2012 - 7 Sport and Conditioning Research

JULY 2012
Being a biomechanics geek, I loved this study. Showed

INTRODUCTION that a little bit of cheating isn’t so bad.
Muscular strategy shift in human running: dependence

Bret Contreras says…
of running speed on hip and ankle muscle performance
Welcome back to another month of S&C Research!
We’ve got some great studies for you this month. Allow Hip muscles are the key to increased running speed!
me to dive right into my favorites:
Independent activation in adjacent lumbar extensor
Resistance Training to Momentary Muscular Failure muscle compartments
Improves Cardiovascular Fitness in Humans: A Review
of Acute Physiological Responses and Chronic Add another muscle group to the list. Muscles contain
Physiological Adaptations functional subdivisions that operate independently.
I loved this study for many reasons. For selfish reasons I Electromyography variables during the golf swing: A
like to justify not having to do “cardio” and in my literature review
training of others I like to understand why so many
clients get markedly better at endurance events from Don’t forget to work the gluteus maximus as a hip
weight training even in the absence of endurance external rotator!
training. This study sheds some light on these topics.
What makes champions? A review of the relative
Meta-Analysis of Post Activation Potentiation and contribution of genes and training to sporting success
Power: Effects of Conditioning Activity, Volume,
Finally someone took a stab at the “10,000 Hour Rule.”
Gender, Rest Periods, and Training Status
Personally, I’ve always felt this rule was absolutely
It’s about time a researcher did a meta-analysis on PAP absurd. Genetics is huge and you can’t ignore it.
research! This was fantastic.
The effects of endurance, strength, and power training
Low-Intensity Exercise Can Increase Muscle Mass and on muscle fiber type shifting
Strength Proportionally to Enhanced Metabolic Stress
Excellent review on fiber type shifting! I’ve been waiting
Under Ischemic Conditions
for this too!
Studies such as this one continually remind me about
Gender differences in trunk, pelvis and lower limb
the importance of “metabolic stress” as it pertains to
kinematics during a single leg squat
hypertrophy training. Tension is king, but other factors
are important too. This study was great! I didn’t realize how incredibly
different women’s single-leg squat mechanics were
Hamstring exercises for track and field athletes: injury
compared to men. This explains a lot.
and exercise biomechanics, and possible implications
for exercise selection and primary prevention Evidence-Based Practice for Rehabilitation
Professionals: Concepts and Controversies
I was very pleased to see my “gliding leg curl” exercise
as well as many other excellent hamstring exercises It’s very nice to see more of these types of articles
make it into this journal article. Sometimes researchers emerging, explaining what “evidence-based” means.
are stuck in the 90’s but this article was very progressive
and showed very up-to-date exercises. These were my favorites for the month, but I’m sure
yours will be different than mine. I hope you enjoy this
Effects of load and training modes on physiological and month’s issue as much as I did.
metabolic responses in resistance exercise
- Bret
How can you expend the most energy via weight
training? Choose somewhat lighter loads and lift
explosively, according to this study.
Does cheating pay: the role of externally supplied

momentum on muscular force in resistance exercise
comes to their mass, cross-sectional area (which is a
INTRODUCTION continued… good indicator of force production capability), length
(which is a good indicator of how fast the muscle can
Chris Beardsley says… contract), and pennation angle. The researchers found
that the semimembranosus fibers attach at larger
Hi all,
pennation angles and have a much shorter normalized
Welcome back to another bumper edition of Strength length but a greater mass and cross-sectional area than
and Conditioning Research. As each month goes by, I the semitendinosus. The researchers concluded that the
think that there is no way we can have another month semimembranosus is therefore more clearly intended
of research to review that will be as fascinating as the for force production than the semitendinosus, which is
month before. But it seems to happen each time! intended for smaller forces over a larger range of
lengths.
Is this the hamstring edition? By the time you finish up the Biomechanics section,
This month will probably get remembered for a number you’ll likely be fed up of the hamstrings muscle group.
of reasons but above all for being The Hamstring Edition. Fortunately, the physiology section will prove a
After all, the Strength & Conditioning section kicks off complete break from the subject, as there are some
right away with a discussion of the evidence for fairly important articles there this month, particularly
including eccentric hamstring exercises in injury around hypertrophy and protein synthesis. Lots of
prevention routines for athletes who engage in regular people have already been talking about the recent
sprinting, whether on track or on the playing field. It’s a findings that men and women display similar protein
controversial study in some ways as there are some synthesis rates following resistance exercise. So it was
high-profile coaches who are very critical of the Nordic fun to juxtapose a discussion of that study with another
Hamstring Curl. that found the opposite when it came to sprint training!
And soon afterwards, we delve into a study in which our But that’s not the last time we talk about hamstrings this
very own Bret Contreras contributed, on the differences month because they crop up again in our double-study
in signal intensity observed in two hamstring exercises. special right at the end of the Physical Therapy section,
This study shows that different exercises lead to when we review a new algorithm for helping prevent
different hypertrophy signals in different parts of the ACL injuries in female athletes. One of the key factors
hamstring muscles. But we are not done yet, because used by this algorithm is the ratio of quadriceps to
before we leave the Strength & Conditioning section, we hamstrings strength, noting that many females have
cover a review article that draws on the themes from sub-optimal hamstring strength and that by improving it,
both the previous studies and discusses more general they can reduce their risk of ACL injury.
methods for preventing hamstring injuries.
So by the end of this issue, you’ll hopefully have seen
Going into the Biomechanics section, there is also a sides of the research into hamstrings that you hadn’t
strong hamstring flavour. In a study looking into the previously delved into. But that doesn’t mean we
different muscles that are involved in increasing haven’t covered the whole range of literature. There is
sprinting speed from different speeds, the researchers a whole battery of other great studies I haven’t talked
found that the iliopsoas, gluteus maximus and about here, including research into strength training for
hamstrings contributed most to the hip and knee swimming, resistance-training under conditions of
accelerations with increasing running speed, particularly restricted blood flow for hypertrophy, a discussion of
between the top-end sprinting speeds of 7.0 – 9.0m/s. whether cheating works better than using strict reps and
In other words, if you want to improve your top-end much more besides.
speed, your posterior chain had better be up to scratch!
That’s all from me for this month. But if you have any
But that’s not all for the Biomechanics section, because feedback on our product or on something that you
the very last article covers hamstring architecture. Now would like us to introduce, please drop us a line through
this is a study that is well worth channeling your inner our Facebook page. We’ve had some great suggestions
geek to get stuck into. The researchers in this study so far and we’re working hard to get them introduced.
discovered by cutting up the hamstring muscles into
pieces and measuring them in various ways that there I hope you enjoy the issue!
are significant anatomical differences between the
hamstrings. For example, the semitendinosus and Chris.
semimembranosus muscles are very different when it
Strength and Conditioning Research JULY 2012
CONTENTS
1. STRENGTH AND CONDITIONING ..................................................................................................................................................................... 1
1. Why hamstring eccentrics are hamstring essentials, by Thorborg, in British Journal of Sports Medicine, 2012....................................................... 2
2. Thomas L. DeLorme and the Science of Progressive Resistance Exercise, by Todd, in Journal of Strength and Conditioning Research Published
Ahead of Print ......................................................................................................................................................................................................... 3
3. Resistance Training to Momentary Muscular Failure Improves Cardiovascular Fitness in Humans: A Review of Acute Physiological Responses and
Chronic Physiological Adaptations, Steele, Fisher, McGuff, Bruce-Low and Smith, in Journal of Exercise Physiology Online, 2012 ......................... 4
4. Non-uniform changes in MRI measurements of the thigh muscles following two hamstring strengthening exercises, by Mendiguchia, Garrues,
Cronin, Contreras, Los Arcos, Malliaropoulos, Maffulli and Idoate, in Journal of Strength and Conditioning Research, Published Ahead of Print .. 6
5. Meta-Analysis of Post Activation Potentiation and Power: Effects of Conditioning Activity, Volume, Gender, Rest Periods, and Training Status, by
Wilson, Duncan, Marin, Brown, Loenneke, Wilson, Jo, Lowery, and Ugrinowitsch, in Journal of Strength and Conditioning Research Publish
Ahead of Print ......................................................................................................................................................................................................... 7
6. Low-Intensity Exercise Can Increase Muscle Mass and Strength Proportionally to Enhanced Metabolic Stress Under Ischemic Conditions, by
Takada, Okita, Suga, Omokawa, Kadoguchi, Sato, Takahashi, Yokota, Hirabayashi, Morita, Horiuchi, Kinugawa and Tsutsui, in Journal of Applied
Physiology, 2012...................................................................................................................................................................................................... 8
7. Kinematic, strength, and stiffness adaptations after a short-term sled towing training in athletes, by Alcaraz, Elvira and Palao, in Scandinavian
Journal of Medicine and Science in Sports, 2012 ..................................................................................................................................................... 9
8. Hamstring exercises for track and field athletes: injury and exercise biomechanics, and possible implications for exercise selection and primary
prevention, by Malliaropoulos, Mendiguchia, Pehlivanidis, Papadopoulou, Valle, Malliaras and Maffulli, in British Journal of Sports Medicine,
2012 ...................................................................................................................................................................................................................... 10
9. Exercise-Training Intervention Studies in Competitive Swimming, by Aspenes and Karlsen, in Sports Medicine, 2012 .......................................... 11
10. Effects of load and training modes on physiological and metabolic responses in resistance exercise, by Buitrago Wirtz, Yue, Kleinoder and
Mester, in European Journal of Applied Physiology, 2012 ..................................................................................................................................... 12
11. Does cheating pay: the role of externally supplied momentum on muscular force in resistance exercise, by Arandjelovic, in European Journal of
Applied Physiology, 2012 ....................................................................................................................................................................................... 13
2. BIOMECHANICS ............................................................................................................................................................................................. 14
12. Unilateral eccentric exercise of the knee flexors affects muscle activation during gait, Dover, Legge and St-Onge, in Gait & Posture, 2012 ........ 15
13. Three-dimensional kinematic analysis of the snatch technique for lifting different barbell weights, Hadi, Akkus and Harbili, in Journal of Strength
and Conditioning Research, 2012 .......................................................................................................................................................................... 16
14. Selected reflections of the third Fascia Research Conference (FRC3), Vancouver BC, March 2012, by Chaitow, Journal of Bodywork & Movement
Therapies, 2012 ..................................................................................................................................................................................................... 17
15. Predicting the metabolic cost of incline walking from muscle activity and walking mechanics, by Silder, Besier and Delp, in Journal of
Biomechanics, 2012 ............................................................................................................................................................................................... 18
16. Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance, by Dorn, Schache and Pandy, in
The Journal of Experimental Biology, 2012 ............................................................................................................................................................ 19
17. Moderate-Intensity Running Causes Intervertebral Disc Compression in Young Adults, by Kingsley, D’Silva, Jennings, Humphries, Dalbo and
Scanlan, in Medicine & Science in Sports & Exercise, Published Ahead of Print ..................................................................................................... 20
18. Leg stiffness in human running: Comparison of estimates derived from previously published models to direct kinematic–kinetic measures, by
Coleman, Cannavan, Horne and Blazevich, in Journal of Biomechanics, 2012 ....................................................................................................... 21
19. Leg stiffness can be maintained during reactive hopping despite modified acceleration conditions, by Kramer Ritzmann, Gruber and Gollhofer, in
Journal of Biomechanics, 2012 .............................................................................................................................................................................. 22
20. Independent activation in adjacent lumbar extensor muscle compartments, Nugent, Stapley and Milner, in Journal of Electromyography and
Kinesiology, 2012 .................................................................................................................................................................................................. 23
21. Foot kinematics and loading of professional athletes in American football-specific tasks, by Riley, Kent, Dierks, Lievers, Frimenko and Crandall, in
Gait & Posture, 2012 ............................................................................................................................................................................................. 24
22. Electromyography variables during the golf swing: A literature review, by Marta, Silva, Castro, Pezarat-Correia and Cabri, in Journal of
Electromyography and Kinesiology, 2012 .............................................................................................................................................................. 25
23. Distinct profiles of neuromuscular fatigue during muscle contractions below and above the critical torque in humans, by Burnley, Vanhatalo and
Jones, in Journal of Applied Physiology, 2012 ........................................................................................................................................................ 26
24. Comparison of changes in the contraction of the lateral abdominal muscles between the abdominal drawing-in maneuver and breathe held at
the maximum expiratory level, by Ishida, Hirose and Watanabe, in Manual Therapy, 2012 ................................................................................. 27
25. Are titin properties reflected in single myofibrils? By Herzog, Leonard, Jinha and Herzog, in Journal of Biomechanics, 2012 ............................... 28
26. Architectural differences between the hamstring muscles, by Kellis, Galanis, Kapetanos and Natsis, in Journal of Electromyography and
Kinesiology, 2012 .................................................................................................................................................................................................. 29
This document is copyright Strength and Conditioning Research Limited, 2012. Bret and Chris both work very hard to bring you this
information. Help us to continue our work by not sharing it with your friends, however tempting it may be. Thank you.
Page 1
3. PHYSIOLOGY ................................................................................................................................................................................................. 30
27. What makes champions? A review of the relative contribution of genes and training to sporting success, by Tucker and Collins, British Journal of
Sports Medicine, 2012 ........................................................................................................................................................................................... 31
28. The effects of endurance, strength, and power training on muscle fiber type shifting, by Wilson, Loenneke, Jo, Wilson, Zourdos and Kim, in
Journal of Strength and Conditioning Research, 2012 ........................................................................................................................................... 32
29. Strength training reduces intra-cortical inhibition, by Weier, Pearce and Kidgell, in Acta Physiologica, 2012 ....................................................... 33
30. Sprint exercise enhances skeletal muscle p70S6k phosphorylation and more so in females than in males, by Esbjörnsson, Rundqvist, Mascher,
Österlund, Rooyackers, Blomstrand and Jansson, in Acta Physiologica, 2012 ....................................................................................................... 34
31. Similar muscle protein synthesis rates in young men and women: men aren’t from Mars and women aren’t from Venus, by Smith and
Mittendorfer, in Journal of Applied Physiology, 2012 ............................................................................................................................................ 35
32. Nutritional regulation of muscle protein synthesis with resistance exercise: strategies to enhance anabolism, by Churchward-Venne, Burd and
Phillips, in Nutrition & Metabolism 2012 ............................................................................................................................................................... 36
33. Low Muscle Glycogen Concentration Does Not Suppress the Anabolic Response to Resistance Exercise, by Camera, West, Burd, Phillips,
Garnham, Hawley and Coffey, in Journal of Applied Physiology, 2012 .................................................................................................................. 37
34. Lipid metabolism in skeletal muscle: generation of adaptive and maladaptive intracellular signals for cellular function, by Watt and Hoy, in
American Journal of Physiology: Endocrinology & Metabolism, 2012 ................................................................................................................... 38
35. Dissociation of heart rate variability and heart rate recovery in well-trained athletes, by Lee and Mendoza, in European Journal of Applied
Physiology, 2012.................................................................................................................................................................................................... 39
36. Caloric Restriction Alters the Metabolic Response to a Mixed-Meal: Results from a Randomized, Controlled Trial, by Huffman, Redman,
Landerman, Pieper, Stevens, Muehlbauer, Wenner, Bain, Kraus, Newgard, Ravussin and Kraus, in PLoS One, 2012 ............................................ 40
4. PHYSICAL THERAPY ....................................................................................................................................................................................... 41

37. What do physiotherapists consider to be the best sitting spinal posture? By O’Sullivan, O’Sullivan, O’Sullivan, and Dankaerts, in Manual Therapy,
2012 ...................................................................................................................................................................................................................... 42
38. What can I do for sciatica? By Liebenson, in Journal of Bodywork & Movement Therapies, 2012 ......................................................................... 43
39. Using the Functional Movement Screen to evaluate the effectiveness of training, by Frost, Beach, Callaghan and McGill, in Journal of Strength
and Conditioning Research, 2012 .......................................................................................................................................................................... 44
40. Neuroplasticity: Synapse to System, by Gillick and Zirpel, in Archives of Physical Medicine and Rehabilitation, 2012........................................... 45
41. Neuromuscular manifestations of viscoelastic tissue degradation following high and low risk repetitive lumbar flexion, by Solomonow, in Journal
of Electromyography and Kinesiology, 2012 .......................................................................................................................................................... 46
42. Initiation and progression of mechanical damage in the intervertebral disc under cyclic loading using continuum damage mechanics
methodology: A finite element study, by Qasim, Natarajan, An and Andersson, in Journal of Biomechanics, 2012 .............................................. 47
43. Gender differences in trunk, pelvis and lower limb kinematics during a single leg squat, by Graci, Van Dillen and Salsich, in Gait & Posture, 2012
.............................................................................................................................................................................................................................. 48
44. Femoroacetabular Impingement in Former High-Level Youth Soccer Players, by Johnson, Shaman and Ryan, in American Journal of Sports
Medicine, 2012 ...................................................................................................................................................................................................... 49
45. Extent of nucleus pulposus migration in the annulus of porcine intervertebral discs exposed to cyclic flexion only versus cyclic flexion and
extension, by Balkovec and McGill, in Clinical Biomechanics, 2012 ....................................................................................................................... 50
46. Evidence-Based Practice for Rehabilitation Professionals: Concepts and Controversies, by Dijkers, Murphy and Krellman, in Archives of Physical
Medicine Rehabilitation, 2012 ............................................................................................................................................................................... 51
47. Effect of Core Stability Exercises on Feed-Forward Activation of Deep Abdominal Muscles in Chronic Low Back Pain: A Randomized Controlled
Trial, by Vasseljen, Unsgaard-Tøndel, Westad and Mork, in Spine, 2012 .............................................................................................................. 53
48. An Integrated Approach to Change the Outcome Part I: Neuromuscular Screening Methods to Identify High ACL Injury Risk Athletes, by Myer,
Ford, Brent and Hewett, in Journal of Strength and Conditioning Research Publish Ahead of Print, 2012............................................................. 54
49. An Integrated Approach to Change the Outcome Part II: Neuromuscular Screening Methods to Identify High ACL Injury Risk Athletes, by Myer,
Ford, Brent and Hewett, in Journal of Strength and Conditioning Research Publish Ahead of Print, 2012............................................................. 55
50. An Acute Bout of Self Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force, by
MacDonald, Penney, Mullaley, Cuconato, Drake, Behm and Button, in Journal of Strength and Conditioning Research Publish Ahead of Print,
2012 ...................................................................................................................................................................................................................... 56
Page 2
1. STRENGTH AND CONDITIONING
Page 1
Why hamstring eccentrics are hamstring essentials, by Hamstring injury prevention mechanisms
Thorborg, in British Journal of Sports Medicine, 2012 Thorborg explains that the precise preventive injury
mechanism that results from the eccentric strength
The Review training of the Nordic hamstring exercise is not clear. He
notes that some researchers have proposed that the
Hamstring injuries are commonplace in sports requiring
exercise causes a shift in the optimum angle for torque
high-speed sprinting. In this review, Thorborg wanted to
generation to longer hamstring muscle lengths. This
set out some evidence-based recommendations for
shift is thought to be protective for the muscle.
hamstring injury prevention.
Additionally, Thorborg notes that many sprinting studies
have found that the peak muscle-tendon tension in the
Early return to sport
hamstring occurs in the terminal swing phase, just
Thorborg notes that early return to sport is often
before ground contact. Such studies have often
proposed as a key risk factor for recurrent hamstring
suggested that this is the point at which the muscle is at
injuries. Thorborg explains that a key consideration in
greatest risk of injury. Thorborg adds that two recent
this regard is the function of the hamstring muscle in
case studies have confirmed that hamstring injuries do
dissipating forces through lengthening contractions
occur at this point in the cycle. With these points in
during running. Thorborg explains that this function is
mind, Thorborg notes that some practitioners have
not challenged except during high-paced running.
therefore proposed that the eccentric training should be
Consequently, despite the fact that athletes often find
performed at longer muscle-tendon lengths, in order to
that they are able to engage in jogging and moderate-
closely mimic the action of the hamstring during the late
paced running quite soon following an injury, it may be
swing phase.
the case that full recovery of the functional capacity of
the hamstring may take significantly longer. Thorborg
Criticism of the Nordic hamstring exercise
notes research that suggests that the isometric
Thorborg responds to critics of the Nordic hamstring
hamstring muscle strength in sprinters was 70% of
exercise, who suggest that it should be contraindicated
previous levels two weeks after injury, 85% three weeks
because of anecdotal evidence that the excessive stress
after injury, and 90% six weeks after injury. He notes
to the hamstring muscle actually leads to hamstring
that the athletes were only back to pre-injury levels
injury. He notes that this is likely due to aggressive
after a median time of 16 weeks.
introduction of the exercise following injury.
Function dependent, not time dependent
Based on the research noted above, Thorborg proposes What did the researcher conclude?
that the criteria for return-to-sport following a Thorborg concludes that the Nordic hamstring exercise
hamstring injury should be function-dependent rather (natural eccentric glute-ham raise) has class one
than time-dependent. He suggests that these criteria evidence (an RCT) in favor of its use as a hamstring
should include assessments involving hamstring muscle injury and re-injury prevention tool.
lengthening and contraction, on account of its key role
with eccentric contractions during sprinting.
Limitations
Nordic hamstring prevents injuries and re-injuries This review was an editorial and may not represent the
Thorborg notes that in a recent RCT involving 942 soccer opinions of all researchers working in this area.
players, the effect of using the Nordic hamstring curl
(natural eccentric glute-ham raises) was assessed in
Key points
respect of acute hamstring injuries and re-injuries in
soccer. The study showed that acute hamstring injuries The Nordic hamstring exercise (natural eccentric glute-
(both new and re-injuries) could be reduced by 70% ham raise) has class one evidence (an RCT) in favor of
through a 10-week program involving this exercise. its use as a hamstring injury and re-injury prevention
Moreover, re-injuries alone were reduced by 85%. tool
Thorborg therefore concludes that it is “incontrovertible
that the Nordic hamstring exercise reduces hamstring
injuries.” Moreover, he suggests that, “it could almost
be considered negligent not to provide eccentric
hamstring strengthening in this form for athletes with a
history of previous hamstring injury.”
Page 2
Thomas L. DeLorme and the Science of Progressive Sets and reps

Resistance Exercise, by Todd, in Journal of Strength and Initially, Todd explains, DeLorme started out by
Conditioning Research Published Ahead of Print recommending seven sets of ten repetitions to his
patients. He also referred to his protocols as “heavy
The biography resistance exercise.” The roots of these points lie in his
own weight training history. However, DeLorme soon
DeLorme starts work at the hospital
found that in the context of his new battle to help
DeLorme is one of the most important early figures in
survivors of polio regain their lost function, these same
progressive resistance training. Todd tells the story of
points were preventing physicians from recommending
how in February 1944, Dr. Thomas Lanier DeLorme
his protocols to patients. Therefore, Todd explains, he
reported for duty at Gardiner General Army Hospital, in
switched to a model involving three sets of ten. One set
Chicago. Todd explains that DeLorme was a newly
was to be done at 50% of the patient’s 10RM, one at
commissioned lieutenant in the Army’s Medical Corps
75%, and finally one at 100% of 10RM.
and had been assigned to the Orthopedic Section, which
was filled to overflowing with wounded servicemen. A lifelong lifter
Todd tells how DeLorme quickly realized that the Todd tells us that DeLorme remained a serious lifter well
overflowing number of patients wasn’t because of a into later life. She notes that in the basement of his
shortage of physicians but because the rehabilitation home in Milton, he had a gym with more than 3,000
protocols were too slow. pounds of weights. One of his favorite exercises was
apparently parallel bar dips and he reportedly did them
DeLorme the weight lifter
with 150lbs attached to his body on several occasions.
Todd explains how DeLorme was a habitual weight-
trainer because he had used it to recover from a child- The legacy of DeLorme
hood illness of rheumatic fever, which his doctors Todd wonders what might have happened had DeLorme
erroneously treated with extreme bed rest, which made his discovery in less unsettled times. After all,
wasted his physique. DeLorme took his weight training Thomas Kuhn’s seminal work, The Structure of Scientific
seriously, building up to a 500lbs deadlift. Revolutions, demonstrates that paradigm shifts in
science generally take at least a generation before they
Fighting the current prevailing attitudes
are accepted. However, the military dramatically
Todd explains that before DeLorme arrived at the
accelerated acceptance of DeLorme’s methods by simply
hospital, physical therapy protocols generally consisted
ordering all other military rehabilitation units to begin
of rest, heat, and various exercises using a high number
using them.
of repetitions with little to no resistance. Physicians at
the time were keen to stress that the muscles should Todd explains that the polio epidemic in the late 1940s
not be overworked and many believed that high- then provided DeLorme with the opportunity to show
intensity exercise was bad for the heart. the miraculous power of resistance exercise to
strengthen weakened muscle to the broader medical
DeLorme experiments
community. This sequence of events led to the use of
However, despite the prevailing approaches, at the
resistance training in physical therapy far faster and with
hospital, Todd explains how DeLorme experimented
a greater degree of acceptance than it might otherwise
with first one then several patients and quickly found
have done.
that weight training was very much more effective at
rehabilitation of injury, both in terms of speed and in
the degree of the faculties regained. Key points
DeLorme takes his research to other hospitals DeLorme’s initial strength training protocol was seven
Todd goes on to tell how DeLorme, having built a facility sets of ten reps.
to handle the physical therapy of the patients at
The DeLorme protocol developed to assist polio
Gardiner, went to other hospital to explain the basic
patients is three sets of ten, where one set was to be
concept of the methodology. She quotes DeLorme done at 50% of the patient’s 10RM, one at 75%, and
saying, “Most injuries of the trunk and extremities result finally one at 100% of 10RM.
in atrophy of varying degree. When the local injury has
healed, redevelopment of muscle power is the most
important factor in restoring normal function to the
extremity.”
Page 3
Resistance Training to Momentary Muscular Failure Acute Metabolic Responses

Improves Cardiovascular Fitness in Humans: A Review of Steele et al. observe that many other researchers have
Acute Physiological Responses and Chronic Physiological previously concluded that RT is not an appropriate
Adaptations, Steele, Fisher, McGuff, Bruce-Low and stimulus to improve aerobic metabolism. However, they
Smith, in Journal of Exercise Physiology Online, 2012 note that this conclusion appears to be predicated upon
the idea that the energy-producing metabolic pathways
Background differ between AT and RT. But Steele et al. explain that
the mitochondria within cells are fueled by pyruvate
Steele et al. identify from other studies that the key
produced by glycolysis, which is performed in both
variables of cardiovascular (CV) fitness are: maximum
aerobic and anaerobic respiration, meaning that aerobic
volume of oxygen consumption (VO2-max), movement
and anaerobic metabolism share common pathways.
(e.g. running) economy, and lactate threshold (LT). They
Moreover, they note that many studies have shown an
note that previous reviews have concluded that
improvement in aerobic performance following interval
although resistance training (RT) is able to improve VO2-
training, which is heavily anaerobic. They note that
max, movement economy and LT, it is not as effective as
similar improvements in aerobic performance are
aerobic training (AT) or combined training. However,
therefore likely to occur as a result of RTF.
the researchers note that many previous studies have
combined studies in which subjects went to muscular Acute Blood Lactate Responses
failure with those in which they did not, on the basis Steele et al. explain that since RTF provides a maximal
that the percentage of 1RM was the key variable. stimulus to both aerobic and anaerobic metabolism,
However, the researchers propose that intensity with blood lactate production is very likely increased during
respect to the point of failure is a more important factor exercise and thereby stimulates and develops the
than percentage of maximum loading. mechanisms involved with its removal and metabolism.
Steele et al. propose that studies comparing resistance Acute Molecular Responses
training to failure (RTF) with AT have found that they do Steele et al. explain that molecular signaling pathways
not differ in the degree of VO2-max adaptations control many adaptations to training. They note from
produced. Additionally, they note that studies using RTF recent studies that the adenosine monophosphate-
with athletic populations have reported significant activated protein kinase (AMPK) pathway is important
improvement in running economy compared to the for inducing mitochondrial biogenesis, stimulating slow
control groups that continued to perform the normal AT twitch fiber adaptations and developing oxidative
program. Finally, Steele et al. note that LT has been properties in type IIX fibers. On the other hand, they
found to improve in untrained but not in trained explain that the mammalian target of rapamycin
subjects as a result of RT. The researchers summarize pathway (mTOR) is an important molecular signaling
that while the research appears inconclusive in respect pathway that causes increased protein synthesis.
of the effect of RT on LT, it appears to support the
recommendation that RTF may well induce significant Steele et al. explain that some researchers have broadly
improvement in CV fitness. concluded that the AMPK pathway is triggered by AT
and is responsible for endurance adaptations, while the
mTOR pathway is important for hypertrophy and is
What did the researchers do?
triggered by RT. Additionally, the researchers note that
Steele et al. wanted to present the findings of a other studies have found AMPK to inhibit the activation
literature review that undermines the traditional of mTOR. However, the picture is not completely clear,
dichotomy between AT and RT. They presented their as other studies have found that AMPK can be
findings regarding both acute and chronic responses: significantly activated and mTOR inhibited during certain
RT protocols, including RTF. Steele et al. propose that
Acute Oxygen Cost Responses
since interval training also triggers AMPK, this may imply
Steele et al. explain that it is not clear from current
that AMPK is triggered whenever there is a high enough
research what the true VO2 requirement is from RTF
intensity, irrespective of the modality of the exercise
because of methodological issues. However, they note
They note that this interpretation is supported by the
that there is no substantial evidence to suggest that a
role of AMPK as a key sensor of cellular energy
defined percentage of VO2-max during a training
requirements and has been found to respond very
program is necessary for its improvement. So whether
quickly to decreases in cellular ATP.
monitoring this accurately during RT or RTF would be
useful is doubtful.
Page 4
Resistance Training to Momentary Muscular Failure Additionally, the researchers note that RTF may well
Improves Cardiovascular Fitness in Humans: A Review of increase muscle capillarization. They note conflicting
Acute Physiological Responses and Chronic Physiological studies that suggest that RT does not improve capillary
Adaptations, Steele, Fisher, McGuff, Bruce-Low and density may have failed to control for an increase in the
Smith, in Journal of Exercise Physiology Online, 2012, muscle cross-sectional area.
continued…
What did the researchers conclude?
Acute Myocardial responses Acute responses
Steele et al. suggest that the increased blood pressure Steele et al. conclude that the acute metabolic and
responses that result from RT might result in cardiac molecular responses to RTF appear not to differ
adaptations, particularly size increases. Since heart rate significantly from AT. The division between RT and AT
is also significantly increased during RT, the researchers may therefore not be as significant as exercise
suggest that increased stress to the myocardium via physiologists have previously thought.
increased heart rate might be the mechanism by which
such adaptations occur. Chronic responses
Steele et al. conclude that the physiological adaptations
Acute Vascular response achieved through RT that lead to improved CV fitness
Steele et al. explain that local blood supply to the might be mainly due to employing RTF. They therefore
muscle impacts on oxygen delivery. They observe that suggest that the key factor in determining physiological
stimulation of the vasculature might therefore result in adaptations to promote CV fitness is intense muscular
increased delivery of oxygen to the muscles. They note contraction.
that research has found that adaptations within the
vasculature seem to be caused by shear stress and wall
Limitations
tension of the vasculature. These factors may be
increased by increased blood pressure and heart rate, This review article was limited insofar as it was not
and therefore by RT. trying to establish the equivalence of aerobic and
resistance training, but was rather trying to demonstrate
Chronic Metabolic and Molecular Adaptations that many of the adaptive processes are caused by
Steele et al. explain that RT has been found to increase similar mechanisms and pathways.
resting muscular ATP concentration, which may imply
that aerobic ATP production is also improved. They note Key points
in passing that while some researchers have proposed
that RT could reduce mitochondrial density, this may be The acute metabolic and molecular responses to
because they have failed to consider the increase in resistance training to failure appear not to differ
myofibrillar volume when taking such measurements. significantly from aerobic training
They note that the increase in oxidative capacity
observed in studies employing RTF may be caused by a The division between resistance training and aerobic
change in muscle fiber type, as type IIX fibers have less may therefore not be as significant as exercise
physiologists have previously thought.
oxidative capacity than type IIA fiber activity and RTF
tends to induce an increase in type IIA fibers at the
The physiological adaptations achieved through
expense of type IIX. resistance training that lead to improved CV fitness
might be mainly due to employing resistance training
Chronic Myocardial Adaptations to failure
Steele et al. note that researchers have discovered that
the left ventricle wall thickness in endurance-trained The key factor in creating physiological adaptations to
athletes is greater than that of both controls and promote CV fitness may be intense muscular
strength-trained athletes. Additionally, their review of contractions
the effect of RT on cardiac hypertrophy suggests that RT
does not always result in increases in left ventricle size.
Chronic Vascular Adaptations

Steele et al. note that studies have found that RTF
produces vascular adaptations including improved
endothelial function through increased peak flow and
artery diameter.
Page 5
Non-uniform changes in MRI measurements of the thigh Semitendinosus

muscles following two hamstring strengthening The researchers commented that the large changes in
exercises, by Mendiguchia, Garrues, Cronin, Contreras, signal intensity in the ST following the eccentric leg curl
Los Arcos, Malliaropoulos, Maffulli and Idoate, in Journal might relate to its architectural characteristics. It has
of Strength and Conditioning Research, Published Ahead the longest normalized fiber length and smallest
of Print physiological cross-sectional area of the hamstring
muscles and takes the form of a fusiform arrangement
Background rather than a pennate arrangement, like the BLH and
SM. Consequently, it would be expected to function in
Hamstring injuries are a very common sporting injury
producing large forces, quickly, over a long contraction
and many cases reoccur. Eccentric training of the
length.
hamstrings has been recommended as a method of
reducing injury and re-injury rates by increasing the size Adductor magnus
and strength of the muscles while also positively The researchers suggested that the greater signal
modifying some of its other mechanical properties, such intensity observed in the AM during lunges might be
as the optimum length at which maximum contraction caused by the role of the AM as a hip extensor and its
strength occurs. The hamstrings group comprises: the superior moment arm to both the hamstrings and
long head of the biceps femoris muscle (BFLH), the short gluteus maximus at 90° of hip flexion.
head of the biceps femoris (BFSH), the semitendinosus
(ST), the semimembranosus (SM) and the adductor
magnus (AM).
The researchers concluded that their data support
previous findings regarding the lunge, in that there
appears to be a short phase of eccentric hamstring
The researchers wanted to assess changes in signal contraction during that exercise.
intensity in the upper thigh muscles using MRI scanning
48 hours after either a lunge or a supra-maximally
Practical applications
loaded, eccentric leg curl exercise. The signal intensity
observed would be taken to provide an indication of The researchers suggest that, where practitioners wish
which muscles had been most effectively worked by to load all regions of the ST, the leg curl is an
which exercise. So the researchers recruited 11 male appropriate exercise. On the other hand, the proximal
professional soccer players from the same football team regions of the BFLH and the AM are more effectively
and asked them to perform a resistance-training targeted using the lunge.
protocol involving 3 sets of 6 repetitions with at least a
2-minute rest between sets. After completing the Limitations
protocol for one leg (either the lunge or the eccentric
The study was limited by the use of only two exercises.
leg curl), the subjects took a further 2-minute rest
Moreover, the two exercises selected by the researchers
before completing the same protocol on the other leg
were very different in a number of ways (concentric-
but with the other exercise. All subjects therefore
eccentric vs. eccentric only, multi-joint vs. single joint,
performed both exercises, one on each leg.
maximal vs. supra-maximal loading, open chain vs.
closed chain etc.). It would be very interesting to see a
What happened? greater number of popular hamstring exercises
The researchers found that in the ST, significant changes compared using the same experimental approach.
in signal intensity were found following the leg curl in
sections 4-10 (the sections were numbered from most Key points
proximal to most distal). However, following the lunge,
only section 8 of the ST was found to differ significantly The leg curl is a better exercise for loading the
from pre-testing levels. In the AM muscle, the semitendinosus than the lunge, while the lunge is
researchers observed significant changes for the lunge better for targeting the adductor magnus and the
biceps femoris (long head)
exercise in sections 4 to 7 but only in section 4 following
the leg curl. In the BFLH, the researchers noted
significant differences after both exercises in section 7.
No changes in signal intensity were observed for the SM
and BFSH muscles.
Page 6
Meta-Analysis of Post Activation Potentiation and and potentiation increases with longer training
Power: Effects of Conditioning Activity, Volume, Gender, experience. In addition, they note that trained
Rest Periods, and Training Status, by Wilson, Duncan, individuals possess higher regulatory myosin light chain
Marin, Brown, Loenneke, Wilson, Jo, Lowery, and phosphorylation activity and that this may be connected
Ugrinowitsch, in Journal of Strength and Conditioning to the improved response to PAP.
Research Publish Ahead of Print
PAP activity intensity
The researchers found that moderate intensity (60-84%
Background
of 1RM) exercise is better for creating a PAP
Post activation potentiation (PAP) is a phenomenon phenomenon than very high intensities (>85% 1RM).
whereby a heavy load is lifted directly before a planned They suggest that a moderately heavy PAP activity elicits
performance and has been found to increase muscular a PAP without as much mechanical trauma as a heavier
power acutely. The PAP phenomenon is thought to activity.
result from the phosphorylation of myosin regulatory
light chains and increased recruitment of high threshold PAP activity volume
motor units. Researchers have found that a number of The researchers found that multiple sets resulted in a
factors influence the success of the PAP, including greater PAP than single sets but noted that this was
training experience, rest period length and the intensity heavily modified by training status: untrained individuals
of the PAP activity performed. actually experienced reductions in power as a result of
the higher volume PAP.
Rest period lengths
The researchers performed a meta-analytic statistical The researchers found that the ability of a PAP activity
analysis in order to evaluate the effects of training to potentiate performance appears to dissipate after
status, volume, rest period length, PAP activity and about 30 minutes. However, they note that the
gender on power increases caused by PAP. They used research is conflicting regarding the exact length of time
the following criteria for selecting the studies: (1) The to rest between the PAP and the performance. Overall,
primary focus of the study had to be the investigation of they suggest that moderate rest period lengths (7-10
a PAP activity on a power task, (2) The PAP activity had minutes) appear to be ideal for increasing power
to be performed at a greater load than the power task, following a PAP.
(3) No electrical stimuli were used, and (4) The study
had to be a randomized controlled trial.
The researchers concluded that, independent of gender,
What did the researchers find?
a PAP activity can increase power production but the
The researchers found a total of 32 primary studies that extent of the PAP varies significantly as a function of
met their criteria. They found that there were no training experience. For trained individuals, the
significant differences between gender groups or researchers conclude that the most appropriate
between dynamic and static PAP activities. However, protocol for a PAP comprises multiple sets, moderate
they found that there were significant differences intensity (60-85 % 1-RM Loads) and rest periods
between: between the PAP and the performance of 7-10 minutes.
• Untrained populations and athletes, as well as

between trained populations and athletes, Limitations
• Moderate intensity and heavy intensity PAP The study was limited by the availability of studies on
activities, PAP and their ability to separate the effects of the key
• Single sets and multiple sets, variables.
• Rest periods of 3-7 minutes and those >10 minutes,
as well as between rest periods of 7-10 minutes 0.70 Key points
and those >10 minutes.
For trained individuals, the most appropriate protocol
Training status to create post-activation potentiation comprises
The researchers comment that they found that athletes multiple sets, moderate intensity (60-85 % 1-RM
with more than 3 years of resistance training experience Loads) and rest periods between the PAP and the
appear to respond optimally to PAP. They therefore performance of 7-10 minutes
propose that it is likely that the balance between fatigue
Page 7
Low-Intensity Exercise Can Increase Muscle Mass and What happened?

Strength Proportionally to Enhanced Metabolic Stress Muscular strength and size
Under Ischemic Conditions, by Takada, Okita, Suga, The researchers discovered significant increases in CSA
Omokawa, Kadoguchi, Sato, Takahashi, Yokota, and 1RM after both 2 and 4 weeks as a result of the
Hirabayashi, Morita, Horiuchi, Kinugawa and Tsutsui, in training program. In addition, the results after 4 weeks
Journal of Applied Physiology, 2012 were significantly greater than those values recorded
after 2 weeks.
Background
Metabolic stress
Skeletal muscle is important in clinical settings as it has a
The researchers found that baseline increases in Pi and
significant effect on both mortality and quality of life.
intramuscular pH decreases during exercise (as a result
This is partly because muscle serves as an important
of the accumulation of hydrogen ions) were correlated
antioxidant system as well as an endocrine source of
with increases in muscle CSA and 1RM after both 2 and
myokines. However, clinicians often struggle to create
4 weeks. They also noted that baseline intramuscular
increases in skeletal muscle mass in a clinical setting
H2PO4 and ADP increases from a resting state were
because of the requirement for high-intensity, long-
correlated with increases in muscle CSA and 1RM after 2
term, heavy resistance exercise.
and 4 weeks.
However, previous research has found that resistance
Fast twitch fiber recruitment
exercise under ischemic conditions (i.e. with constriction
The researchers observed that a splitting of Pi peaks,
to reduce blood flow in and out of the muscle) may
which represents fast-twitch (FT) fiber recruitment, in 9
enhance training stress and increase the training effect
out of the 14 subjects but they did not notice any
even with lighter loads. Researchers have proposed that
difference between the subjects in whom this occurred
this occurs by the enhancement of protein synthesis and
from the 5 in whom it did not occur.
humoral factor secretion.

The researchers concluded that light-weight resistance
The researchers wanted to demonstrate and investigate
training combined with circulatory occlusion can create
the effects of short-term resistance training with a fixed,
significant muscular hypertrophy and strength gains in a
very low-intensity mechanical load combined with
short-term exercise period. They also concluded that
circulatory occlusion.
elevated metabolic stress seems to be an important
So they recruited 14 untrained healthy male subjects factor in achieving these results.
and asked them to partake in a resistance exercise
program comprising unilateral plantar flexion at 30 Limitations
repetitions per minute at 20% of their 1RM combined The study was performed using untrained subjects and it
with circulatory occlusion for a period of 2 minutes. The is unclear whether similar results could be obtained in
circulatory occlusion was applied using a pneumatic cuff trained subjects or athletes.
around the thigh, using a pressure that was 1.3 times
the systolic blood pressure. The program involved 2
sets of the exercise as described with a rest between of Key points
30 seconds, for 2 sessions per day for 3 days per week
It is possible to create significant increases in muscle
for 4 weeks.
cross-sectional area and 1RM strength using a load of
20% of 1RM in untrained subjects in just 2 weeks by
Using MRI, the researchers measured the muscle cross-
using blood flow constriction in conjunction with the
sectional area (CSA) of the plantar flexors (including the resistance exercise.
medial gastrocnemius, lateral gastrocnemius, soleus,
flexor hallucis longus, tibialis posterior, flexor, digitorum
longus, peroneus longus, and peroneus brevis) at a point
30% of the leg length from its proximal attachment. This
was done pre- and post- training, with a space of 3 days
left following the final training session to avoid over-
estimation caused by any local muscular swelling.
Page 8
Kinematic, strength, and stiffness adaptations after a Before and after the 4-week training phase, the
short-term sled towing training in athletes, by Alcaraz, researchers tested the subjects over three days, for the
Elvira and Palao, in Scandinavian Journal of Medicine following activities:
and Science in Sports, 2012
• Day 1: jump and 50 m sprint tests,
• Day 2: hip flexors and extensors isokinetic strength,
Background
1RM testing on the half squat, and peak mechanical
Many athletes make use of resisted sprint training for power output in half squat exercise using resistances
improving sprint performance. Sled towing is one such of 30%, 45%, 60%, 70%, and 80% of 1RM, and
method of resisted sprinting. An important • Day 3: jump and 50 m sprint tests.
consideration in sprinting is the vertical and leg stiffness
of the sprinter and how this affects the displacement of
their center of mass (COM). However, little research has
What happened?
been performed in respect of how training can affect The researchers did not find any differences in sprint
vertical and leg stiffness. performance improvements between the intervention
and control groups. They found that body lean
significantly increased for the intervention group in the
acceleration phase of a sprint following the 4-week
The researchers wanted to examine the effects of 4 training period. They found that in the maximum
weeks of resisted or unresisted sprint training on sprint velocity phase, the stride length of the intervention
kinematics, strength, and vertical and leg stiffness group significantly increased by 5.7 ± 5.3cm. The
adaptations. So they recruited 30 subjects (20 male and researchers did not find any differences in strength gains
10 female), who were national level athletes (24 between the groups and neither did they detect any
sprinters, 2 long jumpers, and 4 decathletes). However, differences in the changes in peak hip flexion torque.
only 22 athletes (14 men and 8 women) completed the The researchers did not find any significant differences
study. The researchers asked the subjects to complete 3 between the pre- and post- test stiffness of the support
weeks of standardized resistance and sprint/jump leg, or in vertical stiffness for either group.
training before embarking upon a 4-week specific
training phase. During the initial 3-week phase, the
subjects performed two sprint/jump sessions, two
resistance-training sessions and a regeneration session. The researchers concluded that there were no clear
After the 3-week initial phase, the subjects were tested. differences between the groups using resisted and
Following initial testing, the subjects carried out a 4- unresisted sprint training. They also concluded that the
week training program. All groups carried out 2 sprint- weighted sled resisted sprint training caused an increase
training sessions of c. 90 minutes per week, as well as a in body lean in the acceleration phase in addition to an
periodized resistance-training program 2 days per week. enhancement in stride length and landing distance in
the maximum speed phase.
The sprint training comprised of a 30-min sprint-specific
warm-up followed by a block of flying sprints consisting
Limitations
of either resisted or unresisted sprints, and a block of
jump/sprint training, consisting of maximal forward The researchers noted that the subjects in the present
bounds over distances of 30m or a 50m sprint from a study were a very well trained sample and therefore the
standing start. The resisted sprints were always results of this research may not be applicable to less
specified with the weighted sled for the intervention well trained subjects.
group. The control group always performed unresisted
sprints. Key points
The resistance-training program comprised 4 sets of 9 Weighted sled resisted sprint training for four weeks
reps with 9RM in the first week, progressing to 4 sets of causes an increase in body lean in the acceleration
6 repetitions with 6RM in the fourth week, using the phase and an increase in stride length and landing
free-weight back squat to a 90° knee angle as their main distance in the maximum speed phase
exercise in addition to supplementary exercises,
including unilateral hip extensions, standing calf raises
and the power clean.
Page 9
Hamstring exercises for track and field athletes: injury Studies reporting hamstring injury prevention
and exercise biomechanics, and possible implications for The researchers note that 5 intervention studies have
exercise selection and primary prevention, by reported on the incidence of hamstring injuries
Malliaropoulos, Mendiguchia, Pehlivanidis, following the use of eccentric training, involving more
Papadopoulou, Valle, Malliaras and Maffulli, in British than 1,000 athletes. However, each study reported
Journal of Sports Medicine, 2012 significant reductions in injury rates.
Exercises for a hamstring injury prevention program

The Review
Malliaropoulos et al. note that since active lengthening
The hamstrings are frequently injured in sports and such of the hamstring muscles may occur both in the late
injuries very often reoccur after initial injury and swing phase (when the foot is not in contact with the
rehabilitation. Malliaropoulos et al. recently reviewed ground) and during late stance phase (when the foot is
the effects of eccentric strength training for hamstring in contact with the ground) both open and closed kinetic
injury prevention. The researchers first explain that the chain exercises should be used. The researchers also
hamstrings are both hip extensors and knee flexors suggest that since the hamstrings have a significant role
during both the stance and swing phases of sprinting. in the SSC during sprinting, this activity should also be
They note that other researchers have proposed that stressed in a resistance-training program. The
the hamstrings are most vulnerable to injury during the researchers observe that in sprinting the hamstrings
late swing phase, because they are at maximum stretch function the late swing phase as hip extensors, while
at this point, as well as being most active (according to also acting as knee flexors to eccentrically decelerate
EMG data) and lengthening under considerable load. the forward swing of the lower leg. They therefore
Malliaropoulos et al. also note that other researchers suggest that an injury prevention program should
have also proposed muscle weakness of the hamstrings include both hip extension and knee flexion actions.
as a cause of strains. Such muscle weakness might be Additionally, the researchers observe that the non-
either in relation to their antagonists or between legs. uniform activation of different components of the
However, they note that evidence is still weak in this hamstring muscle group in different exercises has
regard because a lack of studies. recently been demonstrated. Consequently, they
recommend targeting different parts of the hamstring
Eccentric training
with different exercises. Moreover, since hamstring
The researchers explain that the hamstrings undergo
strains affect different hamstring muscles, they suggest
eccentric lengthening from c. 45 – 90% of the sprinting
that exercise selection should be performed in order to
gait cycle, suggesting that eccentric training is therefore
target specific muscles.
specific to this activity. Malliaropoulos et al. also note
that in sprinting, the hamstrings act as shock absorbers,
then as springs. They suggest that it is possible that What did the researchers conclude?
eccentric training could create a stiffer muscle, which The researchers concluded that hamstring strain
could protect it from damage and also increase the prevention should include specific muscle strengthening,
amount of elastic energy available in the stretch with a focus on eccentric training, which has the ability
shortening cycle (SSC) to increase the size, strength and flexibility, optimum
length and stiffness of the muscles.
The researchers note that muscles have an optimum
length for producing peak tension and that strains are
Limitations
thought to happened when activated muscles are
lengthened to greater than this optimum length. Since The researchers were limited by the availability of
the hamstrings are required to produce high forces at studies in respect of how hamstring muscle imbalances
long lengths, some researchers have proposed that affect injury incidence.
where a muscle is conditioned to produce high forces at
shorter lengths, it is at greater risk of injury. Key points
Additionally, some research has indicated that the
optimum length of the hamstrings is a risk factor for Hamstring strain prevention should include specific
injury. The researchers note that eccentric training is muscle strengthening
the only form of training that can consistently increase
the optimum length of tension development in a Eccentric training of the hamstrings has the ability to
muscle. increase the size, strength and flexibility, optimum
length and stiffness of the muscles
Page 10
Exercise-Training Intervention Studies in Competitive Resistance training: resisted swimming training

Swimming, by Aspenes and Karlsen, in Sports Medicine, The researchers identified 6 studies that investigated
2012 the impact of swim-like resistance training interventions
on swimming performance, including biokinetic swim
The Review bench training, in-water resistance training, and swim
training with paddles. They comment that there is
Aspenes and Karlsen set out to review studies that
currently no evidence that the biokinetic swim bench is
investigated the impact of different modes of training on
effective at improving swimming performance, on
competitive swimming performance. They performed a
account of a lack of successful studies.
literature review and commented on their findings.
They start their review by noting that competitive Aspenes and Karlsen note that resisted swimming can
swimming differs significantly from other sports in take many forms. One study used a ladder-like system
several key respects: swimmers are typically in a prone of fixed rungs that swimmers can pull and push against
position, both arms and legs are used for propulsion, during swimming. Following the use of this device in an
immersion in water supports the body and influences RCT, subjects experienced an improvement in 50m and
the timing of breathing, forces applied by the athlete are 200m freestyle performances after 10 weeks by 0.6s and
normally applied against fluid not hard surfaces, and 2.5s, although compliance was poor. The researchers
equipment has minimal impact on performance. These also noted two other studies in which subjects dragged a
factors mean that studies performed on swimmers perforated bowl and the intervention groups improved
should be preferred, as their sporting challenges are 50m, 100m and 200 m times. They therefore conclude
very different from those of other athletes. that resisted swimming training appears to provide
positive effects on swimming performance.
Resistance training: dry-land training
The researchers note that several studies have reported Finally, the researchers noted that there is no current
positive associations between upper body muscle evidence of improved swimming performance as a result
strength or power and swimming performance. of increasing the volume of swimming training done
Swimmers typically enhance muscular power through with hand paddles.
both dry-land resistance training and through resisted
swimming. They note that observational studies have Other training modalities
found that international swimmers may spend as much The researchers also reviewed other training methods,
as 5 hours a week on dry-land resistance training. including increased relative amounts of leg training and
Aspenes and Karlsen note 5 studies investigating respiratory muscle training. They note that increased
swimming performance following dry-land strength relative amounts of leg training do not seem to improve
training. They note that Strass et al. found a 7.3% whole-stroke swimming performance. However, this
improvement in 50m freestyle over 4 weeks using a was limited by the availability of studies. Respiratory
heavy resistance training regimen 4 times per week for training has been recommended because of the
the elbow extensors of 3 reps of 3 sets at 90% of 1RM, 2 observation that breathing is restricted during
reps of 2 sets at 95% of 1RM, 1 rep at 100% of 1RM and swimming because of water immersion and because
1 rep attempted at 100% of 1RM plus 1kg. swimmers appear to have a high-respiratory capacity,
even compared to other athletes. The researchers
Other researchers found similar results using slightly noted two studies on respiratory muscle training for
higher rep ranges and in relation to longer freestyle swimmers, which produced conflicting results. They
distances (up to 400m) but the number of studies is therefore suggest that this area requires further
small and the sample sizes in all cases were very small. research before the position is clear.
In contrast, they note that a study by Tanaka et al. found
no significant improvements in swimming performance
Limitations
after 8 weeks of dry-land strength training. However,
this program comprised 3 sets of 8–12 reps and The review was limited by the paucity of studies
coincided with a hectic race season. Whether the higher performed regarding swimming training methods.
reps or overreaching or another factor were responsible
for the lack of results is therefore unknown. Aspenes Key points
and Karlsen therefore conclude that the small number of
studies on dry-land strength training suggest a positive Resisted swimming training has the best evidence for
impact on swimming performance but the evidence is improving swimming performance, followed by dry-
not strong at this point. land training
Page 11
Effects of load and training modes on physiological and Buitrago et al. found that the number of reps decreased
metabolic responses in resistance exercise, by Buitrago with increasing load and increased with increasing
Wirtz, Yue, Kleinoder and Mester, in European Journal of tempo, except between 1-1-1-1 and 0-1-1-1.
Applied Physiology, 2012
The researchers found that the total volume of weight
lifted (weight x reps) decreased significantly with
Background
increasing loading but increased with the increasing
Researchers have found that the physiological and tempo, except from 1-1-1-1 to 0-1-1-1. The researchers
metabolic responses to resistance exercise depend on observed significant differences in mean VO2 used
the intensity and also on the velocity of the movement. during exercise according to the tempo used. They
However, there are few studies on the latter variable. found that the VO2 was higher at 0-1-1-1 than at 4-1-4-1.
The researchers did not detect any significant effects of

loading on VO2 but they did find that Consumed O2
Buitrago et al. wanted to investigate the acute during exercise was significantly different as a result of
physiological and metabolic responses to an exhaustive loading in that it was higher during the lower loading
bench press exercise using four different exercise
than during the middle and higher loadings.
velocities (tempos) and loads. So they recruited ten
physical education students with several years of Buitrago et al. did not find any significant differences in
resistance-training experience and who were active in Consumed O2 or EPOC as a result of changing the
competitive sport. The students reported to the tempo.
laboratory on 12 different days in order to perform 12
different protocols with the bench press, combining load
and tempo as follows:
Buitrago et al. concluded that slower tempos (4-1-4-1
• Loading (percentage of 1RM) of low (55%), middle compared to 1-1-1-1) allow a prolonged exercise time
(70%) or high (85%); and but a reduced number of repetitions.
• Tempo (concentric-isometric-eccentric-isometric, in
seconds) of 4-1-4-1, 2-1-2-1, 1-1-1-1 and 0-1-1-1. The researchers also concluded that an increased
loading leads to a decrease in the total volume of weight
Before performing one of the bench press protocols, the lifted in the set but a faster tempo permitted a higher
subjects were connected to an open spirometry system. amount of total volume. They therefore suggest that
After 5 minutes, the researchers recorded resting heart maximal energy expenditure is attainable by lifting
rate and took a blood sample from the ear lobe to lower loads and faster tempos.
determine the blood lactate concentration. The subjects
then performed a brief warm-up session of 15 reps at Limitations
30% of 1RM. After 10 minutes, the subjects performed
The study was limited by the use of EPOC to monitor the
the selected protocol to failure. Immediately after
energy consumption by the anaerobic system. While
failure, the researchers recorded heart rate and took
this method is commonly used, it has not been validated
another blood sample. For 30 minutes following
for accurate measurement of the energy used by this
exercise, heart rate and blood lactate were monitored
pathway.
every 2 minutes in addition to the continuation of the
spirometric measurements.
Key points
The researchers calculated VO2 as well as Consumed O2
both during exercise and in the 30 minutes following Maximal energy expenditure during resistance exercise
exercise. They calculated EPOC by subtracting an is attainable by lifting lower loads and faster tempos
estimate of the basal metabolic rate for each subject
from the Consumed O2 in the 30 minutes following
exercise.
What happened?
The researchers found that both the loading and the
tempo had significant effects on the number of reps that
the subjects were able to perform in each protocol.
Page 12
Does cheating pay: the role of externally supplied Arandjelovic then created a computer program that
momentum on muscular force in resistance exercise, by would estimate the degree of hypertrophy stimulus
Arandjelovic, in European Journal of Applied Physiology, based on the loading and the time under tension of the
2012 muscle. Using this model, he found that as the loading
is increased, so does the theoretical hypertrophy
Background stimulus for any degree of external momentum.
However, he also found that when the loading is
Arandjelovic starts with the principle that momentum is
increased too far, the hypertrophy stimulus drops
an important factor in resistance training, which can
quickly because the number of repetitions that can be
affect the amount of load that can be lifted successfully
completed in one set decreases and with it the time
as well as the effort required to do so. However, he
under tension, which was a key variable in his model.
notes that the role of external momentum in training for
hypertrophy is not clear.
What did the researcher do? Arandjelovic suggests that the use of moderate
momentum at the beginning of each repetition provides
The researcher wanted to investigate whether using
the best compromise between safety and hypertrophy
external momentum, commonly denoted “cheating” is
stimulus. He proposes that the significant increase in
effective in hypertrophy training.
the load that the use of external momentum allows and
the consequently greater overload of muscles outweigh
Arandjelovic explains that the main argument against
the negative effects of the associated reduction in the
the use of external momentum in resistance exercise is
number of repetitions.
that it reduces the force required from the muscles.
This is because less force is required to accelerate an
object that is already moving and therefore has some Limitations
kinetic energy. Additionally, Arandjelovic notes that the The study was limited by the use of computer modeling
force that a muscle is capable of expressing decreases that did not include all of the variables that are known
with increasing speed and that this is an extra factor to affect muscular hypertrophy. It is therefore only as
that may reduce force as external momentum is used. accurate as its assumptions concerning the causes of
However, he notes that, in defense of the practice, it is hypertrophy. Moreover, it modeled an exercise wherein
well known that greater loads can be used by the use of the concentric phase was followed by an eccentric,
external momentum and this increases the force rather than the other way around, which would give rise
required from the muscles. to a stretch shortening cycle (SSC). The findings of the
study might therefore have been different had an SSC
Lateral raises
exercise been performed, such as a squat.
Since there are factors that both increase and decrease
the force required from a muscle as a result of using
external momentum, Arandjelovic therefore modeled Key points
the performance of a set of ten lateral raises with
dumbbells using a computer program, both with and The use of external momentum may be more effective
for hypertrophy training than the use of strict form on
without external momentum.
certain exercises.
He explains that in the strict case with a standard load,
with each repetition, angular velocity reduces for all
abduction angles and the final part of the range of
motion (ROM) becomes progressively more difficult. In
addition, the muscular torque produced about the
shoulder joint similarly decreases with each additional
repetition.
Arandjelovic then modeled the same set of lateral raises

with the same load, using external momentum. He
found that the overall torque was consistently
maintained at a higher level as the set progressed and as
fatigue is accumulated.
Page 13
2. BIOMECHANICS
Page 14
Unilateral eccentric exercise of the knee flexors affects They also found that the eccentric exercise caused a
muscle activation during gait, Dover, Legge and St-Onge, reduction in strength that was apparent on the second
in Gait & Posture, 2012 day of testing.
Additionally, they observed a significant decrease in

Background hamstring ROM as a result of the eccentric exercise.
Delayed onset muscle soreness (DOMS) is soreness and
muscle dysfunction following unaccustomed eccentric In respect of gait, the researchers found that there was
contractions that tends to peak 48 hours following a decrease in biceps femoris EMG amplitude during the
performance of the exercise. Previous research has late swing phase of gait as a result of the eccentric
reported changes in gait as a result of DOMS and this exercise. They proposed that this could be a protection
may inform changes in gait that result from more mechanism for the damaged muscle at its point of
serious muscle strains incurred in sport. greatest length and as it is eccentrically contracting. In
this same phase, the researchers observed an increase
in gastrocnemius EMG activity. Since one of the actions
What did the researchers do? of the gastrocnemius is knee flexion, the researchers
The researchers wanted to measure the effect of propose that this muscle is compensating for the
exercise-induced DOMS in the knee flexors on leg decrease in EMG activity of the hamstrings during this
muscle activity and knee angular displacement during final phase of gait.
gait. So they recruited nine healthy individuals (3 males
and 6 females) and assessed their hamstring ROM and However, the researchers did not observe any
evoked tenderness in the biceps femoris muscle. Then, significant changes in knee angular displacement
the researchers attached surface electrodes to the following eccentric exercise, which conflicts with
tibialis anterior, lateral head of the gastrocnemius, previous studies. This may be because previous studies
vastus lateralis, and biceps femoris muscles of the have induced DOMS in both legs rather than just one
subjects in order to record maximal voluntary isometric leg.
contractions (MVIC) data.
Following these basic tests, the subjects then walked on
a treadmill at self-selected speeds with an The researchers concluded that, following eccentric-
electrogoniometer attached to their dominant leg. exercise induced DOMS in the knee flexors, the
While walking on the treadmill, the researchers hamstring was less active during gait. They propose that
recorded the muscle activity and knee angle of the the pain and muscle damage may cause a compensatory
subjects during 10 steps of gait. Following the treadmill mechanism by increasing activation of the
gait test, the subjects then performed three 5-second gastrocnemius.
MVICs of the knee flexors while the knee was kept at an
O
angle of 90 with 30-seconds rest between each MVIC. Limitations
Then, in the same knee flexion machine, the subjects The study was limited in that the damage to the muscle
performed 10 eccentric contractions at a speed of 1.75 was caused by eccentric contractions and different
rad/s, followed by additional sets of 10 reps at 1.05 results might be obtained as a result of more severe
rad/s, 0.87 rad/s and a set to 50% of maximum MVIC muscle damage, such as strain injuries.
strength at 0.79 rad/s.
After 48 hours, the subjects returned for a second day of Key points
testing, when evoked tenderness was re-assessed,
MVICs were taken and the subjects walked on the Following eccentric-exercise induced delayed onset
muscle soreness in the knee flexors, the hamstring is
treadmill at the same self-selected speed as before.
less active during gait
After the subjects had been walking for 2–4 min, the
muscle activity and knee angle during 10 steps of the
gait cycle were recorded.
What happened?
The researchers found that they were able to cause
DOMS in all of their subjects, as measured by the
evoked tenderness test.
Page 15
Three-dimensional kinematic analysis of the snatch Both measures decreased with increasing percentage of
technique for lifting different barbell weights, Hadi, 1RM. They also found significant differences in the
Akkus and Harbili, in Journal of Strength and maximum vertical displacement and vertical velocity of
Conditioning Research, 2012 the center of mass during turnover under the barbell.
The maximum vertical displacement decreased
Background significantly with increasing percentage of 1RM and the
vertical velocity increased significantly with increasing
The snatch lift involves taking a barbell from the floor to
percentage of 1RM.
a straight-arm overhead position in one continuous
movement. However, despite the focus of the sport on As a result of these basic calculations, the researchers
the lifting of greater barbell weights, there have not were able to deduce that there were also significant
been many studies investigating the effect of increased differences in vertical work done during the first pull and
barbell weight on biomechanics during the snatch. in the total vertical work for each percentage of 1RM.
Moreover, one study that did explore this issue found They found that the vertical work in the first pull and the
that a small decrease in weight of only 5% could have a total vertical work were significantly greater with
significant effect on power output because it required a increasing percentage of 1RM. However, the
considerably faster movement speed and allowed a researchers did not note any significant differences
shorter time period for the completion of the lift. between the percentages of 1RM in total horizontal
work or in the vertical or horizontal work in the second
What did the researchers do? pull.
The researchers wanted to perform a kinematic analysis

of the body and barbell during the snatch with What did the researchers conclude?
increasing barbell weights. Consequently, they recruited The researchers concluded that the most significant
7 elite male weightlifters in different weight classes effects of increasing barbell weight were:
(from 56kg to 105kg) of the Turkish weightlifting
national team during their preparation camp for the • The decrease in the velocity of the barbell and the
2007 European Championship. In order to monitor the vertical displacement of the barbell and center of
movements of the weightlifters and of the barbells, a set mass, and
of 14 reflective markers were attached to the toe, ankle, • The increase in the vertical velocity of center of
knee, hip, shoulder, elbow, and wrist on both sides of mass during the turnover under the barbell, and
the body in addition to two markers on the chin and • The increase in the vertical work done during the
forehead. A final two markers were placed at the right first pull but not in the second pull.
and left ends of the barbell. The researchers used four
digital cameras operating at 50 frames per second in The researchers propose that the increase in the vertical
order to capture the movements of the reflective work and total work values in parallel to the increase in
markers. The researchers recorded lifts by the the barbell weight during the first pull might be the
weightlifters at 60% of 1RM, 80% of 1RM and 100% of longer time period needed to overcome the inertia of
1RM. For analysis, the researchers divided the snatch the barbell. They therefore suggest that this supports
into five phases according to the changes in the knee the idea of a strength-dominated first pull and a power-
angle and the vertical position of the barbell as the first dominated second pull.
pull, the transition, the second pull, the turnover under
the barbell, and the catch phase. They calculated the Limitations
durations of each phase for each lift at the different
This study used subjects that were both elite and from
percentages of 1RM. They also calculated the angular
one country and therefore their technique may be
displacements of the knee joint in each case.
slightly different from that used by less experienced
lifters or lifters who have trained in a different
What happened? environment.
The researchers did not find any significant differences
between the durations of the phases, except for the first Key points
pull, where the 80% of 1RM lift was significantly quicker
than the 100% of 1RM lift. The researchers also found Increasing weight in the snatch causes a decrease in
that there were significant differences between the the velocity of the barbell and in the vertical
maximum height and velocity of the barbell during 60% displacement of the barbell and center of mass
of 1RM, 80% of 1RM and 100% of 1RM snatch lifts.
Page 16
Selected reflections of the third Fascia Research The Stecco model

Conference (FRC3), Vancouver BC, March 2012, by Chaitow reports how Diane Lee was impressed by the
Chaitow, Journal of Bodywork & Movement Therapies, dissection course and the lectures presented by Drs.
2012 Carla Stecco and Antonio Stecco, which made it clearer
how highly complex and organized is the nature of the
The Review superficial and deep fascial systems.
This review by Leon Chaitow is a selection of How exercise shapes connective tissues
observations from key participants in the third Fascia Chaitow notes how Robert Schleip observed that the
Research Conference of the various presentations. presentation by Michael Kjaer on the Adaptation of
Tendinous Connective Tissues to Exercise was
Gerald Pollack, The Secret Life of Water
particularly impressive.
Chaitow explains how Pollack reported to the
conference that a fourth phase of water has been This presentation on how sports and exercise shape the
identified, in addition to the three well-known phases of connective tissues was founded in specific scientific data
solid, liquid and vapor (ice, water and steam). This but also provided very clear suggestions as to the types
phase occurs immediately adjacent to hydrophilic of exercise, intervals and loading are best for increasing
surfaces and is charged, while the water just beyond it is fascial resilience as well for preventing connective tissue
oppositely charged, in effect creating a current injuries. Schleip was intrigued to discover in particular
producing battery. that women’s connective tissues are different
depending on their estrogen level.
Chaitow reports that Pollack explained that light
recharges this battery and that water can therefore
receive electromagnetic energy from the environment,
which can then be used to produce electrical and
mechanical effects.
Two mindsets
Chaitow reports that Michael Schneider commented on
there being “two general mindsets: the researcher-
mindset and the clinician-mindset.” However, Schneider
was impressed with the degree of dialogue and
communication between delegates of both mindsets.
He found that in general, the researchers were trying to
find ways to make their research more clinically relevant
and that the clinicians were trying to understand how
the latest research could assist their practices.
Integrins
Chaitow, via Thomas Myers, reports how Rolf Reed
introduced to the conference the concept of interstitial
pressure and the role of integrins. Reed explained that
when the integrins are damaged, the hydrophilic
proteins are not restrained, and they swell. Reed
proposed swelling pain and tumors might therefore be
treatable by managing the integrin matrix.
Reed also commented on an elegant observation that

had been made regarding mice with the integrin gene
‘removed, which were not eating. For a while, the
researchers had pondered upon the biochemical route
for this reduced appetite. However, they ultimately
discovered that the mice were not eating because,
without integrins, their teeth were loose in their heads
and eating was uncomfortable.
Page 17
Predicting the metabolic cost of incline walking from Muscle activity

muscle activity and walking mechanics, by Silder, Besier The researchers took the sum of squared integrated
and Delp, in Journal of Biomechanics, 2012 EMG signals and correlated them with the normalized
net metabolic cost. They found that the integrated EMG
Background activity of all muscles with the exception of the tibialis
anterior increased with incline. The researchers also
Walking up an incline alters the muscular activations
found that the timing of EMG activity was also altered
found during gait and also requires a greater metabolic
by increasing incline for all muscles except the tibialis
cost when compared to walking on the flat. A previous
anterior and the rectus femoris. They found that with
model created by Pandolf et al. used three variables to
increasing incline, the onset of soleus and
predict the metabolic cost of incline walking, as follows:
gastrocnemius activity occurred later in the stance
subject mass, walking velocity and degree of incline.
phase. They found that the duration of activity
However, this model does not account for changes that
increased for the hamstrings, as a result of these
may occur in the muscular activations or gait.
muscles turning off at a later time. The researchers
Moreover, researchers have found that percent body
found that a model including only the incline and the
fat, perhaps surprisingly, also affects the metabolic cost
squared integrated EMG signals of the soleus and vastus
of inclined walking, independently of body mass.
lateralis explained 96% of the variance in metabolic cost
over walking on the flat.
Body composition
The researchers set out to determine which muscle
The researchers found that a model that included the
activation patterns, physical characteristics and gait
variables of incline, velocity, body fat percentage and
features best predict the metabolic cost during inclined
percent gynoid fat explained 85% of the variance in
walking. So they recruited 16 recreational runners (10
metabolic cost. They were disappointed to find that this
men and 6 women). They first measured each subject’s
was only marginally better than a model that included
total mass, fat mass and lean body mass. They also
only: incline, velocity and body mass, which variables
measured VO2 consumption and CO2 output over a 5-
were used by the previous model developed by Pandolf
minute period in order to establish the standing
et al.
metabolic cost. Then, each subject chose a preferred
walking velocity on a treadmill before beginning the Gait features
walking test. For the test, the subjects performed 15
The researchers found that with the exception of the hip
minutes of continuous treadmill walking, being five moment, power, and work associated with hip power
minutes each at 0%, 5%, and 10% inclines. During the generation during late stance and early swing phase, all
test, the researchers recorded VO2 consumption and CO2
peak joint moments, powers, and work were affected by
output in the final minute of each five-minute period. incline.
Additionally, the researchers recorded whole body
motion using 21 reflective markers placed on anatomical
landmarks as well as 19 additional markers for segment What did the researchers conclude?
tracking. The movements of these markers were The researchers concluded that models including EMG
tracked at 100Hz using eight cameras. The treadmill activities predict the metabolic cost of incline walking.
itself was instrumented and permitted the recording of
ground reaction forces and moments. Finally, EMG Limitations
activity was monitored using surface electrodes on eight
The researchers noted that their study was limited in
leg muscles: soleus, medial gastrocnemius, tibialis
that the EMG activities monitored did not include all of
anterior, medial hamstrings, lateral hamstrings, vastus
the leg muscles.
medialis, vastus lateralis and rectus femoris.
Key points
What happened?
Metabolic cost The EMG activity of muscles can be used to model the
The researchers recorded that the net normalized increased metabolic cost of incline walking
metabolic cost of level walking was 3.3 ± 0.6W per kg. The net normalized metabolic cost of level walking is
They found that this normalized metabolic cost 3.3 ± 0.6W per kg, which increases 52 ± 17% at 5%
increased 52 ± 17% at 5% incline and 113 ± 32% at 10% incline and 113 ± 32% at 10% incline
incline.
Page 18
Muscular strategy shift in human running: dependence the gluteus maximus (GM) and hamstrings (HM)
of running speed on hip and ankle muscle performance, doubled during terminal swing, from 1.0x to 4.6x
by Dorn, Schache and Pandy, in The Journal of bodyweight (BW), at 7.0m/s to 2.2x and 9.0x BW at
Experimental Biology, 2012 9.0m/s. On the other hand, the peak force expressed by
the gastrocnemius (GAS) increased with increasing
Background speed from 3.5 to 7.0m/s but did not increase
significantly after that point. The soleus (SOL) behaved
Runners increase speed either by taking longer strides or
similarly but actually decreased slightly above 7.0m/s.
by increasing their stride frequency. Importantly, stride
Additionally, the researchers found that the bi-articular
length is generally inversely proportional to stride
muscles played a significant role in force generation for
frequency, as the increased length of stride increases
running at all speeds. The HM increased force
the distance that the legs have to travel before returning
production with increasing speed. Significantly, the
for the next stride. Additionally, Dorn et al. explain that
researchers also found that the peak vertical ground
until c. 7m/s, runners appear to increase speed by
forces increased from 2.7x BW at 3.5m/s to 3.6x BW at
exerting larger support forces in the stance phase, which
7.0m/s and did not change above that speed. They
seems to increase stride length. At speeds of c. 7m/s
found that all at speeds, the SOL, GAS and vasti muscles
ground contact times become very small and this seems
provided roughly 75% of total vertical support forces.
to reduce the ability of the legs to generate higher
The researchers found that the mechanical work
ground forces and thereby further increase stride
performed by the hip muscles during swing increased
length. The researchers explain that above c. 7m/s,
with increasing running speed. They noted that the
runners appear to increase running speed by increasing
iliopsoas (IL) did more work at the hip during the first
stride frequency not by increasing stride length. This is
half of swing, the GM did more work in the second half
achieved by moving the legs faster through the air.
of swing, the rectus femoris absorbed more work at the
hip and the knee in the first half of swing and the HM
What did the researchers do? absorbed more work at the hip and knee in the second
The researchers wanted to use computer modeling to half of swing. The researchers concluded that the IL,
see how the leg muscles co-ordinate motion of the body HM and GM contributed to greater hip and knee
segments during running, particularly in relation to accelerations with increasing running speed particularly
increases in stride length and stride frequency. So they between 7.0 and 9.0m/s, in which range these muscles
recruited nine subjects (five males and four females) and produced an almost twofold increase in hip and knee
asked them to run on an 110m track at four steady-state joint acceleration.
speeds: 3.5m/s, 5.0m/s, at 7.0m/s and maximal
sprinting at 8.0m/s or greater. The researchers used What did the researchers conclude?
timing gates at 20m intervals along the track to ensure
The researchers concluded that the SOL and GAS
that data collection was performed while the runners
contribute most significantly to vertical support forces
were running at a steady state rather than accelerating
and increases in stride length up to 7.0m/s. Above
or decelerating. The subjects wore small reflective
7.0m/s, runners increase stride frequency through
markers on specific anatomical locations, which were
increases in the activity of the IL, GM and HM, which
recorded by a 3D video motion capture system. The
accelerate the leg and provide the high stride
researchers also measured the ground reaction force
frequencies needed to reach the fastest running speeds.
using eight force plates spaced out over the 11.5m
measurement section of track. EMG activities of 11 leg
muscles were recorded. Limitations
Computer models are based on a limited data sets, the
What happened? researchers looked at support forces and not horizontal
forces which are better correlated with maximum
The researchers found from the raw data that the
speed, and the researchers did not examine hip muscles
percentage increase in stride length was greater than
during ground contact, only during swing.
that in stride frequency as running speed increased from
3.5 to 7.0m/s but the opposite observation was made
above 7.0m/s. They found that ground contact time Key points
decreased steadily with increasing running speeds, while
Computer models predict that increases in force from
aerial time and effective vertical ground impulse
the iliopsoas, hamstrings and gluteus maximus cause
reached a maximum point at 7.0m/s before decreasing.
increases in running speeds above 7.0m/s
In their model, the researchers found that peak forces of
Page 19
Moderate-Intensity Running Causes Intervertebral Disc Disc volume changes

Compression in Young Adults, by Kingsley, D’Silva, The researchers found that the disc volumes were 6.9 ±
Jennings, Humphries, Dalbo and Scanlan, in Medicine & 1.0% less post-exercise compared to pre-exercise values.
Science in Sports & Exercise, Published Ahead of Print Moreover, as with the relative changes in disc height the
relative change in the volume of intervertebral discs in
Background the thoracic and lumbar regions were 8.4 ± 1.4% and 4.2
± 0.6%, respectively.
There are two main types of spinal loading during
walking and running: compressive and impact loading. Changes in height
Compressive loading is caused by weight-bearing The researchers found that the height of the subjects
activities while impact loading is caused by landing on reduced as a result of exercise by 8.1 ± 0.6 mm.
the ground following a period of time in which both feet
have been in the air.
Throughout the day, healthy individuals lose c. 1% of The researchers concluded that 30 minutes of
their height as a result of the increased compressive moderate-intensity treadmill running resulted in a 6.3 ±
loading on the spine that results from being vertical and 0.9% reduction in the height of intervertebral discs in
therefore weight-bearing. This increased pressure addition to a 6.9 ± 1.0% reduction in their volume.
causes fluid to be expelled from the intervertebral discs.
The size of intervertebral discs can be measured using Limitations
MRI scanning technology.
The researchers did not observe whether the subjects
were accustomed to running on the treadmill and
What did the researchers do? therefore it is possible that different results might have
The researchers wanted to use MRI scans to see how a been obtained with individuals who were accustomed to
30-minute bout of moderate-intensity treadmill running regular running. Moreover, it is not clear from this
affected the size of the intervertebral discs. study whether the reduction in intervertebral height and
volume has adverse health consequences.
So they recruited eight male subjects, who then
attended three testing sessions within 30 minutes of
Key points
rising in the morning on different days, separated by at
least three days. The researchers measured the height
30 minutes of moderate-intensity treadmill running
of the subjects carefully to a high degree of accuracy results in significant reduction in the height and
both before and after a treadmill run. volume of intervertebral discs
They also performed MRI scans of the spine before and

after the run. The treadmill run was performed after a
5-minute warm-up. The treadmill was inclined at an
angle of 10° and the subjects began running at 2.0mph
and increased in speeds every 2 minutes until volitional
exhaustion. During the test, the researchers monitored
heart rate and rating of perceived exertion (RPE).
What happened?
Disc height changes
The researchers found that the heights of the
intervertebral discs measured by MRI scans were
different in that they decreased from pre-exercise to
post-exercise by 0.33mm, or 6.3 ± 0.9% of pre-exercise
values. The researchers found that the relative loss in
the height of the intervertebral discs was greater in the
thoracic region (7.7 ± 1.2%) than in the lumbar region
(3.7 ± 0.6%).
Page 20
Leg stiffness in human running: Comparison of estimates The researchers noted that the stiffness values for their
derived from previously published models to direct model 1, which used direct measurements of stiffness,
kinematic–kinetic measures, by Coleman, Cannavan, were lower than previously published estimates.
Horne and Blazevich, in Journal of Biomechanics, 2012 However, they noted that the model 2, which was
produced by Morin et al., 2005 provided predicted
Background values of leg stiffness closer to those of Model 1 than
the other models tested.
Researchers often model human runners as a spring-
mass system, in which the support leg is treated as a Moreover, the researchers noted that the relationships
massless spring loaded by the body mass above it. This between Model 1 and Models 3–5 were poor, indicating
model has been found to have a great deal of coherence that some of the assumptions made in these models
with observed running kinetics. Consequently, were not appropriate.
researchers have been interested in how the degree of
stiffness of the support leg influences running speed,
stride frequency and running economy. This has led to a
number of computer modeling studies designed to The researchers concluded that previously published leg
clarify this behavior. However, such studies have not stiffness models, in which leg stiffness is derived rather
been explicitly compared against direct measurements. than directly measured, do not produce accurate
predictions of leg stiffness. However, they note that
models similar to those produced by Morin et al., 2005
may produce accurate predictions when a high degree
The researchers wanted to compare leg stiffness values of accuracy is not essential.
measured using direct methods with those calculated
using previously published computer models.
Limitations
So they recruited 19 well-trained distance runners and The study used well-trained distance runners and it
recorded their movements using infra-red motion might be expected that these runners would display
capture video cameras that tracked highly reflective different leg stiffness from either untrained subjects or
markers attached to their left and right greater trained sprinters. Moreover, the distance runners might
trochanter, lateral condyles of the left and right knee be expected to exhibit different degrees of leg stiffness
joints, left and right lateral malleoli, left and right heels, at the speeds they most frequently train and race at as
and left and right second toes. The subjects ran for a against faster or slower speeds.
number of trials at varying speeds from 2.5–6.5m/s on a
60m track with a force plate in the middle for recording Key points
ground reaction forces.
Previously published leg stiffness models, in which leg
What happened? stiffness is derived rather than directly measured, do
not produce accurate predictions of leg stiffness.
The researchers input the data from their experiment However, models similar to those produced by Morin
into the four models to reproduce leg stiffness et al., 2005 may produce accurate predictions when a
predictions for their subjects in each of their trials. They high degree of accuracy is not essential.
found that there were significant differences in the
predictions for leg stiffness between the models. The
mean values for stiffness (kN/m) are presented below:
• Model one (actual) - 13.91 ± 3.30

• Model two - 13.18 ± 2.96
• Model three - 17.14 ± 4.21
• Model four - 25.06 ± 4.8
• Model five - 18.89 ± 4.88
The researchers also noted that there were significant

differences between the participants’ leg stiffness values
using each of the five methods, except between models
1 and 2.
Page 21
Leg stiffness can be maintained during reactive hopping The researchers recorded kinematic data regarding the
despite modified acceleration conditions, by Kramer jumps using a motion capture system comprising ten
Ritzmann, Gruber and Gollhofer, in Journal of cameras that tracked reflective markers placed on
Biomechanics, 2012 anatomical landmarks of the right leg, as follows: hallux,
fifth metatarsal bone, lateral malleolus, lateral knee
Background joint center and greater trochanter. A further marker
was placed on the sternum.
The stretch–shortening cycle (SSC) is a muscular
phenomenon that researchers have extensively studied.
In the SSC, a muscle–tendon unit is stretched and then What happened?
there is a subsequent contraction of the muscle. The The researchers discovered that the subjects were able
stretching phase allows the storage of elastic energy in to maintain the preactivity of the leg extensors and leg
the muscle–tendon unit, which is then released during stiffness irrespective of the degree of acceleration. They
the subsequent contraction. The SSC can be observed in noted that there was no heel contact in any of the
many everyday and sporting actions, including running jumps. They also noted that increasing the acceleration
and jumping. Some researchers have proposed that, from 0.7x to 1.3x gravity caused an almost linear
during reactive jumps that involve the SSC, it is increase in the peak ground reaction forces and an
important that there is no heel contact and that there is increase in kinetic energy.
a high degree of muscle stiffness, which requires a high
preactivation of the leg extensor muscles. These The researchers noted that the EMG activity of soleus,
researchers have proposed that if these conditions are gastrocnemius, rectus femoris and biceps femoris
not fulfilled, the energy is not stored but rather changed significantly with increasing degree of
dissipates as heat. acceleration. However, the changes were not linear.
Kramer et al. note that one factor that seems to limit the What did the researchers conclude?
ability to perform reactive jumps is the acceleration
The researchers concluded that regardless of the
acting on the jumper. They note that studies have
acceleration level, subjects were able to maintain a high
indicated that jumps with accelerations above and
preactivity of the leg extensors and also high leg
below gravity produce inferior degrees of elastic energy
stiffness, enabling them to perform reactive hops under
storage compared to those operating under
conditions of different accelerations. They therefore
gravitational acceleration.
propose that the neuromuscular system is able to cope
with different acceleration levels.
The researchers wanted to assess the effects of Limitations
modulated acceleration with a new piece of apparatus,
The researchers note that this study is limited in that it
called the sledge-jump-system, which allows a variation
used repeated hops rather than drop jumps, as have
in the amount of acceleration without altering inertia or
been used in other similar studies. Moreover, they note
causing sudden changes in the acceleration acting on
that the subjects’ experience with reactive jumps
the jumper.
differed, as they practiced different sports.
So they recruited 20 subjects (4 females and 16 males)
who were physically active sports science students. The Key points
subjects performed hops in the sledge-jump-system
using seven different accelerations (0.7, 0.8, 0.9, 1, 1.1, Regardless of a varied acceleration level, subjects are
1.2 and 1.3x gravity). The subjects performed the hops able to maintain a high preactivity of the leg extensors
bare-footed on two force plates, while the researchers and also high leg stiffness, enabling them to perform
recorded electromyographic (EMG) data using surface reactive hops under conditions of different
accelerations
electrodes place on the soleus, gastrocnemius medialis,
tibialis anterior, rectus femoris, vastus lateralis and
biceps femoris of the right leg. The sledge jump system
is a horizontally aligned frame in which a subject can
jump with hardly any restrictions concerning the joint
movements, allowing almost natural jumps. The subject
is strapped to a wooden sledge that can move along rails
within a frame.
Page 22
Independent activation in adjacent lumbar extensor What happened?

muscle compartments, Nugent, Stapley and Milner, in The researchers discovered four distinct patterns
Journal of Electromyography and Kinesiology, 2012 corresponding to the four different movements, which
were consistent across subjects and their training levels.
Background The researchers found that the forward bend displayed
Some researchers maintain that muscles do not function very similar EMG activity patterns across all eight muscle
as single units but rather contain a number of distinct compartments. In comparison, the researchers found
muscle compartments that are innervated by their own that for the side bend, the EMG activity displayed earlier
nerve branches, which have their own stretch reflexes burst onsets and longer burst durations at sites 1-4
and biomechanical functions. Nugent et al. suggest that compared to sites 5-8. Sites 1-4 were placed inferiorly
the structure and innervation of the lumbar spine to sites 5-8. The researchers found that the EMG
extensors imply that they contain such segmentally pattern for serpentine at 60 beats/min showed the
specific biomechanical functions. They note that reverse sequence of EMG activation to the maya, with
previous researchers have described the anatomy of the onsets and EMG bursts occurring later for electrodes
superficial muscles within the posterior lumbar region as 1-4 compared to electrodes 5-8.
principally comprising the multifidus and two main
divisions of the erector spinae, being the medial What did the researchers conclude?
longissimus thoracis and the lateral iliocostalis The researchers concluded that in contrast to the
lumborum. They note that some researchers have also simultaneous activation of ipsilateral lumbar erector
identified a deeper compartment of the erector spinae, spinae compartments above and below L3 during spine
which is comprised of partially overlapping fascicles that bending tasks (such as a forward bend or side bend),
run from the iliac crest to the lumbar vertebrae. asynchronous activation occurred during figure eight
movements, as found in belly dancing movements (such
What did the researchers do? as the serpentine or maya).
The researchers wanted to establish the degree to which
The researchers observed that these regions are
compartmental control of each of the different
consistent with the separate superficial and deep sub-
segments of the lumbar paraspinals was independent.
sections of the lumbar erector spinae previously
So they recruited 14 healthy female subjects of whom 7
identified by other researchers. Consequently, the
were novice belly dancers with (<1 year of training) and
researchers suggest that these data support the idea
7 were trained (>1 year of training). The researchers
that muscles do not function as single units but rather
used surface electrodes to measure the EMG activity of
contain a number of distinct muscle compartments that
the muscle compartments in the right lumbar region.
are innervated by their own nerve branches, which have
The researchers placed electrodes 1 and 2 to record the
their own stretch reflexes and biomechanical functions
EMG activity of the multifidus at L5 and L4. They placed
electrodes 3, 5 and 7 to record EMG activity of the
medial longissimus thoracis at levels L4, L2, L3 and L1, Limitations
respectively. They placed electrodes 4, 6 and 8 to record The study was performed solely by a small group of
from lateral iliocostalis lumborum at levels L4, L2, L3 and female subjects, the majority of whom had some belly
L1, respectively. While the researchers took EMG dancing training.
measurements, the subjects performed maya and
serpentine belly dancing movements, which involved
Key points
moving the pelvis in a figure eight pattern in the frontal
plane by using anti-phase hip and leg motions. During
Simple spine-bending tasks cause simultaneous
these movements, spinal motion is mainly lateral activation of ipsilateral lumbar erector spinae
flexion, while the lower limbs alternately flex and compartments, while figure-of-eight movements cause
extend, along with alternating hip adduction/abduction. asynchronous activation of the fibers in these
The subjects performed the movement cycles in time compartments
with a metronome set at 60 and 120 beats/min. The
subjects also performed two comparison tasks during Muscles do not function as single units but rather
contain a number of distinct muscle compartments
which activation of the erector spinae was expected to
that are innervated by their own nerve branches,
be synchronous: alternating spine flexion/extension in
which have their own stretch reflexes and
the sagittal plane (forward bend) and alternating spine biomechanical functions
lateral flexion/extension in the frontal plane (side bend).
Page 23
Foot kinematics and loading of professional athletes in Regarding angles and ROMs at the foot and ankle, the
American football-specific tasks, by Riley, Kent, Dierks, researchers found that the talocrural angle motion was
Lievers, Frimenko and Crandall, in Gait & Posture, 2012 similar in change-of-direction activities to when running.
However, the subtalar joint angles for the cuts were
Background similar to those of running, but with a larger ROM.
Professional American Football players experience Movement initiation activities

significant loads on their muscles, tendons, ligaments, The researchers found that the three movement
and bones and are often susceptible to injury. initiation events displayed similar vertical ground
Moreover, researchers have identified that foot and reaction forces. They noted that the average maximum
ankle injuries account for 15 – 20% of all game-related vertical ground reaction force was c. 1.5x body weight.
injuries. The researchers found that movement initiation
activities started with the talocrural joint dorsiflexed and
What did the researchers do? the subtalar joint inverted. This pattern was followed by
rapid talocrural plantar-flexion and eversion at push-off.
The researchers wanted to investigate foot and ankle
They noted that the forward start was accompanied by a
kinematics of professional American Football athletes
large dorsiflexion of the hallux metatarsophalangeal
during the stance phase of various football-specific
joint that was in excess of normal ROM.
activities. They were interested in finding out whether
these activities involved normal or extreme ranges-of-
Movement termination activities
motion (ROMs) in the foot and ankle. So they recruited The researchers observed that the kinematics of
9 professional American Football players, drawing the movement termination were the opposite of those
players in equal numbers from three main classes, observed in movement initiation. They noted that lateral
designated as power players (linemen), speed players
plants created medial braking forces that ranged as high
(running backs and receivers) and hybrid players as 1.1x bodyweight. The highest talocrural angle ROM
(linebackers and tight ends). The researchers monitored O
was observed in jumping (67.8 ± 6.48 ), which exceeded
the players during the following activities:
the value for loaded talocrural flexion ROM of 59.1 ±
O
6.98 previously reported by other researchers for
• Forward start
healthy, young people. High subtalar ROMs were
• Lateral start
O associated with reversals, cutting, and starts. The
• 90 cut right
O highest average maximum vertical ground reaction force
• 90 cut left
was observed in jump landing.
• Direction reversal
• Full run
• Forward plant
• Lateral plant The researchers concluded that the talocrural and
• Jump metatarsophalangeal ROMs observed during these
• Jump landing common American Football movements were larger
than normal.
The researchers used cameras set up to track reflective
markers placed on the anatomical landmarks of the Limitations
players in order to monitor kinematic data. They used
There researchers noted that this study was limited by
force plates at key locations on the ground in order to
the number of subjects, the small number of repeats of
track kinetic information.
each activity, and the lack of data on the reliability of
motion capture for the range of activities considered.
What happened?
Change-of direction activities Key points
The researchers investigated three change-of-direction
O O
events: direction reversal, 90 cut right and 90 cut left. The talocrural and metatarsophalangeal ROMs
They found that the mean stance time was 0.44 ± 0.04s observed in common American Football movements
for reversal, 0.30 ± 0.03s for the right leg cut, and 0.34 ± are larger than normal ROMs observed in walking and
0.07s for the left leg cut. They noted that the pattern of running
vertical ground reaction forces for the left and right cuts
was similar to the pattern observed in running, while the
reversal was more similar to a walking pattern.
Page 24
Electromyography variables during the golf swing: A The reviewers noted that the other shoulder muscles
literature review, by Marta, Silva, Castro, Pezarat- studied (supraspinatus, infraspinatus, anterior deltoid,
Correia and Cabri, in Journal of Electromyography and middle deltoid and posterior deltoid) displayed only
Kinesiology, 2012 weak to moderate levels of activation during the golf
swing. They reported that one study found that the
The Review right serratus anterior muscle was most active and that
the right trapezius muscle was most active during the
The researchers reviewed available electromyography
backswing.
(EMG) studies performed on the muscles used in the
golf swing. Forearm muscles
The reviewers noted that the studies showed that the
Movement phases of the golf swing
highest levels of EMG activity were noted in the forward
The reviewers found that most of the studies divided the
swing and acceleration phases. One study reported
golf swing into five phases, being the backswing, the
EMG activity above 100% MVC (and even above 200%)
forward swing, the acceleration phase to ball impact,
for the flexor carpi ulnaris of the trail forearm during the
the early follow-through, and the late follow-through.
forward swing phase.
Data are presented for right-handed golfers.
Leg muscles
EMG data concerning the golf swing
The reviewers found that there was higher EMG activity
The reviewers found that most of the EMG studies
in the forward swing in the trail leg than in the front leg.
focused on the trunk, shoulder, forearm and legs. They
They noted that one study found that the gluteus
noted that seven of the studies used surface electrodes
maximus was the most active leg muscle. This study
while another seven used fire wire electrodes. They
found that the right gluteus maximus showed high levels
noted that normalization of the EMG data was carried
of activity (80 – 100% MVC) in the forward swing phase
out in only nine studies.
while the left gluteus maximus presented moderate to
high levels in the acceleration phase. The reviewers also
Trunk muscles
reported that a high level of EMG activity was found in
The reviewers noted from studies that recorded EMG
the right hamstrings during the forward swing phase.
data of the trunk muscles that the right erector spinae
had high levels of activity during the forward swing
phase, while the left erector spinae was more active in Limitations
the acceleration phase. They noted that one study The reviewers noted that their review was limited in
found that when the swing was performed with a that it was difficult to compare the levels of EMG activity
shorter backswing, the golfer presented significantly between the studies since they each used different
lower levels of EMG activity in the left erector spinae normalization methods or did not even perform any
during the forward swing phase. normalization. Additionally, the reviewers noted that
most studies were performed on professional or highly
The reviewers found that the right abdominal oblique
skilled golfers, which is unfortunate, as the vast majority
displayed moderate to high levels of activity in the
of participants in the sport are amateur or even largely
forward swing, acceleration and early follow-through
untrained.
phases while the left abdominal oblique showed
moderate levels of activation during the forward swing
phase and weak activity during the other phases. They Key points
noted that one study found that the external abdominal
oblique muscles on both sides had significantly higher The erector spinae and abdominal obliques are very
active during the golf swing
levels with a long backswing than in a swing with a short
backswing. Finally, the reviewers noted that the upper
The pectoralis major, subscapularis, latissimus dorsi
rectus abdominis and the lower rectus abdominis are serratus anterior and upper trapezius are very active
recruited only at low levels during the backswing. during the golf swing
Shoulder muscles The forearm muscles are very active in the golf swing,
The reviewers noted that the pectoralis major, particularly the flexor carpi ulnaris
subscapularis and latissimus dorsi were significantly
active during the golf swing. The maximum levels of The gluteus maximus and hamstrings are very active
activation were generally noted during the acceleration during the golf swing
phase.
Page 25
Distinct profiles of neuromuscular fatigue during muscle What happened?

contractions below and above the critical torque in Trials performed above the critical torque
humans, by Burnley, Vanhatalo and Jones, in Journal of As expected, the researchers found that all trials above
Applied Physiology, 2012 the critical torque resulted in a significant decrease in
the MVC torque throughout the test. Using the
Background interpolated twitch technique, the researchers noted
Very simply, the fatigue experienced during resistance- the development of central fatigue.
exercise is a reversible decline in the maximum level of
Trials performed below the critical torque
muscular force that can be exerted. Fatigue is thought
The researchers found that in contrast to the
to arise from a number of central and peripheral
contractions performed above critical torque, all of the
processes. Researchers have found that central and
subjects managed to complete 60 minutes of
peripheral fatigue can both be quantified using electrical
contractions in the critical torque less 20% condition,
stimulation of the muscles by a technique known as an
and 8 out of the 9 subjects managed to complete 60
interpolated twitch during a maximal voluntary
minutes of contractions in the critical torque less 10%
contraction (MVC).
condition. Importantly, at the end of the trials, the
Researchers have generally concluded that during mean MVC torque was significantly greater than the
submaximal tasks, the fatigue processes that arise submaximal torque requirements of the trial. Using the
during low intensity contractions differ from those that interpolated twitch technique, the researchers noted
arise during high-intensity contractions. Specifically, the development of central fatigue.
researchers have observed that during low intensity
Rates of fatigue development
contractions, central fatigue is considerable while during
The researchers commented that the rates of decrease
high intensity contractions, peripheral fatigue is
in the MVC torque and the measure of central fatigue
substantial and central fatigue is either low or non-
were not different between the critical torque less 10%
existent. However, it is not clear whether the transition
condition and the critical torque less 20% condition. The
in fatigue processes between low intensity contractions
researchers found from their data that the rate of
and high intensity contractions occurs gradually as the
decrease in MVC and the measure of central fatigue
force requirements are increased, or whether there is a
above critical torque increased as the torque
sudden threshold at which there is a shift from one
requirements increased.
mechanism of fatigue to another.
Burnley et al. note that the relationship between power, What did the researchers conclude?
force (or torque) and the time to failure is hyperbolic The researchers conclude that there is a critical
and that the asymptote of this relationship is known as threshold in fatigue development in submaximal
the critical torque. A consequence of this discovery is contractions. They based this conclusion on their
that contractions performed below the critical torque observation that during contractions below critical
level should not be subject to any fatigue. The torque, MVC torque declined modestly, and at task end
relationship should also allow the time to failure to be the MVC torque was substantially higher than the target
predicted at any given loading. torque. However, on the other hand, in all trials above
critical torque, MVC torque fell progressively until task
What did the researchers do? failure, at which point a maximal contraction was
The researchers wanted to find out whether critical required to attain the target torque.
torque represents a threshold that informs the nature of
fatigue. They therefore recruited nine male subjects Limitations
and tested their knee extension torque on 8 occasions This study was limited by a small number of subjects
over a 6-week period, including 5 separate intermittent and only used a single muscle group for testing.
contraction protocols to failure. From these 5 tests, the
researchers calculated the critical torque. Following
computation of the critical torque, the subjects then Key points
performed an additional two tests at 10% and 20%
There is a critical threshold in fatigue development in
below the level of critical torque for 60 minutes or until
submaximal contractions
failure, whichever was sooner.
Page 26
Comparison of changes in the contraction of the lateral The researchers noted that there was a fairly large
abdominal muscles between the abdominal drawing-in variation in EMG activity between the subjects when
maneuver and breathe held at the maximum expiratory performing the abdominal drawing-in maneuver and
level, by Ishida, Hirose and Watanabe, in Manual when performing a maximum expiration. They
Therapy, 2012 suggested that this might be caused by variations in
muscle strength among the subjects.
Background
The abdominal muscles are involved in breathing and What did the researchers conclude?
are some of the strongest muscles involved in this The researchers concluded that the lateral abdominal
activity. Recent research suggests that the individual muscles exhibit stronger contractions during maximum
abdominal muscles may contribute differently to expiration than during an abdominal drawing-in
respiration. The abdominal drawing-in maneuver is a maneuver. They therefore suggest that maximum
mechanism used by some practitioners as part of a expiration may therefore be an effective method for
lumbar stability program. training co-activation of the lateral abdominal muscles.
What did the researchers do? Limitations

The researchers wanted to compare the changes in the The researchers noted that this study was limited in that
contraction of the lateral abdominal muscles during the the abdominal drawing-in maneuver is difficult to
abdominal drawing-in maneuver and maximum standardize and that only males were used in the study.
expiration. So they recruited 33 healthy male subjects
with no history of lower back pain. The subjects lay in Key points
the supine position with their arms crossed over their
chest and hands over their opposite shoulders. In this The lateral abdominal muscles exhibit stronger
position, the subjects then performed three tasks: contractions during maximum expiration than during
an abdominal drawing-in maneuver
• They held their breath at the resting expiratory level,
• They performed a maximum expiration with an open Maximum expiration may be an effective method for
airway, and training co-activation of the lateral abdominal muscles
• They performed the standard abdominal drawing-in
maneuver.
While the subjects performed these tasks, the

researchers collected ultrasound images in addition to
electromyography (EMG) measurements of the external
oblique muscle. The EMG measurements were
normalized using maximum voluntary contractions
(MVCs). The MVC of the external oblique was recorded
by way of an oblique curl-up while attempting to move
the right shoulder toward the opposite knee.
What happened?
Ultrasound testing
The researchers found from their ultrasound scans that
the maximum expiration test significantly increased the
thickness of the transverse abdominis and internal
oblique muscles compared to the abdominal drawing-in
maneuver.
EMG testing
In addition, they found that the EMG activity of the
external oblique muscle was significantly higher during
maximum expiration than during the abdominal
drawing-in maneuver.
Page 27
Are titin properties reflected in single myofibrils? By Loss of energy

Herzog, Leonard, Jinha and Herzog, in Journal of The researchers found that energy loss decreased
Biomechanics, 2012 significantly with repeated SSCs. For example, the
energy loss for the first cycle of the repeat testing set
Background (10 minutes after the first set) was significantly smaller
than the first cycle of the first set.
Titin is a large, abundant structural protein found in
muscle fibers. It spans a half sarcomere from the Z-band
to the M-line and has been implicated in the production What did the researchers conclude?
of passive force, having spring-like properties in its The researchers concluded that the properties of titin
extensible I-band domain dominated by the Ig segments molecules appear to be reflected in whole myofibrils,
and the PEVK (proline, glutamate, valine and lysine) except possibly the onset of Ig domain unfolding and the
region. Researchers have previously investigated the consequent elastic behavior of titin prior to reaching the
elasticity of titin on a molecular level. They have inflection point.
proposed that titin behaves as a nonlinear spring that
starts to unfold at a certain level of tension, while a Limitations
variable section remains permanently unfolded. This
The researchers performed the experiment using a
behavior means that the molecule exhibits a range of
rabbit psoas muscle and therefore slightly different
elastic properties that change with its length. The
results might be obtained with human muscle tissue.
researchers noted that energy loss in the titin molecule
in passive stretch-shortening cycles (SSCs) decreases
with repeated stretch cycles but increases with Key points
increasing stretch magnitudes. They also observed that
there is a distinct inflection point in the force–stretch The elastic properties of titin within a sarcomere
curve. They associated this inflection point with the Ig appear to be replicated within a whole myofibril (chain
of sarcomeres)
domain elements starting to unfold.

The researchers wanted to measure the passive
mechanical properties of isolated single myofibrils
(chains of sarcomeres found within muscle fibers) and
evaluate whether these properties reflect the basic
elastic properties of the titin molecule. So they
collected a number of individual myofibrils from rabbit
psoas muscle passively stretched them from a nominal
initial average sarcomere length of 2.5 – 2.7mm by 1.0,
2.0, 2.5, and 3.0mm at a speed of 0.1 mm/s and then
released them at the same speed to their original
length. They performed three consecutive SSCs without
rest, followed by a 10-minute rest before repeating of
the same SSC protocol.
What happened?
Inflection point
The researchers noted a distinct change in stiffness of
the force–stretch curve in 8 of the 28 tested myofibrils.
They commented that this inconsistency might have
resulted from fact that the attachment of myofibrils can
produce considerable stretching of the sarcomeres and
that this stretching might have led to the unfolding of
some of the Ig domains, which may have affected their
subsequent behavior.
Page 28
Architectural differences between the hamstring The following table shows the key data recorded by the
muscles, by Kellis, Galanis, Kapetanos and Natsis, in researchers:
Journal of Electromyography and Kinesiology, 2012
BFSH BFLH ST SM
Background Mass (g) 55.88 96.27 84.65 109.33
The hamstrings (HAMs) comprise the semimembranosus NFL (cm) 10.40 7.02 14.87 5.43
(SM), the semitendinosus (ST) and the long and short Pennation 13.17 13.46 9.14 15.95
heads of the biceps femoris (BFLH and BFSH). Muscle angle O
architecture significantly affects the ability of a muscle PSCA 5.03 12.68 5.39 18.21
to produce force. Previous research looking into the
Ratio 0.50 0.27 0.58 0.22
muscle architecture of the HAMs has found that they
have a relatively long fiber length and a lower
physiological cross-sectional area (PCSA) than many The ratio (noted above) between NFL and muscle length
other muscles. Consequently, researchers have is for understanding whether the fiber is predominantly
concluded that the HAMs have mainly developed for for quick contractions over long lengths or for force
quick contractions over long distances. However, more production. The researchers noted that the ST and BFSH
recent studies have reported large differences in the muscle have a ratio that is almost double that of the SM
architecture of the individual HAMs. Researchers have and BFLH. The researchers noted that this means across
noted that the ST muscle fibers are arranged in a parallel the medial and lateral HAMs, there is one muscle that is
configuration while BFLH and SM have a pennate for quick contractions over long lengths and another
arrangement. Additionally, the ST and BFLH have a that is for force production.
longer fiber length than the other HAMs while the SM
has a higher PCSA than the others. The different The researchers also note that there are significant
muscles also have different moment arms on account of differences between the HAMs. For example, the ST
their different origin positions on the ischial tuberosity and SM muscles are very different. The SM fibers attach
of the pelvis. Finally, the ST and SM have different at larger pennation angles and have a much shorter NFL
insertion points to the BFLH. These factors all have but a greater mass and PSCA than the ST. The SM is
bearing on the force-producing ability of each HAM. much more clearly intended for force production than
the ST, which is intended for smaller forces over a larger
range of lengths.
The researchers wanted to investigate differences in
Limitations
architecture of the HAMs. So they obtained a leg each
from eight male human cadavers with a mean age of The researchers noted that a limitation of the study, as
67.8 ± 4.2 years. Firstly, they measured the length of with all cadaveric studies, is the shrinkage of muscle
each muscle-tendon unit. Then they took c. 5 separate fibers. Additionally, the age of the cadavers means that
fiber bundles from each muscle region and isolated the results of the study may be different from those that
them under a dissection microscope before measuring would be obtained from younger, stronger subjects.
the fiber bundle length was measured using digital
calipers. The researchers calculated the normalized fiber What did the researchers conclude?
length (NFL) by multiplying the measured fiber length by
The researchers concluded that the muscles that make
the ratio of the optimal sarcomere length (2.7μm) and
up the HAMs are not homogenous but have differing
the measured sarcomere length. NFL is an important
architectural characteristics. However, there are
computation that permits comparisons of fiber lengths
similarities between certain of the HAMs in respect of
between muscles, irrespective of how stretched they are
some of the key architectural variables.
when the measurements are taken. Pennation angle
was measured at three different equally paced points
along the length of the muscle. Key points
There are significant architectural differences between

What happened? the hamstring muscles, which may be to allow the
The researchers found the overall results indicated a low muscle group to produce a range of different force
to moderate similarity between HAMs. They found the characteristics
highest similarity between the BFLH and the SM.
Page 29
3. PHYSIOLOGY
Page 30
What makes champions? A review of the relative Genetics

contribution of genes and training to sporting success, Tucker and Collins suggest that it is not likely that a
by Tucker and Collins, British Journal of Sports Medicine, single or even a small number of physiological genetic
2012 elements are the cause of elite performance. However,
they note that there are a number of traits that play a
The Review considerable role in the performance of some sports and
which are known to be affected by genes. These are
In their review, Tucker and Collins wanted to explain the
gender, height, VO2-max and skeletal muscle properties.
contributions made by practice and genetics to the
The reviewers note that while it seems slightly absurd to
development of elite performance.
comment upon, gender is a key predictor of absolute
levels of performance and is probably the most
Practice makes perfect
fundamental biological characteristic whereby genes can
Tucker and Collins explain that the model for practice
conclusively be said to influence performance levels. By
being the predominant, perhaps even sole, contributor
way of example, they note that elite males currently
to the development of elite performance has been
outperform elite females by 9 – 14% at long-distance
championed by Ericsson et al. This viewpoint argues
running events.
that the abilities of elite performers are the result of
adaptations to deliberate practice. This practice is then
Tucker and Collins note that height is determined by
thought to activate dormant genes that are contained
both genetic and environmental factors (including
within the DNA of all individuals. A corollary of this
critically nutrition). However, studies have found that
theory is that elite performance is therefore attainable
height is very strongly determined by genes, with 80% of
by anyone. A key element of the model, of course, is
its variance controlled by a number of genes.
the volume and nature of the practice required in order
to achieve such expert status. Tucker and Collins note Regarding VO2-max, the reviews indicate that many
that Ericson has specified that 10,000 hours of practice studies have found that individuals who undergo a
are required over c. 10 years. This observation was standardized training program experience significantly
based upon a study performed on violinists in Germany, different individual changes in VO2-max as a result. They
in which the skill level of these musicians was correlated note that genetic studies have found a set of markers on
with the amount of time they had spent practicing up to chromosomes that are linked to VO2-max in the
the age of 20 years old. However, Tucker and Collins untrained state and another set of markers on
note that this study did not present ranges or standard chromosomes that have been linked to the trainability
deviations to the data and therefore it is difficult to of VO2-max.
assess the degree to which this correlation can be
observed in all individuals. Additionally, they note Finally, the reviewers note that skeletal muscle is a
studies of chess performance, in which the practice time highly adaptable tissue that responds accordingly to
required to reach master level in a group of 104 players either use or disuse. They note that while there is a
was 11,053 ± 5,538 hours. They note that while the strong heritability component, with values of nearly 50%
mean number of hours is very close to the time required being documented in some studies, the general view is
by the violinists, the range of hours required by that the environment plays the predominant role in the
individuals is very significant compared to the mean. aerobic capacity of skeletal muscle, while there is less
Indeed, they note that the fastest chess player to reach data available for the anaerobic capacity.
master level did so after only 3,016 hours, while another
had taken 23,608 hours. In sport, Tucker and Collins Limitations
note that studies have shown that elite athletes rarely
This review was performed by one group of researchers
complete 10,000 hours before reaching internationally
and may not represent the viewpoints of all teams
competitive levels. By way of example, they note a
working in this field.
study in which it was found that 28% of elite Australian
athletes reached elite status within 4 years of taking up
the sport for the very first time and had not Key points
accumulated 10,000 hours of practice by this point. The
reviewers therefore conclude that the practice model Both environment and genetics are key factors in the
for performance does not demonstrate that expert development of elite athletes
performance levels are achievable for any individual,
The “10,000” hour rule appears incomplete
since large individual differences are observable in
practice times.
Page 31
The effects of endurance, strength, and power training What did the reviewers conclude?
on muscle fiber type shifting, by Wilson, Loenneke, Jo, The reviewers conclude that while a number of studies
Wilson, Zourdos and Kim, in Journal of Strength and show that exercise-induced alterations in muscle fiber
Conditioning Research, 2012 type only occur between fast twitch fiber types, other
studies suggest that shifts between fast and slow twitch
The Review fibers can happen.
Researchers typically categorize muscle fibers as slow
twitch I, fast twitch IIA and fast twitch IIX, although a Practical applications
more extensive categorization into seven different The reviewers suggest that endurance athletes looking
subgroups has also been recognized. Wilson et al. note to increase their proportion of slow twitch fiber
that in general, studies have found that athletes in percentages should train using high volumes and low
sports requiring endurance capacities have very slow intensities, while anaerobic athletes should employ
twitch fiber percentages (up to 95%) while athletes in high-intensity, low volume and high velocity training
sports requiring greater anaerobic capacities have high programs. Additionally, the reviewers note that
proportions of fast twitch fibers (60 – 80%). In addition, strength and power athletes should limit the amount of
the reviews note that studies have found a correlation low-intensity training that they perform, as this may
between VO2-max and the proportion of slow twitch lead to a shift from fast twitch fibers to slow twitch
fibers, between the proportion of slow twitch fibers and fibers.
endurance running performance over 1-6 mile runs and
between the proportion of IIA fibers and 1RM snatch
performance in Olympic weightlifters. Limitations
The reviewers note that there were not a huge number
The effect of exercise on fiber types of studies in this area available for review and those that
The reviewers assert that studies are conclusive in were tended to be of relatively short duration. They
showing that training can cause a two-way shift note that since it generally takes several years of active
between type IIX and IIA fibers. However, they note participation in a sport to become an expert, studies
that whether fast twitch fibers can be changed into slow lasting 5–6 months are unlikely to provide conclusive
twitch fibers and vice versa is less clear. They note that results regarding the effects of exercise on muscle fiber
early studies certainly suggested that exercise was not types.
able to cause fiber type shifting between slow and fast
fibers. However, they note that more recently, some
Key points
studies have cast doubt upon this. One particularly
interesting field of research suggests that high velocity
Several studies show that exercise-induced alterations
resistance exercise and sprinting may be able to increase in muscle fiber type only occur between fast twitch
fast twitch fibers at the expense of slow twitch fibers. fiber types. However, other studies suggest that shifts
Similarly, some researchers have found that long, slow between fast and slow twitch fibers can happen.
duration activities such as walking and cycling may lead There is currently no strong consensus view and the
to an increase in slow twitch fibers at the expense of fast literature is still conflicting.
twitch fibers. The reviewers conclude that the research
is currently still conflicting in this area and there is no
strong consensus view.
Mechanisms of muscle fiber type conversion

The reviewers note that the exact mechanisms by which
fiber changes occur are unknown. The myoblast cell
lineage is clearly important, as transplant studies have
found that moved muscles retain some of their original
characteristics. On the other hand, innervation plays a
key role. Studies that have transplanted nerves from
muscles of one fiber type to another have shown that it
is possible to convert slow twitch to fast twitch fibers
and vice versa. This suggests that nerves to fast and
slow twitch muscles send out different signals that can
alter the properties of the muscles.
Page 32
Strength training reduces intra-cortical inhibition, by What happened?

Weier, Pearce and Kidgell, in Acta Physiologica, 2012 Muscle strength and size
Using an ultrasound measurement for the anterior thigh
Background muscle thickness, the researchers did not detect any
Weier et al. explain that a technique known as paired- differences following the intervention. The researchers
pulse transcranial magnetic stimulation (TMS) enables did not detect any changes in the maximum voluntary
researchers to assess neurophysiological changes in the isometric contraction knee extension torque using a
primary motor cortex in response to various tasks. TMS dynamometer at a trunk-thigh angle of 110° as a result
uses the electromagnetic induction caused by changing of the intervention. However, the 1RM squat strength
magnetic fields to generate weak electric currents in the of the intervention group increased significantly over
brain. By this method, both single and paired pulse TMS the 4-weeks.
techniques cause neurons in the primary motor cortex
Active Motor Threshold and Motor Evoked Potentials
to emit an action potential, called a motor evoked
The researchers found that the TMS stimulus needed to
potential (MEP), which can then be detected using
reach the active motor threshold was 44.2 ± 1.4% and
electromyography (EMG) apparatus.
44.7 ± 2.0% for the control and intervention groups
Importantly, Weier et al. explain that when a paired- before the intervention. Following the intervention, the
pulse technique is employed, such that sub-threshold intervention group reduced to 41.0 ± 2.3% while the
TMS stimulus is created prior to a supra-threshold TMS control group did not change. Additionally, the
stimulus by a time interval of less than 5 ms, then this researchers found that there was a significant change in
leads to a suppressed MEP compared a single-pulse MEP amplitude at 1.2× the active motor threshold for
stimuli. Weier et al. explain that the ratio between the the intervention group following the resistance-training
amplitudes of the paired-pulse and the single-pulse period.
MEPs provide researchers with an indication of short-
Short-interval Intra-cortical Inhibition
interval intra-cortical inhibition. Additionally, they note
The researchers found that the mean and absolute
that studies have suggested that the improvements in
short-interval intra-cortical inhibition as a ratio of MEPs
strength training that appear to precede hypertrophy
reduced as a result of the 4-week intervention.
gains in beginners may be caused by changes in the
central nervous system (CNS). Such changes may
include changes in short-interval intra-cortical inhibition, What did the researchers conclude?
as this mechanism regulates the level of excitation of The researchers concluded that the 4-week resistance-
the CNS in producing movements. training period led to significant increases in 1RM
strength and measures of corticospinal excitability, as
What did the researchers do? well as significant reductions in short-interval intra-
cortical inhibition. They note that they did not record
The researchers wanted to investigate the effect of a
any corresponding increase in muscle thickness of the
short period of strength training on short-interval intra-
anterior thigh musculature.
cortical inhibition, which may be an important
mechanism in the development of strength, particularly
in beginners. So they recruited 12 subjects (6 males and Limitations
6 females), allocated them to either an intervention The main limitation of the study is that the
group or a control group and performed tests both measurements used by the researchers may not have
before and after a 4-week resistance-training program been sufficiently accurate to detect the small levels of
performed by the intervention group only. hypertrophy that occur in a short period of time such as
4 weeks.
The resistance-training program was supervised and
took place three times per week for four weeks. The
subjects first warmed up with 5 minutes of stationary Key points
cycling followed by five warm-up squats with gradually
A 4-week resistance-training period causes significant
increasing weights. The resistance-training protocol was
increases in 1RM strength, measures of corticospinal
4 sets of 6-8 reps at 80% of 1RM, with 3 minutes rest excitability and significant reductions in short-interval
between sets. The reps were performed with a defined intra-cortical inhibition without a corresponding
tempo, being a 3-second eccentric phase immediately increase in muscle thickness of the thigh musculature
followed by a 3-second concentric phase.
Page 33
Sprint exercise enhances skeletal muscle p70S6k Plasma leucine

phosphorylation and more so in females than in males, The researchers found that pre-exercise, plasma leucine
by Esbjörnsson, Rundqvist, Mascher, Österlund, levels were higher in males than in females and that
Rooyackers, Blomstrand and Jansson, in Acta during exercise, the levels decreased in both males and
Physiologica, 2012 females. However, the researchers found that the levels
of plasma leucine decreased more in males than in
Background females following the sprints.
Although researchers have performed many studies in Plasma glucose

relation to the signaling pathways activated following The researchers found that during the sprints glucose
resistance exercise, little is known about the pathways levels increased in both genders and remained elevated
that are activated following sprint exercise. One of the but the increase was c. 15% greater for females.
key pathways activated following resistance exercises is
the mammalian target of rapamycin (mTOR) pathway, Correlations
which is characterized by a cascade of phosphorylations The researchers noted a positive correlation between
including p70S6k, which lead to protein translation and the phosphorylations of Akt and p70S6k and the
consequently hypertrophy. increase in insulin concentrations, as a result of the
sprints.
Esbjörnsson et al. note that a recent study found that
the mTOR pathway was not activated after repeated
bouts of 30-second sprint exercise in males. In this
study, the researchers also detected an elevated AMPK The researchers concluded that repeated 30-second all-
phosphorylation. Since AMPK phosphorylation is out sprints, separated by 20-minutes of rest, led to
thought to interfere with the mTOR activation, the increased activity of the Akt-mTOR signaling pathway.
activation of this pathway may explain the lack of They also concluded that the mTOR signaling pathway
activity in the mTOR pathway. Other studies of sprint was more strongly activated in females than in males, as
exercise have noted both Akt and AMPK indicated by the greater levels of p70S6k. The
phosphorylation but did not report on the activity of researchers note that previous studies on metabolic and
mTOR. hormonal responses to sprint exercise have found
gender-related differences and these might inform why
this occurs. They note that previous studies have found
that the accumulation of muscle lactate and ammonia is
The researchers wanted to study the mTOR signaling lower and the recovery of ATP is faster in females than
pathway activity following repeated 30-second all-out in males following sprints. Additionally, they note that
sprints in both males and females. the hormonal response to sprinting is different: females
display lower levels of catecholamines but higher levels
So they recruited 17 subjects (9 males and 8 females).
of insulin. Moreover, males display larger decreases in
Four of the females used oral contraceptives. The
plasma leucine following sprints, possibly because of
subjects performed three 30-second all-out sprints on a
increased oxidation of amino acids.
stationary bicycle, with 20-minutes rest between sprints,
after which the researchers collected blood samples and
took muscle biopsies. Limitations
The study was limited by being performed fasted and
What happened? therefore different results might occur in the fed state.
Change from rest to 140 min after the last sprint

The researchers found that phosphorylation of Akt Key points
increased by 50% and phosphorylation of mTOR
Repeated 30-second all-out sprints, separated by 20-
increased by 120 % directly following the last sprint.
minutes of rest, lead to increased activity of the Akt-
They also found that the phosphorylation of p70S6k was
mTOR signaling pathway
larger in females (230%) compared to males (60%). The
researchers recorded that the phosphorylation of AMPK Following repeated 30-second sprints, mTOR signaling
was not different from pre-exercise levels for both pathway is more strongly activated in females than in
males and females. males
Page 34
Similar muscle protein synthesis rates in young men and However, Smith and Mittendorfer note that despite
women: men aren’t from Mars and women aren’t from these similarities, other research suggests that there
Venus, by Smith and Mittendorfer, in Journal of Applied appear to be sex differences in the rates of muscle loss
Physiology, 2012 during aging and inactivity.
Smith and Mittendorfer note that the study by West et

The Editorial
al. were still unable to explain the oscillation of muscle
Smith and Mittendorfer explain that a number of protein synthesis over the course of the day through
researchers have tried to determine whether the reason observations of changes in anabolic signaling activity:
for why men have more muscle than women is because they could not find correlations between the activity of
of differences in rates of muscle protein synthesis or the signaling pathways and the levels of muscle protein
breakdown. However, they note that except for a single synthesis. This therefore remains an area for future
study that reported higher basal rates of muscle protein research. Moreover, Smith and Mittendorfer suggest
synthesis in women than in men, the literature is that the fine-tuning of muscle protein turnover rates
unanimous in reporting similar levels of muscle protein does not appear to be determined by the activity of
synthesis for both sexes. Despite this apparent clarity, mTOR, because of its role in a great many different
Smith and Mittendorfer observe that the subject is not functions, and they propose that we should look much
settled by this body of evidence, as in many cases, the further downstream for the rate-controlling step.
studies do not address the whole period of anabolism
following exercise and ingestion of nutrients.
Key points
Smith and Mittendorfer note that a recent study seems
There is no difference in muscle protein synthesis
to address this issue, by reporting the rate of muscle
between men and women in the fed state following
protein synthesis from the overnight fasted state
resistance exercise
through exercise and into the post-exercise and post-
whey protein consumption window. This study is Sex- There are sex differences in the rates of muscle loss as
based comparisons of myofibrillar protein synthesis after a result of aging and inactivity
resistance exercise in the fed state, by West, Burd,
Churchward-Venne, Camera, Mitchell, Baker, Hawley, The fine-tuning of muscle protein turnover rates does
Coffey and Phillips, in Journal of Applied Physiology, not appear to be determined by the activity of mTOR,
2012. because of its role in a great many different functions,
and the rate-controlling step is likely much further
In this study, West et al. compared muscle protein downstream
synthesis and anabolic signaling following resistance
exercise between men and women and found that the
exercise-induced area under the testosterone curve was
45-fold greater in men than women in the early recovery
period following exercise but muscle protein synthesis
similarly increased in both men and women. West et al.
found that phosphorylation of mTOR was elevated to a
greater extent in men than women following exercise
but increased phosphorylation of p70S6K1 was not
different between sexes. West et al. concluded that
their results imply that there are only minor sex-based
differences in signaling responses, that there is no sex-
based difference in muscle protein synthesis response to
resistance exercise in the fed state, and that exercise-
induced muscle protein synthesis is not associated with
increases in testosterone levels.
Smith and Mittendorfer suggest that this result should

not be surprising, as muscle mass remains steady from
young adulthood to middle age in both men and women
and the relative muscle growth that can be created by
resistance exercise is not different between men and
women.
Page 35
Nutritional regulation of muscle protein synthesis with Leucine as a nutrient signal in skeletal muscle
resistance exercise: strategies to enhance anabolism, by The researchers note that it is the essential amino acids
Churchward-Venne, Burd and Phillips, in Nutrition & that appear to be responsible for stimulating muscle
Metabolism 2012 protein synthesis and that the branched-chain amino
acid (BCAA) leucine appears particularly key as a
The Review regulator of protein translation initiation.
Research to date suggests that the consumption of Dose response of protein consumption
amino acids following resistance exercise is important Churchward-Venne et al. note that where dose–
for stimulating an increase in muscle protein synthesis. response relationships between protein consumption
Moreover, research suggests that factors such as the and muscle protein synthesis have been examined, it
protein quantity, protein source (e.g. whey, soy, etc.) has been found to be maximally stimulated following
and timing of protein intake can all impact on the size resistance exercise with 20g of high-quality protein. It
and duration of the muscle protein synthesis response. was found that 40g of protein did not result in further
In this review, Churchward-Venne et al. review the increases in muscle protein synthesis.
current literature regarding the nutritional regulation of
muscle protein synthesis and propose nutritional Post-exercise nutrition for the elderly
strategies for maximizing it. Churchward-Venne et al. comment that some studies
have proposed that the elderly are resistant to the
The window of anabolic potential anabolic effects of resistance exercise and protein.
Churchward-Venne et al. note that while the increase in However, they also note that despite the reduced
muscle-protein synthesis caused by the consumption of response, there is a response from both stimuli and it is
protein is only lasts a few hours, resistance exercise increased when the two are used in combination.
results in increased rates of muscle-protein synthesis
that are sustained for 48 hours. Consequently, they Role of carbohydrate and insulin in the regulation of
suggest that the consumption of amino acids in the 24 – muscle protein metabolism
48 hour likely conveys benefits similar to those that are The researchers comment that there is little research
observed when amino acids are provided immediately investigating the impact of a fat-protein meal on direct
after resistance exercise. measures of muscle-protein synthesis following
resistance exercise. Despite this, some research
Mechanisms underpinning the enhanced sensitivity of suggests that whole milk produces a better anabolic
skeletal muscle after exercise response than fat-free milk. The reason for this,
Churchward-Venne et al. explain that the protein kinase however, is not clear. Churchward-Venne et al. explain
mTORC1 is an important point of integration from a in the absence of protein, carbohydrate consumption
wide range of signals that promote muscle-protein does not result in a positive net protein balance.
synthesis, including the consumption of amino acids and Moreover, they note that when protein intake is of
the performance of resistance exercise. They explain sufficient quantity, the resulting hyperaminoacidemia
that mTORC1 regulates muscle-protein synthesis by and hyperinsulinemia are sufficient to not only maximize
phosphorylation of downstream protein effectors such muscle protein synthesis but also inhibits muscle protein
as p70S6k and 4E-BP1 that are involved in protein breakdown and therefore carbohydrate is not required
translation. Finally, they note that a number of studies for this purpose.
have found that the consumption of protein following
resistance exercise is correlated with increased
What did the reviewers conclude?
phosphorylation of components of the mTOR signaling
pathway. The reviewers recommend the consumption of 20–25g
of a rapidly absorbed protein such as whey in order to
The role of the protein source maximally stimulate muscle protein synthesis after
Churchward-Venne et al. note that studies have found resistance exercise.
that many different protein sources can increase muscle
protein synthesis. However, they also comment that Key points
different protein sources have differing impacts on the
size of the increase in muscle protein synthesis following Various factors effect muscle protein synthesis rate
resistance exercise. They note that whey and milk have following resistance exercise, including the type and
been found to lead to bigger increases in muscle protein quantity of protein
synthesis following resistance exercise than soy.
Page 36
Low Muscle Glycogen Concentration Does Not Suppress number of reps it performed, in order to ensure a
the Anabolic Response to Resistance Exercise, by matched workload on both legs. The resistance was
Camera, West, Burd, Phillips, Garnham, Hawley and reduced by 5% for each subsequent set. Immediately
Coffey, in Journal of Applied Physiology, 2012 following the resistance exercise and also 2 hours later,
the intervention subjects consumed a 20g of whey
Background protein and 40g of maltodextrin (carbohydrate) while
the control group consumed a placebo beverage
The anabolic signaling pathways that lead to muscle
comprising water and an artificial sweetener. Following
protein synthesis following resistance exercise and
the trials, while the subjects rested, the researchers
protein consumption are complex but include the
took muscle biopsies from the vastus lateralis of both
activation of the Akt-mTOR-p70S6K-rpS6 signaling
legs at 1 hour and 4 hours following the conclusion of
pathway to initiate protein translation. While many
the resistance exercise protocol.
studies have investigated this pathway, how it is
affected by levels of muscle glycogen is unclear.
What happened?
What did the researchers do? The researchers observed that the muscle glycogen
concentration was higher in the leg that did not
The researchers wanted to establish the effect of
participate in the one-legged cycling than in the leg that
glycogen concentration and post-exercise nutrition on
performed the one-legged cycling at all time points
anabolic signaling pathways and rates of muscle protein
measured in both the intervention and control groups.
synthesis following resistance exercise. So they
The researchers also observed from the muscle biopsies
recruited 16 male subjects who had at least one year of
that Akt-mTOR-p70S6K-rpS6 phosphorylation post-
resistance and endurance training experience. They
exercise increased in both groups and that there were
randomly assigned the subjects to either an intervention
no differences between legs. Consequently, the
or a control group. All subjects then performed the
glycogen depletion workout on the previous day had no
following, identical 48-hour routine of diet and exercise.
effect upon this signaling pathway activity following the
resistance exercise. The researchers also observed that,
The subjects performed a single leg glycogen-depletion
as has been reported in many other studies, the
protocol of one-leg cycling to fatigue. This protocol
ingestion of a protein and carbohydrate drink following
involved sets of 10 minutes of cycling at 75% of VO2-max
resistance exercise increased the anabolic response but
with 2 minutes of rest between sets until fatigue, at
did not alter any response between the normal and
which point the power output was decreased by 10W
glycogen-depleted legs.
and subjects continued again using the same format
again until fatigue. Finally, after a 10-minute rest, the
subjects then completed 90-second one-leg maximal What did the researchers conclude?
cycling sprints with 60-seconds rest between sets. The Camera et al. concluded that performing resistance
sprints were performed until the subjects were unable exercise in conditions of low muscle glycogen availability
to perform 70 revolutions per minute. To minimize the does not reduce the mTOR anabolic signal and
chance of glycogen resynthesis in the selected leg, the subsequent rates of muscle protein synthesis during the
subjects also completed 30 minutes of arm cycling on an early (4-hour) post-exercise period.
ergometer and then a low-carbohydrate evening meal
before going to bed. It is important to note that the
Limitations
exercise protocol was only performed with a single leg,
while the other leg rested. The purpose of this routine This study was limited to the 4-hour period following the
was to achieve one leg that was glycogen-depleted and resistance exercise. It is possible that differences in the
one leg that had normal levels of glycogen. rate of muscle protein synthesis could be observed later
in the post-exercise period.
The next morning, following an overnight fast, all of the
subjects then performed a resistance-exercise protocol
Key points
comprising a unilateral leg press for 8 sets of 5 reps at
80% of 1RM. The exercise was performed as a superset Performing resistance exercise in conditions of low
of the two legs with 60-seconds rest between each half muscle glycogen availability does not reduce the mTOR
of the superset and 3 minutes rest between sets. The anabolic signal and subsequent rates of muscle protein
glycogen-depleted leg commenced the first set and synthesis during the early post-exercise period
where the glycogen-depleted leg was unable to perform
the intended reps, the non-depleted leg matched the
Page 37
Lipid metabolism in skeletal muscle: generation of However, this phenomenon has puzzled researchers
adaptive and maladaptive intracellular signals for because it seems to lead to the paradox of endurance-
cellular function, by Watt and Hoy, in American Journal trained athletes having increased skeletal muscle
of Physiology: Endocrinology & Metabolism, 2012 triacylglycerol despite being highly insulin sensitive.
Watt and Hoy explain that there are a number of
The Review theories as to why this occurs but none have strong
evidence in their support at the present time.
Watt and Hoy reviewed how lipids are stored in muscle
and how they affect cellular processes. They begin by Lipid Signals Leading to Insulin Resistance
explaining that fatty acids are taken up into muscle by Watt and Hoy note that insulin resistance is an
passive diffusion and by protein-mediated transport important risk factor for metabolic syndrome and type 2
mechanisms. However, it is protein-mediated transport diabetes. Importantly, muscle is the major site for
that regulates their uptake. Once inside myocytes, fatty glucose disposal as it accounts for c. 75% of whole body
acids are reversibly bound to the abundantly expressed glucose clearance. The reviewers note that while
cytoplasmic fatty acid-binding protein (FABP-C). Watt researchers have repeatedly found that triacylglycerol is
and Hoy explain that FABP-C acts as a sink to protect the increased in insulin-resistant states, they have generally
muscle against a toxic accumulation of free fatty acids. concluded that it is unlikely to be the cause of insulin
These fatty acids can then be either oxidized or stored. resistance because it is stored within lipid droplets and
is therefore unlikely to impact on insulin signaling.
Lipid Droplets in Skeletal Muscle
Watt and Hoy explain that muscle is an important site How might fatty acid oxidation cause insulin resistance?
for the clearance of lipoprotein-triacylglycerol-derived Watt and Hoy note that many researchers have
fatty acids. They note that most fatty acids enter the unsuccessfully spent a lot of time trying to find out how
intracellular triacylglycerol pool, which is an energy excess lipids might cause insulin resistance. They
reservoir with an ATP-generating capacity similar to explain that the prevailing theory is that in conditions of
muscle glycogen. Triacylglycerol is stored in lipid reduced fatty acid storage, muscle cells are under less
droplets, which are located near the endoplasmic stress from the lipid metabolites and this improves
reticulum and are coated in a phospholipid monolayer insulin sensitivity. Consequently, under this theory,
that contains a variety of proteins that mediate lipolysis, having greater reserves of triacylglycerol leads to insulin
and esterification. resistance, which is subject to the same conceptual
problem as the athlete’s paradox noted above.
Lipase regulation of skeletal muscle lipolysis
Additionally, exactly what form this stress takes is not
Watt and Hoy explain that the mobilization of stored
clear. More recently, as an alternative theory,
fatty acids from the triacylglycerol pool is catalyzed by
researchers have proposed that the metabolic link
three individual lipases: adipose triglyceride lipase,
between excess lipids and insulin resistance in muscle is
hormone-sensitive lipase and monoacylglycerol lipase.
caused by a mismatch between the mitochondrial β-
oxidation and flux through the tricarboxylic acid cycle.
Lipid droplets and futile cycling
However, Watt and Hoy note that there was no
Watt and Hoy explain that the triacylglycerol pool is in a
evidence of insulin resistance in a study involving a
state of constant flux, with a turnover of c. 29 hours, in a
model in which electron transfer capacity was reduced
process called the futile cycle. They note that when ATP
and decoupled from tricarboxylic acid cycle flux.
demand from fatty acids is increased by short-term
fasting or low-intensity exercise, triacylglycerol turnover
increases but this does not significantly alter the What did the reviewers conclude?
availability of triacylglycerol in the lipid droplets, which The reviewers conclude that lipids and their metabolites
implies that lipolysis is matched by synthesis from cause a great number of different processes in muscle
uptake of exogenous fatty acids. However, the and dysregulated lipid metabolism might be connected
reviewers note that triacylglycerol content is reduced to insulin resistance.
with higher-intensity exercise because incoming fatty
acids are repartitioned away from esterification and
Key points
toward oxidation.
Lipid droplets and metabolism Lipids and their metabolites cause a great number of
different processes in muscle and dysregulated lipid
Watt and Hoy explain that increases in the muscle
metabolism might be connected to insulin resistance
triacylglycerol content are associated with insulin
resistance.
Page 38
Dissociation of heart rate variability and heart rate What happened?

recovery in well-trained athletes, by Lee and Mendoza, in Gender differences
European Journal of Applied Physiology, 2012 The researchers observed that resting mean arterial
blood pressure was higher in the male subjects than the
Background female subjects (98.2 ± 4.9 vs. 92.3 ± 5.0 mmHg) and
Both heart rate variability (HRV) and heart rate recovery that resting tidal volume was greater in the male
(HRR) are considered to be indicators of autonomic subjects than in the female subjects (0.85 ± 0.34 vs. 0.55
control of the heart and they provide researchers and ± 0.11 liters/breath). However, number of breaths per
clinicians with information about heart health and minute, peak respiratory exchange ratio, peak rating of
overall mortality. perceived exertion, maximum heart rate and the indices
of HRV and HRR did not differ between the sexes.
Research indicates that endurance athletes have
increased parasympathetic modulation of the heart Relationships between HRV indices and other variables
compared to sedentary populations, as measured by The researchers found that age was significantly
HRV. Research has also frequently indicated that negatively correlated with measures of HRV. However,
endurance athletes have a far superior HRR than they also found that VO2-max and physical activity levels
sedentary individuals. More recently, researchers have were not correlated with any index of HRV. Additionally,
suggested that HRR may be a more sensitive measure of body fat percentage, BMI, and waist circumference were
autonomic training adaptations than HRV and have also not significantly correlated with any measurement of
found relationships between HRR, peak power output HRV.
and sporting performance in endurance sports.
Relationships between HRR and other variables
The researchers found that HRR, physical activity levels
What did the researchers do? and VO2-max were significantly correlated with each
The researchers wanted to examine the relationships other but the strongest predictor of HRR was physical
between aerobic fitness, training volume, HRV and HRR activity level. They found that HRR was not correlated
in endurance athletes. with mean arterial blood pressure, body fat percentage,
BMI, or waist circumference.
So they recruited 19 subjects (8 males and 11 females)
who regularly engaged in endurance exercise training in
the last 12 months and who had a VO2-max within the
top 1% of individuals, as defined by the American The researchers concluded that HRV and therefore our
College of Sports Medicine (i.e. 61.2 and 58.3 ml/kg/min understanding of cardiac autonomic modulation is not
for males aged 20–29 and 30–39 years and 55.0 and well correlated with aerobic fitness in endurance
52.5 ml/kg/min for females aged 20–29 and 30–39 athletes. They also concluded that HRR is more strongly
years). associated with aerobic fitness in endurance athletes.
They also noted that HRV was inversely correlated with
The subjects performed a maximal graded exercise test age, as was expected.
on a treadmill to establish of VO2-max. This test began
with the subject running at self-selected speed on the Limitations
flat. The treadmill incline was increased by 2% every 2
The study involved an elite group of endurance athletes
minutes until the subject was not able to continue
and different results might be obtained with either
further.
sedentary populations or resistance-trained subjects.
While the subjects ran, the researchers measured
expired gases and monitored heart rate, blood pressure Key points
and rating of perceived exertion. At this point, the
treadmill was set to a speed of 2.41 km/hr and an incline Heart rate variability is not well correlated with
of 2.5%. During this warm-down period, the researchers aerobic fitness in endurance athletes
monitored heart rate and blood pressure. In a separate
visit, the researchers performed an electrocardiogram Heart rate recovery is strongly associated with aerobic
on the subjects, while also simultaneously monitoring fitness in endurance athletes than heart rate variability
respired gases and blood pressure over a 30-minute
Heart rate variability is inversely correlated with age
period. The subjects also completed a physical activity
questionnaire.
Page 39
Caloric Restriction Alters the Metabolic Response to a What happened?

Mixed-Meal: Results from a Randomized, Controlled Metabolic flexibility
Trial, by Huffman, Redman, Landerman, Pieper, Stevens, The researchers found that over 3 and 6 months, there
Muehlbauer, Wenner, Bain, Kraus, Newgard, Ravussin were significantly larger differences in fasting-to-
and Kraus, in PLoS One, 2012 postprandial concentrations of medium and long chain
acylcarnitines in the calorie-restricted groups compared
Background to the control group.
Metabolic flexibility is a health indicator that refers to
Insulin sensitivity
the ability of the body to make efficient use of different
The researchers also observed significant improvements
energy substrates (i.e. from different macronutrients)
in insulin sensitivity in the calorie restriction plus
depending their availability and the needs of the body at
exercise group and a trend towards improvement in
that time. For example, efficient use of different energy
insulin sensitivity in the calorie restriction group, when
substrate switching after a meal comprising all three
each was compared to the control. However, the
macronutrients would involve a decrease in the
researchers noted that there were considerable
oxidation of fatty acids and a fall in circulating free fatty
individual differences in the degree of insulin sensitivity
acids and intermediates of fatty acid oxidation. This
improvement achieved.
reflects the shift from the use of fatty acids as the main
energy source during fasting conditions to glucose Correlations
utilization in a fed state. The researchers also noted that higher insulin sensitivity
was generally associated with better metabolic
What did the researchers do? flexibility, as indicated by larger changes in fasting-to-
Huffman et al. wanted to establish whether caloric postprandial differences scores for both acylcarnitines
restriction would lead to changes in the metabolic and amino acids.
intermediates that are released into the blood in
response to meals comprising various macronutrients. What did the researchers conclude?
They also wanted to see how these intermediates The researchers concluded that the caloric restriction
affected insulin sensitivity. The results of these led to improvements in metabolic flexibility. They also
investigations would inform the degree of metabolic noted that these improvements correlated with
flexibility of the subjects. improved insulin sensitivity.
So they recruited 46 subjects and randomly assigned

them to one of three intervention groups or a control Limitations
group. The control group ate a weight maintenance diet This study was limited insofar as it clarifies how calorie
while the intervention groups ate a: restriction can affect the indicators of metabolic
flexibility. However, it does not indicate the effects on
• 25% calorie reduction diet metabolic flexibility of diets of differing macronutrient
• 12.5% calorie reduction diet plus a 12.5% energy proportions. In addition, it does not explain why there
deficit created by aerobic exercise were such great differences in insulin sensitivity
• Liquid calorie diet of 890 kcal/day until 15% improvements between individuals as a result of the
reduction in body weight interventions.
The subjects followed these programs for 6 months.

The researchers took blood samples from the subjects in Key points
both fasting and postprandial conditions before the trial
and after 3 and 6 months. With the blood samples, the Caloric restriction leads to improvements in metabolic
flexibility
researchers used targeted mass spectrometry to
measure the blood concentrations of individual free
Improvements in metabolic flexibility are correlated
fatty acids, amino acids and acylcarnitines, which are by- with improved insulin sensitivity
products of fatty acid oxidation. In addition, they
measured insulin sensitivity using an intravenous
glucose tolerance test.
Page 40
4. PHYSICAL THERAPY
Page 41
What do physiotherapists consider to be the best sitting Comments on the two popular postures
spinal posture? By O’Sullivan, O’Sullivan, O’Sullivan, and O’Sullivan et al. reported a number of comments made
Dankaerts, in Manual Therapy, 2012 by the physiotherapists who selected either of the two
popular postures. The researchers noted that the main
Background positive comment directed at for posture 9 was that the
lumbar and thoracic regions were described as being
Physiotherapists often provide advice regarding sitting
moderately lordotic and kyphotic respectively. The
posture in their treatment of lower back pain. Many
physiotherapists often commented that this posture
lower back pain sufferers find that extended periods of
followed the natural curvature of the spine. The
sitting aggravate their symptoms and research suggests
researchers reported that negative comments included
that the typical sitting posture of subjects with lower
the observation that there was too much cervical
back pain often differs from that of controls. However,
extension, too much thoracic kyphosis and excessive
it is unclear what sitting posture is best or what degree
shoulder protraction. The researchers noted that the
of lumbar flexion in sitting is optimal. Increased lumbar
physiotherapists commenting positively on posture 5
flexion is traditionally regarded as problematic. On the
said that the lumbar region was moderately lordotic,
other hand, increased lordosis has also been reported in
that there was good head/neck alignment and good
lower back pain subjects and some lower back pain
thoracic posture. However, the negative comments
sufferers experience relief in more flexed postures.
centered around the posture involving too much
forward trunk lean as well as excessive muscle tone.
Variations between countries
The researchers asked physiotherapists their opinion on
The researchers noted that physiotherapists in Ireland,
the best sitting posture. The researchers recruited the
England and the Netherlands most commonly selected
assistance of 296 physiotherapists who attended
posture 9. In Germany, where the mean experience of
continuing professional development workshops in four
the physiotherapists was highest, the delegates most
European countries, being Ireland, England, Germany
often selected posture 5.
and the Netherlands.
Factors associated with choice of best sitting posture
The researchers showed the delegates a series of
The researchers found that the subjects who selected
photographs of a model seated upon a stool without a
the posture 5, which had more forward trunk lean but
back support and asked them to identify the best (or
less thoracic kyphosis and cervical extension, had
least worst) sitting posture. The researchers selected a
significantly more negative beliefs about lower back pain
range of postures between slumped and upright sitting,
than those delegates who selected the posture 9, which
including some postures with varying cervical, thoracic
was more upright but had greater thoracic kyphosis and
and lumbar spine angles, as well as varying degrees of
greater cervical extension.
trunk lean.

What happened?
The researchers concluded that the choice of best sitting
Physiotherapists opinions
posture by physiotherapists varies between countries
The researchers reported that only one physiotherapist
and is related to beliefs about lower back pain.
stated that there was no best sitting posture and
believed that all postures were acceptable options. The
other 295 provided preferences. Two postures were Limitations
selected more often than the others. This study was limited to a collection of clinical opinions
and was not intended to establish a generic, optimal
The two most popular postures
sitting posture.
Posture 9 (was selected by 54.9% of the delegates and
posture 5 was picked by 30.5% of the delegates.
Posture 9 involved slight lumbar lordosis and also slight- Key points
moderate kyphosis and cervical extension. Posture 5
The choice of best sitting posture by physiotherapists
involved the same degree of lumbar lordosis but only
varies between countries and is related to beliefs
slight kyphosis and cervical extension in addition to a
about lower back pain
small amount of trunk lean.
Page 42
What can I do for sciatica? By Liebenson, in Journal of In phase two of the sciatica slider, the subject then
Bodywork & Movement Therapies, 2012 drops their leg fully until it is dangling while bending the
neck forward until the chin is resting against the chest,
The Editorial while the lower back rounds into a more flexed position.
In this very brief article, Liebenson explains what sciatica

is, what activities should be avoided to limit aggravation Limitations
of its symptoms, and what basic exercises can be This editorial is a clinical recommendation for generic
performed in order to help alleviate it. sciatica symptoms and is not intended to be an
exhaustive treatment of the subject.
What is sciatica?
Liebenson explains that sciatica is a common but
Key points
disabling condition, involving pain, numbness or tingling
down the back of the thigh and leg. He notes that it is
A sciatica slider technique can be used to alleviate the
often caused by a bulging spinal disc, which compresses symptoms of sciatica in conjunction with avoiding
a nerve at the base of the spine, and comments that it is activities that cause pain and bringing the spine back
usually aggravated by sitting, driving, bending forward, into alignment using stretches
or lifting objects.
What is the common prescription for sciatica?

Liebenson notes that while clinicians often prescribe rest
for this condition, the research suggests that this
prescription may actually do more harm than good.
What is the best approach to management?

Liebenson suggests that a stepped approach to the
management of sciatica is best, as follows:
• Consult a physician to confirm the diagnosis,

• Avoid what causes pain (e.g. sitting for longer than
20 minutes without getting up, bending forward,
especially in the morning,
• Gradually bring the spine back into alignment by
arching it by using the yoga sphinx posture, followed
later by the cobra pose (Liebenson notes that these
poses may feel uncomfortable in the back but
should relieve the leg symptoms),
• Mobilize the nerve by gliding it back and forth using
a process called nerve mobilization or sciatic slider.
Liebenson notes that should this process not have any

effect or if symptoms worsen then the patient should
consult an appropriately trained physician or specialist.
The sciatic nerve slider

The sciatic nerve slider begins in a seated position on a
chair or on the edge of a table or bed. It is to be
performed for 12-20 slow repetitions, 4-6 times per day
for 1-2 weeks. It has two distinct phases.
In phase one, the subject lifts up their head to create

neck extension and to look upwards, at the ceiling. At
the same time, they arch the lower back and push out
the chest. Next, they raise the leg that is affected by
sciatica until the knee is straight and their toes are
pointing up towards the knee.
Page 43
Using the Functional Movement Screen to evaluate the Additionally, the researchers reported that there were
effectiveness of training, by Frost, Beach, Callaghan and no significant changes in the total FMS score for any
McGill, in Journal of Strength and Conditioning Research, group following the 12-week interventions.
2012
The researchers noted that despite the group average
FMS scores remaining unchanged as a result of the 12-
Background
week intervention, there was low consistency between
Researchers have previously proposed the lack of the FMS scores on an individual basis. In particular, the
various qualities as risk factors for injury, including researchers were surprised to find that the scores of
flexibility, strength, passive joint range of motion (ROM), 85% of the participants in the control group changed.
motor patterns, core stability and proprioception. Many The researchers commented that the shoulder mobility
clinicians use movement-based screens to reveal motor test, which is a simple ROM test, was found to be more
patterns that might predispose individuals to any injury. variable than all other tasks. They found that 15 of the
However, the research is not clear regarding what 20 subjects in the control group either increased or
patterns should be assessed. The Functional Movement decreased their shoulder mobility score after 12 weeks.
Screen (FMS) is a movement pattern grading system
comprising 7 different tasks that has widespread
recognition. It uses a 4-point ranking system in which
scores of 0–3 are assigned for each test based on certain The researchers concluded that the FMS scores of
criteria. Additionally, a cumulative grade is given for all subjects who had engaged in a movement-based
7 movement tasks out of 21. Previous research training program did not exhibit more consistent and
regarding the FMS has been conflicting. Several studies greater changes than a control group. Additionally, the
have found positive correlations with lower FMS scores researchers noted that while their research was not
and injury while others have not found any relationship. intended to perform the role of reliability study, their
findings raise questions about the ability of the FMS to
assess changes in movement quality over multiple
testing sessions.
The researchers wanted to assess the efficacy of the
FMS as a tool to evaluate changes in movement patterns
Limitations
following exercise. So the researchers recruited 60
professional male firefighters from the Pensacola Fire The researchers note that this study was limited in that
Department and assigned them either to one of two the FMS results would have been different and likely
different 12-week training programs or to a control better had they reported what each individual could do,
group. One of the programs was fitness-oriented and rather than what they chose to do in each movement
the other was movement-oriented. The researchers task.
screened each of the subjects with the FMS both before
and after the 12-week period. Importantly, each Key points
individual was graded on how they chose to perform the
tasks rather than how they could perform given FMS scores as assessed based on self-selected
coaching or feedback. This criterion was set in order to movement patterns do not significantly change
remove the criticism that just because individuals are following a 12-week movement-based training
program
able to perform a movement pattern in a certain way
does not mean they will perform it in the same way
FMS scores of individuals over a 12-week period do
during their occupation or sport. Researchers have
not show a high degree of consistency, irrespective of
previously commented that if injury prediction is the whether any training is performed or not
desired outcome of movement screening, it may be
more important to evaluate instinctive movement The movement-oriented program did not lead to
patterns rather than coached patterns. better results than the fitness-oriented program
What happened?
Functional Movement Screen
The researchers reported that the total FMS scores were
not significantly different between the various groups
before the start of the 12-week training intervention.
Page 44
Neuroplasticity: Synapse to System, by Gillick and Zirpel, Magnetic Stimulation

in Archives of Physical Medicine and Rehabilitation, 2012 The reviewers explain that the technique of transcranial
magnetic stimulation (TMS) was invented as a test for
The Review brain excitability. They note that the ability of the brain
to respond to TMS can be measured using EMG
Gillick and Zirpel performed a literature review in order
electrodes to monitor motor evoked potentials placed
to integrate the current state of functional knowledge in
on target muscles.
neurorehabilitation with common theories and current
research in neuroplasticity. Antidepressants and Stimulants
The reviewers note that antidepressants and stimulants
Neurotransmitters
are frequently used in neurorehabilitation. They note
Gillick and Zirpel note that two key neurotransmitters
that antidepressants appear to promote neurogenesis,
are glutamate (GLUT) and gamma-aminobutyric acid
increase motor recovery of function and increase levels
(GABA). They explain that GLUT can produce excitatory
of brain-derived neurotrophic factor, which preserves
or depolarizing responses in the postsynaptic neuron,
nerve function and supports nerve growth.
which can change the concentration of key ions,
including calcium (Ca2+), and they thereby influence
almost every aspect of cell function. They note that What do the reviewers conclude?
GABA produces inhibitory postsynaptic potentials and The reviewers conclude that an understanding of
causes ions, such as chloride (Cl-), to flow across the neuroplasticity and the potential benefit of the
postsynaptic membrane thereby increasing the interventions that are used clinically level can
polarization of the cell and increasing the cell membrane strengthen our appreciation of the ability of the nervous
and makes it harder to initiate an action potential. system to change in response to stimuli.
Receptors and Ions

Limitations
Gillick and Zirpel explain that the terms central nervous
system long-term potentiation (LTP) and long-term This study was limited in that it reviewed literature that
depression (LTD) describe chronic alterations to the mainly used either animal subjects or human subjects
efficacy of synapses. Both LTP and LTD changes are with a pathological condition.
thought to happen via activation of certain GLUT
receptors. They explain that LTP is induced through the Key points
use of high frequency stimulation while low frequency
stimulation produces LTD. The nervous system has a significant ability to change
in response to stimuli
Positive changes lead to a cascade of alterations,
including increases in the concentration of Ca2+ ions
and an increase in number, length, and size of the
dendritic spines of neurons. New dendritic spines reveal
new synapses, with increased ability to encode new
information. The reviewers note that the mechanism
for LTD is similar in nature but leads to a reduction in
the efficacy of synaptic transmission.
Neuronal Electrical Activity

The reviewers note that animal studies have advanced
our understanding of neuroplasticity, including studies
in adult primates. In consequence, researchers have
demonstrated the potential for change in the adult
cortex in respect of complex motor tasks.
Functional Magnetic Resonance Imaging (fMRI)

Gillick and Zirpel explain that fMRI is a non-invasive
method of measuring the brain’s requirement for blood
in response to changes in cortical activity. They note
that fMRI can be used to investigate changes in brain
activity that occur with alterations in behavior.
Page 45
Neuromuscular manifestations of viscoelastic tissue However, he also found that low loads, a lower number
degradation following high and low risk repetitive of repetitions, low frequency and long rest periods
lumbar flexion, by Solomonow, in Journal of resulted in reduced normalized integrated EMG.
Electromyography and Kinesiology, 2012
The researcher found significant differences in the
expression level of cytokines between the controls and
Background the cats who had been subject to the loading with 20 -
Cumulative trauma disorder or repetitive strain injury is 60N. This indicated that significant pro-inflammatory
diagnosed where there is severe pain, weakness, limited degradation of the ligaments occurred with any load
range of motion (ROM) and stiffness. Individuals who that was applied in a cyclic manner for a total of 60
typically perform prolonged cyclic activities within a day minutes.
are at a high risk of exposure. However, the mechanism
by which prolonged cyclic work leads to cumulative What did the researcher conclude?
trauma disorder is not clear. It is not known which
The researcher found that in a repeated-loading trial of
tissues fail and in what way.
the lumbar ligaments, discs and spine, it was the lumbar
viscoelastic tissues that failed and inflammation was the
What did the researcher do? mode by which failure occurred.
The researcher obtained a number of adult cats, with an
average weight of 4.0 ± 0.35kg, and anesthetized them, Limitations
taking care to follow guidelines set by the Institutional
This study involved anaesthetized cats and therefore
Animal Care and Use Committee. The researchers made
different results might be obtained for human subjects.
a small, superficial skin incision at lumbar spine in order
to reveal the dorso-Iumbar fascia, and applied an S-
shaped, 1.5mm diameter stainless steel hook around the Key points
supraspinous ligament between L4 and L5. This hook
was attached to a small oscillating device that created Inflammation appears to be the mode by which
repetitive stress injury is caused following prolonged
anterior flexion-extension of the lumbar spine while
cyclic activities
simultaneously straining the supraspinous, intra-
spinous, and posterior longitudinal ligaments. External
fixators were then applied to L1 and L7 to limit the
lumbar flexion. Additionally, fine wire electrodes were
inserted into the right multifidus at L3–4, L4–5, and L5–
6, in order to monitor their EMG activity. Initially, the
researcher applied three single cycles of 20N peak load
at 0.25Hz with a 10-minute break between each cycle.
Following this test cycle, a 7-hour break was taken.
During this 7-hour break, the researcher performed
single test cycles of 20N peak load at 0.25Hz, firstly at
10, 30 and 60 minutes after the initial test and then
once every hour. The researcher then carried out the
same experiment with loads ranging from 20 – 60N.
Following the experiments, the researcher removed the
supraspinous ligaments for cytokines analysis. The
supraspinous ligament of the lumbar spine was
compared with the same ligament of the thoracic spine
by way of an intra-subject control, as the thoracic
ligament was not subject to the cyclic motion.
What happened?
The researcher found that increasing the load, the
number of repetitions, decreasing the rest period and
increasing the frequency of loading led to a significant
increase of the normalized integrated EMG over the
baseline level.
Page 46
Initiation and progression of mechanical damage in the The researchers found that the damage accumulation in
intervertebral disc under cyclic loading using continuum the annulus increased almost linearly with increasing
damage mechanics methodology: A finite element study, number of load cycles until the point of failure in all
by Qasim, Natarajan, An and Andersson, in Journal of loading conditions applied. The researchers found that
Biomechanics, 2012 the application of 6Nm moments in the three main
directions without accompanying compressive loading
Background did not lead to disc failure irrespective of the number of
applied load cycles.
Intervertebral disc degeneration is associated with lower
back pain and some researchers have proposed the Compressive forces
appearance of annular lesions as the first sign of the The researchers found that cyclic compressive loading
degeneration process. Additionally, epidemiological with a peak load of 400N did not lead to disc failure.
studies have identified frequent bending and lifting as a However, they noted that the FE model predicted disc
risk factor for disc prolapse, as have in vitro studies failure after in 50,798 load cycles of compressive loading
involving cyclic loading of the spine. Recent in vitro with a peak load of 800N.
experiments performed on spinal segments taken from
pigs have led researchers to conclude that cyclic Combined shear and compressive forces
flexion/extension bending results in disc failure of the The researchers found that the introduction of 6Nm
disc while heavy compressive loading fractures the moments in the three main directions in conjunction
vertebral body. with compressive loading decreased the number of load
cycles to failure by 50% (flexion), 32% (lateral bending)
and 18% (axial rotation) compared to solely compressive
loading. They found that applying 6Nm moments in
The researchers used a previously validated, three-
flexion, lateral bending and axial rotation at the same
dimensional, non-linear poro-elastic finite element (FE) time as well as the compressive loading reduced the
model of a healthy lumbar L4–L5 motion segment. This number of load cycles to failure by 71% compared to
model included all of the key variables, including
solely compressive loading.
porosity, osmotic pressure and strain dependent
permeability. The researchers explain that FE models
are often used in the investigation of spine What did the researchers conclude?
biomechanics. They observe that the progression of The researchers concluded that their poro-elastic FE
structural damage within the various elements of the model of L4/L5 lumbar motion segment predicted
vertebrae can be tracked while other variables are structural damage in the annulus of the disc under cyclic
altered. The researchers used their validated FE model loading. The researchers also concluded that the
to assess the progression of damage to the annulus of numbers of load cycles to failure that were predicted for
the lumbar disc under cyclic loading. In addition, they multi-directional loading were considerably smaller than
tested their model against the results of an in vitro study those for uni-directional loading. Finally, they concluded
performed using human spinal segments taken from that the damage initiated and progressed in the
cadavers. posterior annulus under all loading conditions.
What happened? Limitations

Validation of the model The study involved a computer model and was therefore
The researchers found that their FE model predicted limited by the programmed assumptions.
that the motion segment would fail after 31,855 cycles
of a similar combined loading protocol to that used in Key points
the cadaver study. The cadaver study had found that
the segments failed after 36,750 ± 12,612 cycles. A finite element model predicts disc failure similar to
that found in in vitro experiments
Initiation and progression of the damage
The model identified the onset of the damage at the
posterior region of the inner annulus next to the inferior
endplate and the progression of the damage was
towards the outer periphery. This initiation and
progression was found to be the same irrespective of
the loading condition.
Page 47
Gender differences in trunk, pelvis and lower limb Moreover, at 45KF, females rotated the pelvis toward
kinematics during a single leg squat, by Graci, Van Dillen the weight-bearing leg (which was in the same direction
and Salsich, in Gait & Posture, 2012 as the rotation of the trunk) while males rotated the
pelvis toward the non-weight-bearing limb (which was in
Background the opposite direction of the rotation of trunk). Finally,
the researchers observed that at both 45KF and PKF,
Research has shown that females display greater knee
females displayed greater hip adduction and knee
abduction and hip adduction and less hip and knee
abduction than males.
flexion than males in landing from jumps and in single
leg squatting. Additionally, studies have found that
females display more hip internal rotation and knee What did the researchers conclude?
external rotation than males in running and in landing The researchers concluded that the differences in
on one leg. While there are many proposed risk factors kinematic data were so significant that they were able to
for anterior-cruciate ligament (ACL) strains, some assert that females and males use different movement
researchers have proposed that tibial abduction and strategies at all the levels of the kinematic chain (trunk,
external rotation lead to ACL strains or patellofemoral pelvis, hip and knee) to complete a single leg squat.
pain syndrome (PFPS). In addition, several studies have
found that females experience a higher incidence of ACL The researchers also commented that the more vertical
injuries and PFPS than males. Consequently, some torso angle that females displayed during the descent
researchers have proposed that the differences between phase could lead to increased risk of ACL injuries by
males and females noted in respect of hip and knee increasing the load on the quadriceps.
angles during running, jumping and squatting could
The researchers also commented on the greater degree
account for this higher injury incidence.
of knee abduction and hip adduction displayed by the
female subjects, noting that this implies females are
What did the researchers do? closer to valgus collapse during the squat, which could
The researchers wanted to investigate differences in be dangerous for the knee joint.
joint angles between males and females during a single
leg squat. So they recruited 19 moderately active Limitations
subjects (10 males and 9 females) who were all right-leg
The researchers commented that their study was limited
dominant. The researchers then took a visual recording
in that it did not record strength measures or muscle
of the subjects while they performed a single-leg squat
activation patterns using EMG electrodes. This data
with the rear leg bent behind them, in a form sometimes
would have been interesting, as previous research has
referred to as a “skater squat”. The researchers
found that hip abductor and external rotator muscle
collected their kinematic data using an 8-camera, 3D
weakness can contribute to increased hip adduction and
motion capture system and reflective markers placed on
internal rotation.
key anatomical landmarks. The researchers identified a
small number of key points in the single leg squat
movement at which they wanted to compare data. Key points
These were: the start of movement (SOM), the end of
O Females use a different movement strategy at the
movement (EOM), 45 of knee flexion in the descent
phase (45KF) and peak knee flexion (PKF), which they trunk, pelvis, hip and knee during a single leg squat
from males
identified as the point at which the knee was at
maximum loading.
The movement pattern used by females in the single
leg squat could lead to an increased risk of knee injury
What happened?
The researchers found that the females kept a more
erect posture and flexed their trunk less than males at
both 45KF and PKF. Additionally, at 45KF, females
showed a tendency to flex their trunk laterally toward
the weight-bearing limb but males showed a tendency
to flex their trunk laterally toward their non-weight-
bearing limb. Similarly, at 45KF, the researchers noted
that the females rotated their trunk in the transverse
plane toward the weight-bearing leg less than males.
Page 48
Femoroacetabular Impingement in Former High-Level Female subjects

Youth Soccer Players, by Johnson, Shaman and Ryan, in The researchers found that 4 of the 25 female former
American Journal of Sports Medicine, 2012 soccer players demonstrated cam impingement in both
hips, 4 had it localized to the right hip, and 1 had it in
Background the left hip only.
Femoroacetabular impingement (FAI) is a cause of hip However, the researchers found that 6 of the 25 female
pain thought to occur as a result of alterations in the subjects in the control group demonstrated cam
shape of the femoral head. This changed shape is impingement in both hips, 1 had it only in the right hip,
understood to lead to abnormal contact forces inside and 1 had it only in the left hip. Consequently, the
the hip joint, labral tears and chondral lesions and researchers found that the differences between the
ultimately arthritis. groups were again not statistically significant.
Researchers have previously identified two different

types of FAI. Johnson et al. explain that the first, cam What did the researchers conclude?
impingement, occurs when a non-spherical femoral The researchers concluded that participation in youth
head abuts the acetabulum and injures the labrum and high-level soccer does not appear to increase the risk of
acetabular cartilage. The researchers go on to outline cam impingement in both young men and women.
how the second type of FAI, pincer impingement, occurs
where there is abnormal contact between the Limitations
acetabular rim and the femoral neck. This also leads to
The study was limited to comparing soccer players with
labral injury. Some clinicians have noted that patients
controls, who had not competed at any sport to a
who have required treatment for FAI were high-level
significant degree. It therefore does not preclude the
soccer athletes in their youth, possibly as a result of the
possibility that other sports could have a lower or
activities required in high-level soccer performed during
greater risk of cam impingement development.
skeletal immaturity.
Key points
The researchers wanted to investigate the prevalence of Participation in youth high-level soccer does not
the first type of FAI (cam impingement) subjects who appear to increase the risk of cam impingement in
had taken part in high-level soccer in their youth. young men and women
So they recruited 25 male and 25 female Division 1,

semi-professional, or high-level recreational soccer
players in addition to the same number of control
subjects, who had not played soccer in their youth. All
of the subjects were between 18 and 30 years old, had a
body-mass index of less than 30 and had no history of
hip disorders.
What happened?
Male subjects
The researchers found that 12 of the 25 male former
soccer players demonstrated cam impingement in both
hips, 2 had it only in the right hip, and 1 had it in the left
hip.
However, of the 25 men in the control group, 10 had

cam deformity in both hips, 2 had it only in the right hip,
and 2 had it only in the left hip. Consequently, the
researchers found that the differences between the
groups were not statistically significant.
Page 49
Extent of nucleus pulposus migration in the annulus of What happened?

porcine intervertebral discs exposed to cyclic flexion only Balkovec and McGill found that the first group, which
versus cyclic flexion and extension, by Balkovec and was subjected to only flexion had a significantly lower
McGill, in Clinical Biomechanics, 2012 degree of nucleus movement through the annulus than
the second group, which had been subjected to a
Background combined flexion and extension movement. The
Previously, researchers performing in vitro experiments researchers found that the average percentage of the
with spinal segments have found that repetitive flexion annulus that was covered in each case was 5.9% and
to extension movements or neutral to flexion 12.4% respectively.
movements can produce intervertebral disc herniation
The researchers noted that there was considerable
after a certain number of cycles. However, researchers
variability within the two groups and four specimens
have also found that repeated extension movements
within the flexion-only group showed no signs of nucleus
can reverse the posterior displacement of nucleus within
movement. However, every specimen in the flexion-
the annulus that is associated with disc herniation.
extension group showed some degree of nucleus
movement.
Balkovec and McGill wanted to establish whether flexion What did the researchers conclude?
alone or flexion combined with extension would
Balkovec and McGill concluded that flexion-extension
produce more movement of the nucleus pulposus
movements caused a larger degree of nucleus migration
through the annulus of an intervertebral disc and
than flexion-only movements. They note that it is
therefore create circumstances under which disc
important to appreciate that the flexion-extension
herniation can easily occur.
movement is not the same as repetitive extension,
So they obtained 30 cervical spines from pigs aged 6 which has previously been found to lead to reduced
months with an average weight of 80kg and isolated the nucleus migration in some cases. They suggest that this
C3/C4 vertebral sections and the intervening disc. The could imply that movements or exercises that require
spinal sections were secured within an apparatus and cyclical spinal flexion and extension could produce
tested using a hydraulic system. After pre-loading all of significantly more annular damage than movements that
the specimens for 15 minutes at 300N of axial require only cyclical flexion.
compression to counter post-mortem swelling, the
specimens were separated into two equal groups. Limitations
The researchers note that a key limitation of this study
The researchers then applied only cyclic flexion followed
was the use of animal spinal segments. They also note
by a return to the neutral position to the first group.
that the study was limited by the quantification of
They applied a combined cyclic flexion and extension
damage in single plane, while a herniation could in fact
movement to the second group. In both cases, the
be found in any region of the disc.
researchers applied 10,000 cycles of the movement
concomitantly with 1500N of axial compression. The
researchers set the hydraulic apparatus up to create Key points
average movement ranges of 14.8 ± 2.5° for the first
group and 16 ± 2.9° for the second group, including 4.3 ± Flexion-extension movements caused a larger degree
1.3° of extension. of nucleus migration than flexion-only movements in
an in vitro model
Balkovec and McGill tracked the nucleus as it migrated
through the annulus by using a radio-opaque dye, which This could imply that movements or exercises that
require cyclical spinal flexion and extension could
they inserted through the anterior disc using a needle.
produce significantly more annular damage than
From previous experiments, the researchers knew that movements that require only cyclical flexion
the dye would not diffuse into the annulus unless there
was a fissure. Following the testing period, the
researchers dissected the specimens and photographed
them to observe the pattern created by the radio-
opaque dye mixture moving through the annulus.
Page 50
Evidence-Based Practice for Rehabilitation Professionals: Dijkers et al. explain that PBE studies collect information
Concepts and Controversies, by Dijkers, Murphy and on many more variables than RCTs and therefore permit
Krellman, in Archives of Physical Medicine Rehabilitation, a more comprehensive description of various different
2012 treatments and subjects.
Shortcomings of Clinical Research Evidence

The Review
Dijkers et al. draw attention to certain criticisms of the
History of evidence-based medicine and practice current system of evidence collection. Some
Dijkers et al. begin by explaining that current definitions methodologists have found significant evidence for
of evidence-based practice (EBP) are all ultimately publication bias, being the tendency of authors and
derived from the original definition of evidence-based journals only to publish studies that have positive
medicine (EBM) that was proposed by Sackett et al. findings. This results in the literature containing a high
“Evidence-based medicine is the conscientious, explicit, percentage of type one errors, in which a hypothesis is
and judicious use of current best evidence in making erroneously supported. Additionally, authors are often
decisions about the care of individual patients.” tempted to publish only the results of studies that show
marked outcomes or strong correlations.
The reviewers go on to explain that the enormous
growth of research in the 1970s and to date was both a Criticisms of EBP
benefit and a hindrance. The evidence base that this One popular criticism of EBP is that it places much
surge of information created presented a tremendous greater weight on clinical research findings over other
opportunity and yet the sheer quantity is daunting and forms of evidence. The reviewers argue that the
no clinician is able keep up with the literature in all of criticism should not be accepted that EBP excludes other
the key areas. In addition, the reviewers note that until types of evidence. However, they accept that there is a
the mid-1980s, an investigation into a clinical area of strong tendency for EBP to prefer experimental
research required a trip to the medical library. evidence or even observational data above expert
Fortunately, after this date, abstracts became available opinion.
digitally, first on CD-ROM and later via the Internet.
Indeed, from 2010, all journals have been available The reviewers note that another criticism of EBP is that
electronically. However, this increased accessibility of practitioners or organizing bodies only want to deal with
information that began in the mid-1980s was still not the best possible evidence and would rather provide no
sufficient to make the vast body of work user-friendly guidance at all than use the best available evidence if
for EBM or EBP advocates. this evidence is less than the best possible quality.
Certainly, this approach can be noted in some
Dijkers et al. explain that the next key step that was organizations that have an extreme attachment to RCTs,
made in the development of EBM and EBP came when in such as the Cochrane Collaboration, who often produce
England, the medical researcher Cochrane realized that an empty review where there are no RCTs available. The
this huge body of research being published was not reviewers note that this is a disservice to clinicians and
being used in practice. Cochrane therefore proposed misrepresents the spirit of EBP.
and created a database of trials, specifically randomized
controlled trials (RCTs), for health care practitioners to Dijkers et al. explain that some have criticized EBP for
access and learn from. The Cochrane Collaboration was not being directly applicable to many of the burning
established in 1993 and is now is a key resource for questions that trouble clinicians. They note that this will
healthcare providers and policymakers. The Cochrane always occur where the clinician is dealing with an
Collaboration was merely the first step, however, and unusual case or combination of different conditions, for
many other organizations followed, to develop the same example, a stroke occurring after spinal cord injury.
role in other countries and specialties. They note that this will only reduce with time and effort
spent in research and, presumably, by clinicians writing
Types of Evidence up case studies of unusual cases.
Dijkers et al. explain that while RCTs are considered to
be most valid for information about the effectiveness of A common criticism of EBP is that there is no such thing
certain treatments, it is at the end of the day only a as a typical patient and therefore there is no guarantee
simple experiment performed under highly controlled that a treatment that has been supported by evidence
conditions and cannot therefore produce the detailed will be successful with the next patient that walks
information that rehabilitation professionals require. through the door. This criticism will only be met by
Consequently, there appears to be a considerable role researchers improving the external validity of their work
for practice-based evidence (PBE) designs in this field. and by an increase in sub-group analysis.
Page 51
Evidence-Based Practice for Rehabilitation Professionals: • Health Technology Assessments – these works are
Concepts and Controversies, by Dijkers, Murphy and based on or include systematic reviews but the
Krellman, in Archives of Physical Medicine Rehabilitation, subject areas generally cover policy issues rather
2012 continued… than clinical ones.
• Clinical Practice Guidelines – these are statements
that have been carefully put together in order to
While some have criticized EBP for creating a cookbook assist clinicians and patients make appropriate
with which clinicians are supposed to treat patients with health care decisions in specific circumstances. They
disregard for their individual circumstances, EBP are typically highly focused on a single area.
practitioners have argued strongly against this • Clinical Pathways – these documents provide
interpretation. The reviewers explain that the principles guidance regarding the key steps in the process of
upon which EBP is based dictate that the “External assessment and treatment, including the path
clinical evidence can inform, but can never replace, through various clinical settings.
individual clinical expertise, and it is this expertise that
• Databases of Evaluations of Primary Studies - a
decides whether the external evidence applies to the
number of organizations have created databases to
individual patient at all and, if so, how it should be
help clinicians find evidence for specific treatments
integrated into a clinical decision.” Additionally, the
in their areas of interest. They often include
reviewers note acerbically that although some critics still
assessments of the methodological quality of the
grumble about EBP pushing a one-size fits all package,
studies included.
these same critics do not justify why clinicians should
• Databases of Extractions From Primary Studies –
have the freedom to use unusual treatments where the
these databases are very similar to the above but
evidence clearly suggests that more moderate or
also include information on the strength of the
conservative options are available.
intervention as expressed in an effect size and in the
number needed to treat (NNT).
Dijkers et al. note that some critics have taken to
observing that EBP is not itself based on evidence. They • CATs and Critically Appraised Articles – these
documents are short systematic reviews that create
note that there are have been no studies that show that
a critical appraisal of the available studies related to
taking an EBP approach leads to better healthcare than
not. However, the difficulties of such a trial would be a clinical question. They are very focused on the
almost insurmountable, mainly because of the human question of what the clinician needs to do.
tendency to place great weight on habit, tradition, and • EBP Journals – EBP journals publish extracts from
authority. Moreover, health care establishments are newly published research and tend to provide a
complicated bureaucracies and even where an individual rewritten summary of the original article, focusing
clinician begins consciously working according to EBP, on the elements most relevant to the practitioner.
they cannot count on the support of their organization. • Targeted Evidence Dissemination – for the really
time-poor, some services only highlight and review
EBP solutions and resources articles that exceed a threshold value for relevance
At the beginning of their review, Dijkers et al. note that and evidence quality.
one of the problems for EBP practitioners is the sheer
quantity of information relevant to their practice. The What do the reviewers conclude?
reviewers note that there are a number of resources
The reviewers conclude that EBP is a young field in its
available to make the process of keeping up-to-date less
entirety and not just in rehabilitation. Consequently,
painful.
there are still new concepts and controversies that
• Systematic Reviews – these studies synthesize all of clinicians and researchers will need to keep up with.
the relevant research evidence of relevance in a
given area and reduce the impact of bias that is Key points
inherent in a single study.
• Meta-analyses – a meta-analysis is another type of There are many criticisms of evidence-based practice
synthesis of primary studies but done using that provide useful feedback to researchers and
statistical methods that aim to deduce a single effect clinicians in improving their operating methods
size for a given treatment option.
There are many resources available for clinicians and it
• Meta-syntheses – a meta-synthesis is a systematic
is not necessary to spend hours reading individual
review but performed on qualitative research rather studies given the summarizing solutions on offer
than on controlled trials.
Page 52
Effect of Core Stability Exercises on Feed-Forward position at all times. Exercise progression was achieved
Activation of Deep Abdominal Muscles in Chronic Low by gradually reducing the elastic band support.
Back Pain: A Randomized Controlled Trial, by Vasseljen,
Unsgaard-Tøndel, Westad and Mork, in Spine, 2012 The general exercise program comprised general
strengthening and stretching exercises that are
commonly recommended in the treatment of
Background
nonspecific lower back pain, including trunk
Research has indicated that lower back pain may affect extension/flexion/rotation in resistance apparatus and
motor control of the trunk muscles, including the timing stretching of trunk and extremity muscles.
of abdominal muscle activation that occurs in
anticipation of postural perturbations (i.e. feedforward Before and after the intervention, the researchers
activation). Clinicians often make use of core stability measured the change in onset in activity of the deep
exercises (for the rehabilitation of lower back pain abdominal muscles in response to a predictable
because the deep trunk muscles contribute to perturbation of the trunk.
stabilization of the spine. Core stability exercises that
focus on the voluntary and isolated control of deep What happened?
trunk muscles are assumed to help restore the deficit in
The researchers were disappointed to find that no
trunk muscle strength and control what is seen in lower
significant changes were found in mean onset after
back pain sufferers.
treatment in any of the intervention groups.

The researchers performed a randomized controlled
The researchers concluded that no overall improvement
trial in order to establish the effect of three different
in the onset of abdominal muscle activity was found
core stability exercise interventions on feed-forward
after 8 weeks of a variety of different exercises.
activation or timing of the activation of the deep
abdominal muscles in patients with chronic lower back
pain. The researchers recruited 109 subjects and Limitations
randomized them into three exercise intervention The researchers note that since ADIM exercises have
groups: core stability exercise, sling exercise and general been proposed as a first step in correcting feed-forward
exercise. The subjects all received their 40 – 60 minutes delays and regaining control of the deep abdominal
of exercise intervention in a physiotherapy clinic muscles, these were included in the trial. However, the
treatment once per week for eight weeks. The subjects study did not investigate other core stability protocols
were precluded from receiving any other treatment for and these may have had an effect.
lower back pain during this time. However, they were
encouraged to stay active and were provided with basic
Key points
information regarding the management of lower back
pain.
No overall improvement in the onset of abdominal
muscle activity results from 8 weeks of core stability,
The core stability exercise program was based on the
sling or general strengthening and stretching exercises
isolated activation of the transverse abdominis by using
the abdominal drawing-in maneuver (ADIM). The ADIM
was performed in the supine position with real-time
feedback on performance provided by means of
ultrasound. The researchers gave the subjects
instruction to carry out the ADIM exercise at home and
they were encouraged to perform 10 pain-free 10-
second contractions 2 – 3 times per day, holding each
contraction for 10 seconds.
The sling exercise program was adjusted to the ability of

each subject to keep their lumbar spine in a neutral
position throughout a range of leg/ arm positions and
movements. The researchers attached elastic bands to
the pelvis to help the subject maintain a neutral spine
Page 53
An Integrated Approach to Change the Outcome Part I: Knee valgus motion

Neuromuscular Screening Methods to Identify High ACL Additionally, knee valgus motion can be found by
Injury Risk Athletes, by Myer, Ford, Brent and Hewett, in recording the medial knee position occurred for the left
Journal of Strength and Conditioning Research Publish leg just prior to ground contact, by looking at the
Ahead of Print, 2012 camera footage in the frontal plane.
Knee flexion ROM

Background
The researchers observe that knee flexion ROM can be
The researchers note that studies have found that calculated from the sagittal plane footage, using the
landing with a high knee abduction moment is a good data frame immediately prior to initial contact as well as
predictor of non-contact ACL injury risk in young female the data frame in which the maximum knee flexion
athletes. angle occurs, again for the left leg. It is then possible to
calculate knee flexion displacement as the difference in
What did the researchers do? the two knee flexion angles. They explain that all of the
measurements are facilitated by specific software called
The researchers developed and validated a field-based
Dartfish.
assessment in order to assist in the identification and
targeting of injury prevention training to female athletes Quadriceps-to-hamstrings ratio
who display high knee abduction moments. The field The researchers detail the procedure for the calculation
tests recorded five key variables, which could then be
of the strength ratio between the quadriceps and
input into an algorithm that allows the calculation of the hamstrings. They note that a standard isokinetic testing
risk of a knee abduction moment being experienced device for each leg at 300°/second is required for this
during a drop landing. The researchers recruited 744 test.
female basketball and soccer players from a single
county public school district and tested them using 3-
dimensional (3D) motion analysis and field-based What happened?
techniques at the same time. This enabled the field- The researchers were pleased to find that their field
based tests to be validated. tests showed moderate to high agreement with the 3D
motion analysis.
The five variables that are tested by the field tests and
which are input into the algorithm are: tibia length, knee
Practical applications
valgus motion, knee flexion range of motion (ROM),
quadriceps-to-hamstrings ratio and body mass. The researchers explain that their prediction algorithm
can be used by anyone who is able to perform the field
Basic equipment requirements and set-up tests with their female athletes. By recording the
The researchers explain that the field tests require two- various data points for each subject, coaches can refer
dimensional (2D) frontal and sagittal plane knee images, to the algorithm by placing a straight edge on the
which can be obtained using video cameras. They published chart vertically so that it touches the
explain that these cameras should be leveled and placed designated variable on the axis for each predictor value.
at 60 – 80cm in height and perpendicular to each other The values are then summed and a total score obtained,
in the frontal and sagittal planes. The researchers which provides an estimate of the likelihood that the
specify that the box used for starting the landing subject will experience a high knee abduction moment
movement should be 31cm high and should be centered during landings.
on the frontal camera view and approximately 30cm off
center of the sagittal plane view away from the camera Key points
in the frontal plane position such that the jump lands in
the center of this field of view. In jumping from the box, Researchers have developed an algorithm for assessing
the researchers explain that the subject should drop the likelihood that a female athlete will experience
directly down off the box and immediately perform a high knee abduction moments. This algorithm can be
maximum vertical jump, raising both arms towards an accessed by using field tests that require only two
overhead target. video cameras and the facility to perform drop jumps,
in addition to the software required to make the
Tibia length calculations from the camera footage
The researchers stipulate that it is necessary to measure
tibia length, which can be done from the video footage
when the subject is standing upon the box.
Page 54
An Integrated Approach to Change the Outcome Part II: The researchers note that one method for helping
Neuromuscular Screening Methods to Identify High ACL athletes to decrease the tendency towards using small
Injury Risk Athletes, by Myer, Ford, Brent and Hewett, in knee flexion ROM is the use of exercises that emphasize
Journal of Strength and Conditioning Research Publish early co-contraction of the knee flexor muscles. The
Ahead of Print, 2012 principle behind this is that if the hamstrings are already
active, they can increase knee flexion and also decrease
Background ACL loading at the larger knee flexion angles, where they
have greater influence. The researchers suggest
In part one of their study, the researchers produced and
squatting down to touch a box as if box-squatting but
validated an algorithm for establishing the risk of
without resting or bouncing upon the box before
performing a landing with a high knee abduction
returning.
moment (KAM). The five variables that are tested by the
field tests and which are input into the algorithm are: Side-to-side differences contribute to high KAM
tibia length, knee valgus motion, knee flexion range of The researchers note that studies have found that side-
motion (ROM), quadriceps-to-hamstrings ratio and body to-side imbalances in muscular strength, flexibility and
mass. In this review, the researchers turn their coordination can lead to increased injury risk. Of
attention to various factors that may contribute to the particular note in respect of female athletes and ACL
key variables and also make various suggestions for the injury risk is reduced hamstring torque on the non-
reduction of risks that these factors create. dominant side. The researchers suggest that bilateral
symmetry should first be gained during a normally
Rapid growth contributes to high KAM
bipedal task, such as a squat, before clinicians then
The researchers observe that rapid developmental
incorporate single leg exercises in order to even out the
growth leads to increased height, weight and center of
imbalances.
mass (COM). These factors together make it more
difficult for the athlete to balance. Additionally, they Quadriceps-to-Hamstrings ratio
note that while males naturally increase hip abduction The researchers note that female athletes who
strength relative to body mass as they increase in age, demonstrate decreased relative hamstrings to
studies have found that females do not demonstrate the quadriceps strength may be at increased risk of ACL
same adaption. injury. The researchers propose that coaches
implement resistance-training exercises designed to
Targeted training for rapid growth risk factor
increase hamstrings muscle strength, including the
The researchers observe that a reduced ability to
single leg Romanian Deadlift and the hamstring curl, as
activate the hip stabilizers may permit increased lateral
well as synergist posterior chain exercises such as the
trunk positions that can incite increased KAM. They
Glute Bridge and single-leg Glute Bridge.
note that studies have found that trunk and hip control
strength training, such as by using increasing lateral
hops, increases standing hip abduction strength in Limitations
female athletes. This review was based on the principle of reducing the
knee abduction moment (KAM) for the purposes of
Excessive knee valgus motion contributes to high KAM reducing ACL injury risk. However, there are other
The researchers observe that neuromuscular control factors associated with increased ACL injury risk and
deficits, such as ligament dominance, can increase lower these were not covered in this review.
extremity joint loads during sports activities. An
imbalance between the neuromuscular and ligamentous
Key points
control of the knee joint stability can lead to an inability
to control lower extremity frontal plane motion during
Based on the principle that decreasing the knee
landing and cutting. The researchers note that athletes abduction moment reduces the risk of ACL injury in
displaying such tendencies could benefit from specific female athletes, there are a number of training
exercises such as wall jumps while focusing on keeping interventions that can be performed with athletes who
the knees apart when landing, or the tuck jump. display high scores on the various aspects of the knee
abduction moment algorithm described in the
Reduced knee flexion contributes to high KAM previous article
Researchers have found that increasing knee flexion
during dynamic activities helps to reduce the risk of ACL
injuries in female athletes.
Page 55
An Acute Bout of Self Myofascial Release Increases What happened?

Range of Motion Without a Subsequent Decrease in Quadriceps strength
Muscle Activation or Force, by MacDonald, Penney, The researchers found no significant differences in
Mullaley, Cuconato, Drake, Behm and Button, in Journal muscle force, rate of force development or muscle
of Strength and Conditioning Research Publish Ahead of activation between the control and foam roller
Print, 2012 conditions.
Background Knee joint ROM

The researchers found that there was a significant
Restrictions in the fascia can occur in response to injury,
difference in knee joint ROM between the control and
disease, inactivity, or inflammation, which can lead to a
foam roller conditions. Specifically, they found that the
loss of elasticity and dehydration and ultimately the O
subjects in the control condition had approximately 10
formation of fibrous adhesions. Such adhesions can
less ROM compared to when the same subjects were
cause a loss of joint range of motion (ROM) or muscle
tested in the foam roller condition.
length, neuromuscular hypertonicity, decreased
strength and a decrease in soft-tissue extensibility.
Myofascial release therapy is a manual therapy The researchers concluded that two 1-minute bouts of
technique that can help reduce the fibrous adhesions. A foam rolling significantly increased joint ROM and did
new technique of myofascial release therapy called self- not impede the production of muscular force or rate of
induced myofascial release has become increasingly force development.
common for treating soft-tissue restrictions. This
technique works on the same principle as myofascial
release. However, instead of having a therapist provide Limitations
manual therapy to the soft-tissue, the individual uses This study was limited in that there is very little
their own body mass on a foam roller. This creates literature with which to compare it. Consequently,
pressure on the soft-tissue. while the protocol used of two sets of 1-minute (for
example) was effective at increasing joint ROM, this
MacDonald et al. note that the literature on self- does not imply that this is the most effective protocol,
myofascial release is limited. They explain that Miller simply that it is effective. Further research may show
and Rockey have produced the only study on self- that altering the time, sets or other variables may have a
myofascial release and changes in ROM. They looked at material effect.
the chronic effects of an 8-week foam-rolling program
on hamstring flexibility. The results of this study found
Key points
that the foam-rolling program was not effective in
increasing the ROM of the hamstring muscles.
Foam rolling significantly increases joint ROM and does
not impede the production of muscular force or rate of
What did the researchers do? force development
The researchers wanted to establish whether self-

myofascial release using a foam roller affects volitional
and evoked quadriceps muscle force. They also wanted
to see whether foam rolling improves knee joint ROM.
The researchers therefore recruited 11 male subjects

from a university and had them perform each
experimental condition over four sessions, with 24-48
hours rest between sessions. The first two conditions
were controls and the second two conditions used the
foam roller. The conditions measured either force
production or ROM. During the foam roller conditions,
the subjects performed self-myofascial release on the
right quadriceps for two bouts lasting 1-minute with a
minute rest between each bout. The researchers
measured either the force parameters of the knee joint
ROM both before and after the intervention.
Page 56

2012 - 7 Sport and Conditioning Research

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JULY 2012

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