significantly greater during the ASLR in the subjects
without uncontrolled lumbopelvic rotation than that in
subjects with uncontrolled lumbopelvic rotation when
performed without a load (0.74 0.05 vs. 0.69
0.05cm) and when performed with an added 1kg load
(0.98 0.06 vs. 0.66 0.06cm).

The researchers concluded that thickness of the
contralateral psoas major is greater during ASLR in
subjects without uncontrolled lumbopelvic rotation
than in subjects with uncontrolled lumbopelvic rotation
and this may suggest that interventions to help
subjects with uncontrolled lumbopelvic rotation to
activate the contralateral psoas major during ASLR
may help improve core stability.
Limitations
interventions to help activate the contralateral psoas
major would in fact improve core stability in subjects
with uncontrolled lumbopelvic rotation.
Page 60
The immediate effects of doming of the diaphragm

technique in subjects with short hamstring syndrome:
a randomized controlled trial, by Valenza, CabreraMartos, Torres-Snchez, Garcs, Mateos-Toset, &
Valenza-Demet, in Journal of Sport Rehabilitation
(2015)
Background
Manual and self-manual therapies are widely used in
order to increase flexibility. However, the means by
which these techniques increase joint range of motion
is very unclear. Many mechanisms have been
proposed for how pressure (either from the hands of
clinician or from a tool) could increase flexibility.
Mechanisms can be classified into three categories:
mechanical, neurophysiological, and sensation. The
mechanical mechanisms were the first to be suggested
and include: thixotropy, piezoelectricity, rehydration of
fascial tissues, removal of pathological adhesions,
reduction of inflammation, and removal of myofascial
trigger points. Thixotropy is the time-dependent
material property of changing from a viscous state to
a fluid state in response to the application of heat or
kinetic energy. Piezoelectricity is the material property
of producing an electric charge in response to
mechanical loading. Currently, neither thixotropy nor
piezoelectricity are believed to be relevant for the
effects of manual therapy on flexibility, primarily
because the time-course of their effects does not
match the time-course of increases in flexibility that
are observed. The concepts of fascial rehydration,
pathological adhesions and myofascial trigger points
are all interesting but lack research to demonstrate
their involvement. Neurophysiological mechanisms
involve altered neuromuscular activity following the
application of treatment. While there are some
indications that muscle activity may be altered
following manual therapy, there have been conflicting
reports. Moreover, it is not apparent whether Golgi
Tendon Organs, Ruffini or Pacini corpuscles, or some
other mechanoreceptors are involved in this model.
Finally, it has been suggested that manual therapy
might modulate flexibility by altering stretch tolerance
as a result of modulated pain sensation. In this model,
the proposed mechanism of manual therapy for
increasing flexibility would be identical to a proposed
mechanism of manual therapy for reducing pain,
which has some elegance.
OBJECTIVE: To assess the immediate effects of the

doming of the diaphragm technique on hamstrings
flexibility (by reference to both the standing forward
flexion test for distance and the passive knee
extension test using a goniometer) and spine mobility
(by reference to both the Modified Schobers test and
cervical range of motion [ROM] in the average of
flexion, extension, and both lateral flexions, using a
goniometer).
POPULATION: 60 young adults with short hamstring
syndrome, allocated into either an intervention
(DOME) group or a control (CON) group.
INTERVENTION: All subjects received either the
doming of the diaphragm technique or a placebo
ultrasound technique, depending on which group they
were allocated to. The doming of the diaphragm
technique begins with the patient seated and relaxed,
while a therapist stands behind the subject. The
therapist puts their hands around the thoracic cage,
placing the fingers under the costal margins. The
thorax is then rotated in the direction in which it
rotates most freely. This position is then held for 5
minutes.
What happened?
Hamstring flexibility
The researchers found that the DOME group displayed
significantly greater increases in hamstrings flexibility
compared to the CON group, as measured by both the
forward flexion distance test (4.59 5.66 vs. 0.71
2.41cm) and by the passive knee extension test
(6.81 8.52 vs. 0.57 4.41 degrees).
Spine mobility
The researchers found that the DOME group displayed
significantly greater increases in spine mobility, as
measured by both the modified Schober's test (-1.34
3.95 vs. 1.02 3.05) and cervical ROM.

The researchers concluded that the doming of the
diaphragm technique leads to immediate increases in
both hamstrings flexibility and spine mobility.
Limitations
The study was limited in that it did not measure either
the time course of the immediate effects or whether
there was a long-term effect.
Page 61
Acute effects of stretching on passive properties of

human gastrocnemius muscletendon unit: analysis of
differences between holdrelax static stretching, by
Nakamura, Ikezoe, Tokugawa, & Ichihashi, in Journal
of Sport Rehabilitation (2015)
Background
Flexibility is important for both athletes and for the
general population. Flexibility is defined as the ability
to move through a specific joint range of motion
(ROM). Stretching is commonly used to help
individuals achieve greater joint ROM. Researchers
have generally proposed two types of mechanism by
which increases in flexibility can be achieved. One
type of mechanism involves a mechanical change in
the behavior of the muscle tissue while the other type
involves a change in sensation. However, there are at
least four theories that detail ways in which some kind
of mechanical change could occur: viscoelastic
deformation, plastic deformation, increased number of
sarcomeres in series, and neuromuscular relaxation.
However, the evidence to support these has been
found to be weak. In contrast, many studies have
reported that the only variable that changes following
stretching programs in tandem with flexibility is the
sensation of pain (i.e. maximum pain and onset of
pain) during the stretch. This supports the sensation
theory of stretching. Researchers advocating this
theory have formulated the hypothesis that stretching
increases flexibility by reducing the sensation of
increasing muscle length. Nevertheless, irrespective of
how stretching changes joint flexibility, it is apparent
that it can achieve increases in joint ROM that last > 1
day. There are two main types of stretching that are
explored in the literature: static and dynamic
stretching. Static stretching involves moving a joint to
the end of its ROM and holding this stretched position
for a set period of time. On the other hand, dynamic
stretching involves controlled movements through the
active ROM for a joint. While both static and dynamic
stretching have been found to improve joint ROM,
static stretching performed for >45 seconds appears
to lead to meaningful acute reductions in performance
tasks, such as vertical jumping, whereas dynamic
stretching performed for long durations appears to
lead to either no improvement or small improvements
in the same type of actions. It is interesting to note
that reviews of the chronic effects of static stretching
have actually found beneficial effects on both athletic
performance and strength measures. The literature is
currently conflicting regarding whether regular static
or dynamic stretching is effective for reducing the risk
of sports injury, whether the stretching is performed
immediately prior to exercise or at another time.
Additionally, the exact duration of stretches, the total
volume and frequency of stretching per week, and the
rest periods between stretches that are optimal for the
most efficient increases in joint ROM are currently
unknown.
OBJECTIVE: To compare the immediate effects of

proprioceptive neuromuscular facilitation (PNF) (also
known as hold-relax) stretching and traditional static
stretching on flexibility (as measured by reference to
passive ankle dorsiflexion ROM with a dynamometer),
stretch tolerance (as measured by passive torque at
end ROM using a dynamometer), and muscle stiffness
(as measured using ultrasound imaging scans).
POPULATION: 30 healthy males, aged 21.7 1.2
years.
INTERVENTION: All subjects performed both holdrelax and traditional static stretching on separate
occasions. In hold-relax stretching, the ankle was
passively dorsiflexed at a constant velocity of 5
degrees/s from 30 degrees of plantar-flexion to end
dorsiflexion ROM and was held at end ROM for 15
seconds. The subjects were then instructed to perform
a maximum isometric voluntary contraction (MVIC) of
plantar flexion for 5 seconds. After this MVIC, the
ankle was held at end ROM for an additional 10
seconds. This 30-second hold-relax stretch protocol
was repeated 4 times, for a total duration of 2
minutes. In static stretching, the ankle was passively
dorsiflexed at a constant velocity of 5 degrees/s from
30 degrees of plantar-flexion to end dorsiflexion ROM
and was held at end ROM for 30 seconds. This 30second static stretching protocol was repeated 4
times, for a total duration of 2 minutes.
What happened?
The researchers found that both hold-relax stretching
and static stretching conditions increased flexibility as
measured by end ROM (by 5.8 1.5 and 5.3 1.3
degrees, respectively) but there were no significant
differences between conditions. They found that both
hold-relax stretching and static stretching conditions
increased stretch tolerance, as measured by passive
torque at end ROM (by 5.6 3.5 and 2.0 2.3Nm,
respectively) and the change in stretch tolerance was
significantly greater in the hold-relax condition. Lastly,
they found that both the hold-relax stretching and
static stretching conditions decreased muscle-tendon
stiffness (by 4.5 4.7 and 12.0 9.2Nm/cm,
respectively) and this change in muscle-tendon
stiffness was significantly greater in the static
stretching condition than in the hold-relax stretching
condition.

The researchers found that both hold-relax stretching
and static stretching techniques increase flexibility,
decrease muscle-tendon stiffness, and increase
stretch tolerance. They found that hold-relax stretches
lead to greater increases in stretch tolerance while
static stretching leads to greater reductions in muscletendon stiffness.
Limitations
The study was limited in that it was only performed in
a single muscle group and different results might be
observed for other muscle groups.
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