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MAY 2015

PREVENTING HAMSTRING
STRAIN INJURY EDITION
By Chris Beardsley

Welcome
Welcome to the Preventing Hamstring Strain Injury
Edition! In this edition, we report the findings of a
brand new randomized controlled trial exploring the
effects of the Nordic curl on the incidence of new
hamstring strains. In other words, we review a very
high quality study that attempted to find out whether
performing the Nordic curl regularly would actually
stop hamstring strains from happening in the first
place. Previous trials have shown that the Nordic curl
was very good at preventing recurrent hamstring
strains but the evidence for their use in avoiding new
hamstring strains was weaker. This new trial shows us
that they are very valuable for both purposes. Indeed,
despite the determined efforts of a small number of
popular sports coaches who dislike the exercise, it
seems that the evidence continues to grow to support
the use of the Nordic curl to prevent hamstring strains
in a range of sports.

Preventing Hamstring Strain Injury Edition


Introduction
Hamstring strains are very common in a range of
different team sports. The incidence of hamstring
strain injury has been explored by researchers in
rugby union and American football and ranges
between 0.27 5.6 injuries per 1,000 exposure hours,
depending upon the sport and on the exact definition
of exposure. More importantly, the proportion of total
injuries comprised of hamstring strains in common
team sports varies between 12 15% in Australian
Rules Football, track and field, and soccer. Since
hamstring strains can be quite debilitating and difficult
to recover from, finding a way to stop them happening
in the first place would be very valuable.
Mechanisms
Eccentric training has been proposed as a method of
training for the hamstrings that may be useful for
preventing hamstring strains from occurring. There
are at least two mechanisms that could explain why
eccentric training might be effective for preventing
hamstring strains. Firstly, eccentric training seems to
increase the normalized lengths of muscle fibers and
thereby makes it easier for them to lengthen during
high-velocity, lengthening movements such as sprint
running. Secondly, it has been suggested that since
low eccentric hamstrings strength is a risk factor for
hamstring strains, athletes who incur these injuries
might simply have a weakness in these key sprinting
muscles that leads to fatigue, overuse and ultimately
injury. Given that the hamstrings are much more
difficult to train with regularity than the quadriceps
using common, multi-joint exercises, this is not very
surprising.

Increasing normalized muscle lengths


The idea that it is possible to change the normalized
length of a muscle fiber using eccentric training is not
widely known or understood. The normalized muscle
length of a muscle fiber is its resting length adjusted
so that the length of each individual sarcomere is
standardized to 2.5m. Essentially, the normalized
muscle length is a count of the number of sarcomeres
in series. Longer normalized muscle lengths mean that
there are more sarcomeres in series. Eccentric training
increases the number of sarcomeres in series in a
muscle fiber, by a process called sarcomerogenesis.
The effects of this can be observed easily by testing
strength at different joint angles. Eccentric training of
any muscle increases the optimum angle at which
torque is developed. Producing peak force at higher
optimum joint angles means that the muscles are
developing peak forces at longer muscle lengths.
Increasing the number of sarcomeres changes the
amount of overlap between the sarcomeres such that
the maximum amount of overlap occurs at a longer
muscle length. Since the maximum amount of overlap
corresponds with peak force, increasing the number of
sarcomeres means that muscles develop peak force at
longer muscle lengths.
Preventing novel hamstring strains: the trials
With the arrival of the new trial, there are now 6 trials
exploring the effects of eccentric training for the
hamstrings on the incidence of novel hamstring strain
injury, as follows:
Askling (2003) explored the effects of 10 weeks of
eccentric-emphasis training for knee flexion using a
flywheel ergometer in 32 elite male soccer players
from 2 Swedish premier-league teams. They found a
significant reduction in hamstring strain injury in the
eccentric training group.
Gabbe (2006) explored the effects of 12 weeks of
eccentric Nordic hamstring curl training for 12 sets of
6 repetitions in 7 amateur Australian Rules Football
clubs and found no significant reduction in hamstring
strain injury in the eccentric training group but the
relative risk displayed a non-significant trend in that
direction.
Engebretsen (2008) explored the effects of 12
weeks of eccentric Nordic hamstring curl training for 2
3 sets of 5 10 reps in 161 soccer players at highrisk of hamstring strain injury and found no significant
reduction in hamstring strain injury in the eccentric
training group.
Arnason (2008) explored the effects of at least 7
months of eccentric Nordic hamstring curl training for
2 3 sets of 8 12 reps in elite soccer teams in
Iceland and Norway and found a significant benefit of
the eccentric training.
Petersen (2011) explored the effects of 10 weeks of
eccentric Nordic hamstring curl training for 2 3 sets
of 5 12 repetitions, 1 3 times per week in male
soccer players in the top 5 Danish soccer divisions and
found a significant benefit of the eccentric training.

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Preventing novel hamstring strains continued...


Petersen (2014) explored the effects of 13 weeks of
eccentric Nordic hamstring curl training 1 2 times
per week, for 2 3 sets of 5 10 repetitions in
amateur male soccer players. They found a significant
benefit of the eccentric training.
Preventing novel hamstring strains: the reviews
A previous review and meta-analysis by Goode et al.
(2014) included 4 of the above trials and reported that
while the trials involving eccentric hamstring training
did not significantly reduce the risk of hamstring
injury, there was a non-significant trend (risk ratio of
0.59 times) and significant heterogeneity between
trials. Importantly, the systematic review and metaanalysis performed by Goode et al. (2014) found that
most of this heterogeneity came from differences in
compliance between trials. When considering only
those subjects who were compliant with the eccentric
training, there was actually an overall significant
reduction in hamstring injury risk (risk ratio of 0.35
times) and this effect had little heterogeneity. The fact
that compliance was the key factor that drove
differences between study results implies that the
eccentric training was having a very marked effect on
hamstring strain injury incidence.
Evidence for the Nordic hamstring curl
In evidence-based practice, which values science and
the scientific process above opinion, the highest levels
of evidence are awarded to high quality, long-term
studies that measure the exact outcome that we are
looking to achieve. When attempting to find evidence
for the prevention of hamstring strains, the above
analysis shows long-term, controlled trials that have
measured actual numbers of hamstring strains with
and without a training program of Nordic curls. These
studies show that when using the Nordic curl in
training, there are definitively fewer hamstring strains.
This body of literature is therefore the highest level of
evidence that is possible to obtain for this area of
sports science.

Clearly, athletes should engage in multi-joint exercises


most of the time, as these types of exercise are more
well-suited to improving sports performance. However,
the Nordic curl is not being proposed as an exercise
for athlete development but for injury prevention.
Deliberately omitting an exercise on the basis that it
does not fit a training theory for performance even
though it has been shown to be effective for injury
prevention using long-term trials that directly measure
injury incidence is not being fair to the athlete, as it
risks their future in the sport.
Criticizing the Nordic hamstring curl: biomechanics
Another type of criticism directed at the use of the
Nordic curl involves discussions of the biomechanics of
sprint running. These discussions draw attention to
the differences in biomechanics of the Nordic curl and
the biomechanics of sprint running, suggesting that
because the Nordic curl is performed slowly and uses
different joint angle movements to those used during
sprint running, it must be a useless exercise for
developing sprinting speed. This is based on the idea
that transfer to training can be deduced based upon
similarities in the kinematics (joint angle movements)
between an exercise and a sports activity. Indeed, as
noted above, it is entirely possible that the Nordic curl
may not be a valuable exercise for improving sprinting
speed. However, that is not the point. The exercise is
being proposed as a tool for hamstring strain injury
prevention. And based on the long-term trials, which
are the highest form of evidence, it seems to do its
job very well.

Conclusions
There is high quality evidence for the use of eccentric
hamstring training, particularly using the Nordic curl,
for preventing hamstring strains. Criticisms of the
exercise often appeal to inferior forms of evidence,
such as training theory and biomechanics, which may
not even be relevant if they relate to performance
rather than injury prevention.

Criticizing the Nordic hamstring curl: training theory


Several criticisms have been directed at the Nordic
hamstring curl. One type of criticism is based upon
fundamental movement training theory. For example,
it is often suggested that training muscles rather than
movements, training knee flexion rather than hip
extension, or training the hamstrings outside of the
kinetic chain (in all cases by using a single-joint, knee
flexion exercise like the Nordic curl) must necessarily
be less effective for both athletic performance and for
injury prevention than using a multi-joint exercise.
These suggestions are made because multi-joint
exercises are designated as more fundamental than
single-joint movements. However, the above trials
show that while these training theories sound very
plausible, they are clearly false when it comes to the
subject of injury prevention, as the subjects in the
above trials engaged in multi-joint exercise in both
groups but the groups that also performed the Nordic
curl or other, similar exercises displayed fewer
injuries.

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Strength coach notes


The effects of adding singlejoint exercises to a multi-joint
exercise resistance training
program on upper body
muscle strength and size in
trained men
Effects of low- versus highload resistance training on
muscle strength and
hypertrophy in well-trained
men
Is repetition failure critical for
the development of muscle
hypertrophy and strength?
Block versus weekly
undulating periodized
resistance training programs
in women
Elastic bands in combination
with free weights in strength
training: neuromuscular
effects
Short-term effect of crunch
exercise frequency on
abdominal muscle endurance

Acute effects of antagonist


static stretching in the interset rest period on repetition
performance and muscle
activation
Kinematic and sEMG analysis
of the back squat at different
intensities with and without
knee wraps

Lower extremity strength and


the range of motion in
relation to squat depth

The researchers concluded that adding single-joint exercises to a multi-joint


resistance training program does not appear to increase further gains in
muscular strength and size. They therefore suggest that for maximal efficiency
of training, single-joint exercises can be removed from training programs.

The researchers concluded that both heavy and light relative loads increase
muscular size similarly in trained subjects. However, they also concluded that
heavy loads are superior to light loads for increasing muscular strength.

The researchers concluded that training to muscular failure is not necessary to


achieve gains in strength and size.

The researchers concluded that a non-linear, weekly undulating periodization


model may be superior to a block periodization model in a 10-week resistance
training program for increasing maximum lower body strength, size and jumping
performance in resistance-trained females.
The researchers concluded that the variable and constant load external
resistance types led to similar increases in strength and athletic performance.

The researchers concluded there was no difference between the groups training
1, 2, or 3 days per week in the increase in abdominal muscle endurance, as
measured by the bench trunk curl test. They therefore suggested that a small
amount of crunch training (1 day per week) might be sufficient for increasing
abdominal muscle endurance in adolescents.
The researchers found that passive stretching of the antagonist muscles during
the seated row exercise led to a significant increase in the number of repetitions
performed as well as increased muscle activity of the latissimus dorsi and biceps
brachii muscles.

The researchers concluded that increasing relative load with and without knee
wraps during the squat exercise leads to increased muscle activity in the vastus
lateralis and gluteus maximus. They noted that the use of knee wraps with high
relative loads led to reduced muscle activation of the vastus lateralis but not in
the gluteus maximus. They suggested that this reduction in muscle activity
might be caused by the storage of elastic energy in the knee wraps that makes
the movement easier to perform.
The researchers concluded that ankle dorsiflexion ROM with a flexed knee and
hip flexion are important factors for enabling deep squatting in males, while
ankle dorsiflexion with an extended knee and ankle dorsiflexor strength are
important factors for enabling deep squatting in in females. This may indicate
that increasing ankle dorsiflexion ROM, increasing hip flexion ROM, and
increasing ankle dorsiflexor strength might lead to improved squat depth.

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Sports medicine notes


The structural and mechanical
properties of the Achilles tendon 2
years after surgical repair

Human tendon adaptation in


response to mechanical loading: a
systematic review and metaanalysis of exercise intervention
studies on healthy adults
Preventive interventions for
tendinopathy: a systematic review

Immediate combined effect of


gastrocnemius stretching and
sustained talocrural joint
mobilization in individuals with
limited ankle dorsiflexion: a
randomized controlled trial
Short term effectiveness of neural
sliders and neural tensioners as an
adjunct to static stretching of
hamstrings on knee extension
angle in healthy individuals: a
randomized controlled trial
Immediate effects of
neurodynamic sliding versus
muscle stretching on hamstring
flexibility in subjects with short
hamstring syndrome
Effectiveness analysis of active
stretching versus active stretching
plus low-frequency electrical
stimulation in children who play
soccer and who have the short
hamstring syndrome
The impact of neuromuscular
electrical stimulation on recovery
after intensive, muscle damaging,
maximal speed training in
professional team sports players

The researchers concluded that the mechanical properties of previously


ruptured and surgically repaired tendons 2 years post-repair are not
affected by the type of rehabilitation method that is conducted immediately
after surgery. They therefore suggest that early mobilization treatment is as
appropriate as traditional rehabilitation.
The researchers concluded that tendons respond to increased mechanical
loading by altering mechanical, material, and morphological properties.
They also concluded that more effective training interventions involve high
relative loads (>70% of MVIC) over longer durations (>12 weeks).

The researchers concluded that there is limited evidence that a long-term


intervention of soccer-specific balance training may be effective for
preventing patellar and Achilles tendinopathy, while shock absorbing insoles
may also be effective for preventing Achilles tendinopathy. They noted that
HRT seems to reduce the risk of Achilles tendinopathy in post-menopausal
women.
The researchers concluded a combined intervention comprising both static
stretching and talocrural joint mobilization was more effective than static
stretching only for increasing ankle dorsiflexion and the time to heel-off
during walking gait. They also noted that there was a non-significant trend
for greater passive dorsiflexion ROM following the combined treatment.

The researchers found that all treatments led to significantly increased


passive knee extension angle. They found that both combined treatments
were significantly superior to the static stretching only intervention but
there were no significant differences between the two combined treatments.

The researchers concluded that neurodynamic sliding techniques appear to


be able to improve hamstring flexibility at least as well as static stretching,
if not to a greater extent.

The researchers concluded that a long-term program of active stretching


plus TENS was superior to a long-term program of active stretching only for
increasing hamstring flexibility.

The researchers concluded that NMES can be used to improve 24-hour


recovery in soccer players, as measured by reference to countermovement
jump height ability, creatine kinase levels, and perceived soreness.

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Strength and Conditioning Research

CONTENTS
HAMSTRINGS STRAIN INJURY EDITION.............................................................................................................................. 2
CONTENTS.........................................................................................................................................................................5
1. STRENGTH & CONDITIONING, POWER AND HYPERTROPHY........................................................................................... 8
1.

The effects of adding single-joint exercises to a multi-joint exercise resistance training program on upper body muscle strength and size
in trained men, De Frana, Branco, Guedes Junior, Gentil, Steele, and Teixeira, in Applied Physiology, Nutrition, and Metabolism (2015) 9

2.

Effects of low- versus high-load resistance training on muscle strength and hypertrophy in well-trained men, by Schoenfeld, Peterson,
Ogborn, Contreras, and Sonmez, in The Journal of Strength & Conditioning Research (2015) ...................................................................10

3.

Is repetition failure critical for the development of muscle hypertrophy and strength? By Sampson, and Groeller, in Scandinavian
Journal of Medicine & Science in Sports (2015)........................................................................................................................................... 11

4.

Block versus weekly undulating periodized resistance training programs in women, by Bartolomei, Stout, Fukuda, Hoffman, and Merni,
in The Journal of Strength & Conditioning Research (2015)........................................................................................................................ 12

5.

Elastic bands in combination with free weights in strength training: neuromuscular effects, by Andersen, Fimland, Kolnes, and
Saeterbakken, in The Journal of Strength & Conditioning Research (2015)................................................................................................ 13

6.

Effects and mechanisms of tapering in maximizing muscular strength, by Pritchard, Keogh, Barnes, and McGuigan, in Strength &
Conditioning Journal (2015)......................................................................................................................................................................... 14

7.

Short-term effect of crunch exercise frequency on abdominal muscle endurance, by Juan-Recio, Lopez-Vivancos, Moya, Sarabia, and
Vera-Garcia, in The Journal Of Sports Medicine And Physical Fitness (2015) ..............................................................................................15

8.

The effect of long term isometric training on core/torso stiffness, by Lee and McGill, in The Journal of Strength & Conditioning Research
(2015)........................................................................................................................................................................................................... 16

9.

Acute effects of antagonist static stretching in the inter-set rest period on repetition performance and muscle activation, by Miranda,
Maia, Paz and Costa, in Research in Sports Medicine (2015)...................................................................................................................... 17

10. Impact of limited hamstring flexibility on vertical jump, kicking speed, sprint, and agility in young football players, by Garca-Pinillos,
Ruiz-Ariza, Moreno Del Castillo, and Latorre-Romn, in Journal of Sports Sciences (2015) ........................................................................ 18
11. Half-squat or jump squat training under optimum power load conditions to counteract power and speed decrements in Brazilian elite
soccer players during the preseason, by Loturco, Pereira, Kobal, Zanetti, Gil, Kitamura, and Nakamura, in Journal of Sports Sciences
(2015)........................................................................................................................................................................................................... 19
12. Training for power and speed: effects of increasing or decreasing jump-squat velocity in elite young soccer players, by Loturco,
Nakamura, Kobal, Gil, Cal, Cuniyochi, and Roschel, in The Journal of Strength & Conditioning Research (2015) ...................................... 20
13. Sport-specific training targeting the proximal segments and throwing velocity in collegiate throwing athletes, by Palmer, Uhl, Howell,
Hewett, Viele, and Mattacola, in Journal of Athletic Training (2015).......................................................................................................... 21
14. Peripheral heart action (PHA) training as a valid substitute to high intensity interval training to improve resting cardiovascular changes
and autonomic adaptation, by Piras, Persiani, Damiani, Perazzolo, and Raffi, in European Journal of Applied Physiology (2015) ...........22

2. BIOMECHANICS AND MOTOR CONTROL.......................................................................................................................23


15. Control of propulsion and body lift during the first two stances of sprint running a simulation study, by Debaere, Delecluse,
Aerenhouts, Hagman, and Jonkers, in Journal of Sports Sciences (2015)....................................................................................................24
16. Selected determinants of acceleration in the 100m sprint, by Makaa, Fostiak, and Kowalski, in Journal of Human Kinetics (2015) ......25
17. Physical principles demonstrate that the biceps femoris muscle relative to the other hamstring muscles exerts the most force
implications for hamstring muscle strain injuries, by Dolman, Verrall, and Reid, in Muscles, Ligaments and Tendons Journal (2015) .....26
18. Kinematic and sEMG analysis of the back squat at different intensities with and without knee wraps, by Gomes, Brown, Soares, Da
Silva, De Oliveira Silva, Serpa, and Marchetti, in The Journal of Strength & Conditioning Research (2015) ...............................................27
19. Lower extremity strength and the range of motion in relation to squat depth, by Kim, Kwon, Park, Jeon, and Weon, in Journal of Human
Kinetics (2015)..............................................................................................................................................................................................28
20. Effects of an unstable load on force and muscle activation during a parallel back squat, by Lawrence and Carlson, in The Journal of
Strength & Conditioning Research (2015)....................................................................................................................................................29
21. Effects of isometric quadriceps strength training at different muscle lengths on dynamic torque production by Noorkiv, Nosaka, and
Blazevich, in Journal of Sports Sciences (2015)............................................................................................................................................ 30
22. Inhomogeneous quadriceps femoris hypertrophy in response to strength and power training, by Earp, Newton, Cormie, and Blazevich,
in Medicine & Science in Sports & Exercise (2015).......................................................................................................................................31

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Strength and Conditioning Research

23. Influence of bench angle on upper extremity muscular activation during bench press exercise, by Lauver, Cayot, and Scheuermann, in
European Journal of Sport Science (2015)................................................................................................................................................... 32
24. Training-related changes in the EMG-moment relationship during isometric contractions: further evidence of improved control of
muscle activation in strength-trained men? By Amarantini and Bru, in Journal of Electromyography and Kinesiology (2015) .................33
25. Dissociated time course of muscle damage recovery between single and multi-joint exercises in highly resistance trained men, by
Soares, Ferreira-Junior, Pereira, Cleto, Castanheira, Cadore, and Bottaro, in The Journal of Strength & Conditioning Research (2015) ...34
26. Muscle fascicle behavior during eccentric cycling and its relation to muscle soreness, by Peailillo, Blazevich and Nosaka, in Medicine &
Science in Sports & Exercise (2015)..............................................................................................................................................................35
27. Verbal instructions acutely affect drop vertical jump biomechanics implications for athletic performance and injury risk assessments,
by Khuu, Musalem, and Beach, in The Journal of Strength & Conditioning Research (2015) ..................................................................... 36
28. Differences in end range of motion vertical jump kinetic and kinematic strategies between trained weightlifters and elite short track
speed skaters, by Haug, Spratford, Williams, Chapman, Drinkwater, Haug, Leverrier Street, in The Journal of Strength & Conditioning
Research (2015)............................................................................................................................................................................................37

3. ANATOMY, PHYSIOLOGY, AND NUTRITION................................................................................................................... 38


29. Extracellular matrix remodeling and its contribution to protective adaptation following lengthening contractions in human muscle, by
Hyldahl, Nelson, Welling, Groscost, Hubal, and Parcell, in The FASEB Journal (2015)................................................................................ 39
30. Is it time to turn our attention toward central mechanisms for post-exertional recovery strategies and performance? By Rattray, Argus,
Martin, Northey, and Driller, in Frontiers in Physiology (2015)....................................................................................................................40
31. Does regular post-exercise cold application attenuate trained muscle adaptation? By Yamane, Ohnishi, and Matsumoto, in
International Journal of Sports Medicine (2015)......................................................................................................................................... 41
32. Mental fatigue does not affect maximal anaerobic exercise performance, by Martin, Thompson, Keegan, Ball, and Rattray, in European
Journal of Applied Physiology (2014)........................................................................................................................................................... 42
33. High-protein, low-fat, short-term diet results in less stress and fatigue than moderate-protein, moderate-fat diet during weight loss in
male weightlifters: a pilot study, by Helms, Zinn, Rowlands, Naidoo, and Cronin, in International Journal of Sport nutrition and Exercise
Metabolism (2014).......................................................................................................................................................................................43
34. Independent effects of endurance training and weight loss on peak fat oxidation in moderately overweight men: a randomized
controlled trial, by Nordby, Rosenkilde, Ploug, Westh, Feigh, Nielsen, and Stallknecht, in Journal of Applied Physiology (2015) ..............44
35. The impact of neuromuscular electrical stimulation on recovery after intensive, muscle damaging, maximal speed training in
professional team sports players, by Taylor, West, Howatson, Jones, Bracken, Love, and Kilduff, in Journal of Science and Medicine in
Sport (2014)..................................................................................................................................................................................................45
36. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review
and meta-analysis, by Ramos, Dalleck, Tjonna, Beetham, and Coombes in Sports Medicine (2015) ......................................................... 46

4. PHYSICAL THERAPY AND REHABILITATION................................................................................................................... 47


37. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players a randomized controlled trial,
Van der Horst, Smits, Petersen, Goedhart, and Backx, in Injury Prevention (2014).................................................................................... 48
38. Eccentric hamstring strength and hamstring injury risk in Australian Footballers, by Opar, Williams, Timmins, Hickey, Duhig, and Shield,
in Medicine & Science in Sports & Exercise (2014).......................................................................................................................................49
39. Immediate combined effect of gastrocnemius stretching and sustained talocrural joint mobilization in individuals with limited ankle
dorsiflexion: a randomized controlled trial, by Kang, Oh, Kwon, Weon, An, and Yoo, in Manual Therapy (2015) ...................................... 50
40. Immediate effects of neurodynamic sliding versus muscle stretching on hamstring flexibility in subjects with short hamstring syndrome,
by Castellote-Caballero, Valenza, Puentedura, Fernndez-de-las-Peas, and Alburquerque-Sendn, in Journal of Sports Medicine (2014)
......................................................................................................................................................................................................................51
41. Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle
in healthy individuals: a randomized controlled trial, by Sharma, Balthillaya, Rao, and Mani, in Physical Therapy in Sport (2015) .........52
42. Effectiveness analysis of active stretching versus active stretching plus low-frequency electrical stimulation in children who play soccer
and who have the short hamstring syndrome, by Piqueras-Rodrguez, Palazon-Bru, and Gil-Guilln, in Clinical Journal of Sport Medicine
(2015)........................................................................................................................................................................................................... 53
43. The structural and mechanical properties of the Achilles tendon 2 years after surgical repair, by Geremia, Bobbert, Nova, Ott, De Aguiar
Lemos, De Oliveira Lupion, and Vaz, in Clinical Biomechanics (2015)......................................................................................................... 54
44. Preventive interventions for tendinopathy: a systematic review, by Peters, Zwerver, Diercks, Elferink-Gemser, Van den Akker-Scheek, in
Journal of Science and Medicine in Sport (2015)......................................................................................................................................... 55
45. Foot posture and function have only minor effects on knee function during barefoot walking in healthy individuals, by Buldt, Levinger,
Murley, Menz, Nester, and Landorf, in Clinical Biomechanics (2015).......................................................................................................... 56
46. Six weeks of core stability training improves landing kinetics among female capoeira athletes: a pilot study, by Araujo, Cohen, and
Hayes, in Journal of Human Kinetics (2015).................................................................................................................................................57

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47. Core strength training for patients with chronic low back pain, by Chang, Lin, and Lai, in Journal of Physical Therapy Science (2015) . . .58
48. Exercise-based performance enhancement and injury prevention for firefighters: contrasting the fitness- and movement-related
adaptations to two training methodologies, by Frost, Beach, Callaghan, and McGill, in The Journal of Strength & Conditioning Research
(2015)........................................................................................................................................................................................................... 59
49. Balancing hands-on with hands-off physical therapy interventions for the treatment of central sensitization pain in osteoarthritis,
by Girbs, Meeus, Baert, and Nijs, in Manual Therapy (2014).................................................................................................................... 60
50. Loss of range of motion of the hip joint: a hypothesis for etiology of sports hernia, by Rambani and Hackney, in Muscles, Ligaments and
Tendons Journal (2015)................................................................................................................................................................................ 61

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Strength and Conditioning Research

1. STRENGTH & CONDITIONING, POWER AND


HYPERTROPHY

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Strength and Conditioning Research

The effects of adding single-joint exercises to a multijoint exercise resistance training program on upper
body muscle strength and size in trained men, De
Frana, Branco, Guedes Junior, Gentil, Steele, and
Teixeira, in Applied Physiology, Nutrition, and
Metabolism (2015)

Background
Very little long-term research has explored the effects
of altering exercise selection on gains in muscular
strength, size or power. Exercise selection can be
viewed in several different ways. One approach is to
compare the effects of two or more specific exercises,
such as the squat or deadlift. However, this is rarely
done, as it provides conclusions that are limited solely
to a single decision between those exercises and the
findings cannot easily be extrapolated out to other
situations. Therefore, an alternative approach that is
more common is to categorize exercises into broad
types and compare the effects of long-term training
programs within those types. One example of this
categorization is the division of training programs into
groups performing a small number of exercises (low
exercise variety) and those performing a large number
of exercises (high exercise variety). This is an
interesting area of research, as it reflects a common
coaching debate most easily represented by the
Bulgarian approach to weightlifting on the one hand
(high specialization in a few exercises) and the
Russian approach on the other (large variety of special
exercises). Powerlifting programs often polarize in the
same way, with some programs (such as Westside)
making use of many exercises and others focusing
purely on the main lifts. To date, very little research
has been carried out in this area but the limited
evidence indicates that at least three multi-joint
exercises for the lower body might be superior to one
multi-joint exercise. Another example of such
categorization might be the division of resistance
training exercises into either single-joint movements
and multi-joint movements. Previous work in this area
has been very limited but has typically reported no
differences between groups training with either singlejoint or multi-joint resistance training exercises
targeting the same body parts. Thus, researchers
working in this field have concluded that where
efficiency is a priority, then multi-joint exercises
should be preferred, as this enables individuals to
train multiple muscle groups at the same time.

OBJECTIVE: To compare the increases in muscular


strength (as measured by elbow flexion 1RM) and size
(as measured by flexed and un-flexed measures of
arm circumference) between resistance training
programs involving upper body multi-joint exercises
and those involving both upper body multi-joint and
upper body single-joint exercises, in trained subjects.
POPULATION: 20 young, resistance-trained males,
randomly allocated into either a combined multi-jointplus-single-joint group (10 subjects, aged 27.7 + 6.6
years) or a multi-joint only group (10 subjects, aged
29.4 + 4.6 years).
INTERVENTION: Both groups performed an 8-week
period of resistance training for the upper body,
following a linear periodized program. Both groups
performed both free weights and machine exercises
for the upper body, including various pressing and
pulling movements. In addition, the combined group
also performed triceps extensions and biceps curls.
Volume was therefore greater in the combined group.

What happened?
Muscular strength
The researchers reported that both training groups
significantly increased elbow flexion 1RM (multi-jointonly = 5.0%; combined = 6.4%) but there was no
significant difference between groups. They also
reported that both training groups significantly
increased elbow extension 1RM (multi-joint-only =
10.6%; combined = 9.8%) but there was again no
significant difference between groups.
Muscular size
The researchers reported that both training groups
significantly increased flexed arm circumference
(multi-joint-only = 1.8%; combined = 1.5%) and unflexed arm circumference (multi-joint-only = 1.3%;
combined = 3.2%) but there were no significant
differences between groups.

What did the researchers conclude?


The researchers concluded that adding single-joint
exercises to a multi-joint resistance training program
does not appear to increase further gains in muscular
strength and size. They therefore suggest that for
maximal efficiency of training, single-joint exercises
can be removed from training programs.

Limitations
The study was limited in that the measurement of
muscular size was arm circumference. This is not an
optimal measurement of hypertrophy and it is possible
that the different exercises produced gains in
muscular size at different points along the biceps and
triceps muscles. Also, the muscles examined were not
as large as those in the lower body. Different results
might be observed if the same study were performed
with multi-joint and single-joint exercises for the lower
body (e.g. squats plus knee extensions and glute
bridges vs. squats only).

Copyright Strength and Conditioning Research Limited, 2015

Page 10

Effects of low- versus high-load resistance training on


muscle strength and hypertrophy in well-trained men,
by Schoenfeld, Peterson, Ogborn, Contreras, and
Sonmez, in The Journal of Strength & Conditioning
Research (2015)

Background
Effect of relative load on strength gains
Currently, the evidence indicates that heavy loads are
superior to light loads for increasing strength in
untrained individuals, where light loads are defined as
<50% of 1RM. This is on the basis of approximately
24 long-term trials comparing >2 training groups, of
which 15 reported a benefit in favor of heavy loads for
at least one of the outcome measures for strength
while the remainder reported no differences between
groups. The evidence indicates that heavy loads might
also be superior to moderate loads (where moderate
loads are defined as <15RM) for increasing strength in
untrained individuals. However, this is on the basis of
around 11 long-term trials comparing >2 training
groups, of which 5 reported a benefit in favor of heavy
loads for at least one of the outcome measures for
strength while the remainder reported no differences
between groups. Currently, the evidence for trained
individuals is very limited. No studies have yet
compared the effects of heavy and light loads on
strength gains but there are preliminary signs that
heavy loads might be superior to moderate loads for
increasing strength in that population for some
exercises or body parts at least.
More detail
Effect of relative load on size gains
Currently, the evidence indicates that heavy loads
might be superior but could also be quite similar to
light loads for increasing muscular size in untrained
individuals, where light loads are defined as <50% of
1RM. This is on the basis of approximately 13 longterm trials comparing >2 training groups, of which
only 4 reported a benefit in favor of heavy loads for at
least one of the outcome measures for muscular size
while all of the remainder reported no differences
between groups. To date, there have been no studies
published assessing the effects of heavy and light
loads in trained individuals.
More detail

OBJECTIVE: To compare the increases in muscular


strength (as measured by 1RM back squat and bench
press) and size (as measured by ultrasound of the
elbow flexors, elbow extensors and quadriceps)
between resistance training programs involving low
(>15RM) and high (<15RM) relative loads in trained
subjects.
POPULATION: 18 young, resistance-trained males
were first matched for baseline strength levels and
then randomly assigned to either a low-load or a highload group.
INTERVENTION: Both groups performed an 8-week
resistance-training program for the upper and lower
body using the same 3 sets of 7 exercises, 3 times per
week. The exercises comprised: the barbell bench
press, barbell military press, wide grip lat pull-down,
seated cable row, barbell back squat, machine leg
press, and machine knee extension. The low-load
group performed 25 35 repetitions per set per
exercise and the high-load group performed 8 12
repetitions per set.

What happened?
Muscular strength
The researchers reported that the high-load group
significantly improved 1RM bench press (+6.5%) but
the improvement in the low-load group was not
significant (+2.0%). However, the difference between
groups did not reach statistical significance. The
researchers reported that both the high- and low-load
groups significantly improved 1RM squat press
(+19.6% and +8.8%) and on this occasion the highload group increased significantly more than the lowload group.
Muscular size
The researchers reported that both the high- and lowload groups significantly improved elbow flexor muscle
thickness (5.3 and 8.6%), elbow extensor muscle
thickness (6.0% and 5.2%), and quadriceps muscle
thickness (9.3% and 9.5%) and there were no
significant differences between groups.

What did the researchers conclude?


The researchers concluded that both heavy and light
relative loads increase muscular size similarly in
trained subjects. However, they also concluded that
heavy loads are superior to light loads for increasing
muscular strength.

Limitations
The study was limited in that neither the volume nor
the volume load were equated between groups. The
low-load group performed approximately 3 times the
volume of the high-load group. It is therefore unclear
to what extent the greater volume performed by the
low-load group influenced the results. It is also
unclear to what extent the subjects felt that they had
recovered from each workout in each program and
whether one program was easier to perform and
recover from than the other.

Copyright Strength and Conditioning Research Limited, 2015

Page 11

Is repetition failure critical for the development of


muscle hypertrophy and strength? By Sampson, and
Groeller, in Scandinavian Journal of Medicine &
Science in Sports (2015)

Background
Effect of muscular failure on strength gains
Currently, the evidence indicates that training at a
closer proximity to muscular failure is superior to
training further away from muscular failure for
increasing strength in untrained individuals. This is on
the basis of 4 long-term trials comparing >2 training
groups, of which 3 reported a benefit in favor of
training at a closer proximity to muscular failure for at
least one of the outcome measures for strength while
the other trial reported no differences between
groups. The evidence also indicates that training at a
closer proximity to muscular failure is superior to
training further away from muscular failure for
increasing strength in trained individuals. This is on
the basis of 5 long-term trials comparing >2 training
groups, of which 3 reported a benefit in favor of
training at a closer proximity to muscular failure for at
least one of the outcome measures for strength while
the other 2 trials reported no differences between
groups.
More detail
Effect of muscular failure on size gains
Currently, the evidence indicates that training at a
closer proximity to muscular failure is superior to
training further away from muscular failure for
increasing muscular size in untrained individuals. This
is on the basis of 2 long-term trials comparing >2
training groups, of which both reported a benefit in
favor of training at a closer proximity to muscular
failure for at least one of the outcome measures for
strength while the other trial reported no differences
between groups. The evidence also indicates that
training at a closer proximity to muscular failure is
superior to training further away from muscular failure
for increasing strength in trained individuals. However,
this is on the basis of only 1 long-term trial comparing
>2 training groups, which reported a benefit in favor
of training at a closer proximity to muscular failure for
at least one of the outcome measures for strength.
More detail

OBJECTIVE: To compare the increases in muscular


strength (as measured by 1RM elbow flexion and
maximum voluntary isometric contraction (MVIC)
elbow flexion torque), size (as measured by magnetic
resonance imaging (MRI) of the elbow flexors), and
neural activation (as measured by electromyography
[EMG]) between three resistance training programs in
which the participants always trained to muscular
failure or predominantly not to muscular failure.
POPULATION: 28 previously untrained males, who
first undertook a 4-week period of standardized
resistance training to muscular failure before being
designated as either high or low responders and then
randomly allocated into one of 3 different groups.
INTERVENTION: All groups performed a 12-week
resistance training program comprising 4 sets with
85% of 1RM for the elbow flexors, training 3 times per
week. The 3 groups trained using slightly different
numbers of repetitions and proximity to muscular
failure. The failure group performed all sets to
muscular failure (typically 6 repetitions in each set)
and trained using a 2-second concentric and a 2second eccentric muscle action. The fast-concentricnot-to-failure group trained without going to muscular
failure (4 repetitions per set) and trained using a
maximal concentric and a 2-second eccentric muscle
action. Finally, the fast-not-to-failure group trained
without going to muscular failure (4 repetitions per
set) and trained using a maximal concentric and a
maximal eccentric muscle action. Both not-to-failure
groups performed 1 set per week to failure in order to
ascertain the loading for the subsequent week.

What happened?
The researchers reported that although all 3 groups
increased muscular strength in both elbow flexion 1RM
(pooled increase = 31%) and MVIC elbow flexion
torque (pooled increase = 13%), there were no
significant differences between groups. Similarly, they
reported that although all 3 groups increased muscle
size in the elbow flexors (pooled increase = 11%),
there were no significant differences between groups.
The researchers also reported a significant increase in
the agonist EMG activity during 1RM performance
(pooled increase = 22%), although there were again
no significant differences between groups. Care should
be taken in the interpretation of this result, as it does
not reflect an increase in voluntary activation, which
would require a measurement relative to involuntary
stimulation.

What did the researchers conclude?


The researchers concluded that training to muscular
failure is not necessary to achieve gains in strength
and size.

Limitations
Both not-to-failure groups performed 1 set per week
to failure each week. This may have confounded the
results. Also, the failure group performed a greater
volume of training than the other groups.

Copyright Strength and Conditioning Research Limited, 2015

Page 12

Block versus weekly undulating periodized resistance


training programs in women, by Bartolomei, Stout,
Fukuda, Hoffman, and Merni, in The Journal of
Strength & Conditioning Research (2015)

Background
Effect of periodization on strength gains
Currently, the evidence indicates that training using a
form of periodization is superior to training with no
periodization for increasing strength in untrained
individuals. This is on the basis of 7 long-term trials
comparing >2 training groups, of which 4 reported a
benefit in favor of training using a periodization
method for at least one of the outcome measures for
strength, while the other trials reported no differences
between groups. The evidence also indicates that
training using a form of periodization is superior to
training with no periodization for increasing strength
in trained individuals. This is also on the basis of 7
long-term trials comparing >2 training groups, of
which 3 reported a benefit in favor of training at a
closer proximity to muscular failure for at least one of
the outcome measures for strength while the other
trials reported no differences between groups. For
untrained subjects, the exact type of periodization for
optimizing strength gains is unclear. Not all
periodization methods have been compared. To date,
8 trials have compared non-linear and linear
periodization models in untrained subjects and while 4
have reported superior effects of non-linear, 1
reported a superior effect of linear, and the remainder
found no differences between groups. For trained
subjects, periodization type for strength gains seems
to be irrelevant although not all periodization methods
have been compared in multiple trials. To date, 7 trials
have compared non-linear and linear periodization
models in trained subjects and all but 1 trial found no
differences between groups.
More detail
Effect of periodization on size gains
Currently, the evidence indicates that training using a
form of periodization might be superior to training
with no periodization for increasing muscular size in
untrained individuals. However, this is only on the
basis of 2 long-term trials comparing >2 training
groups, of which 1 reported a benefit in favor of
training using a periodization method for at least one
of the outcome measures for strength, while the other
trial reported no differences between groups. On the
other hand, the evidence indicates that training using
a form of periodization is similar to to training with no
periodization for increasing muscular size in trained
individuals. However, is also on the basis of only 2
long-term trials comparing >2 training groups, which
both reported no differences between groups.
More detail

OBJECTIVE: To compare the changes in muscular


strength (as measured by 1RM squat, deadlift and
bench press, and maximal isometric mid-thigh pull
force), body composition (using skin-fold calipers),
and countermovement jump height following different
resistance training programs involving either block
periodization or non-linear (weekly undulating) in
resistance-trained females.
P O P U L A T I O N : 17 resistance-trained females,
randomly allocated to either a block periodization
group (9 subjects, aged 24.7 4.2 years) or a nonlinear periodization group (8 subjects, aged 23.2
2.2 years).
INTERVENTION: Both groups performed a 10-week
resistance-training program, training 3 times per week
with a similar volume and with the same exercises.
The block periodization group was subdivided into two
5-week sections, comprising a hypertrophy section
(high volume, low relative load) and a strength section
(low volume, high relative load). The non-linear
program varied these parameters from one week to
the next, training using a different scheme each week,
in two similar 5-week sections.

What happened?
Muscular strength
The researchers found that countermovement jump
height, 1RM squat, and 1RM deadlift all significantly
increased in both groups, while 1RM bench press and
mid-thigh pull isometric force did not. They noted that
1RM squat increased significantly more in the nonlinear group than in the block group (27.7% vs.
15.2%).
Muscular size
The researchers found that estimated lean body mass,
arm muscle cross-sectional area, and thigh muscle
cross-sectional area increased significantly in both
groups. They noted that thigh muscle cross-sectional
area increased significantly more in the non-linear
group than in the block group (5.8% vs. 1.6%).

What did the researchers conclude?


The researchers concluded that a non-linear, weekly
undulating periodization model may be superior to a
block periodization model in a 10-week resistance
training program for increasing maximum lower body
strength, size and jumping performance in resistancetrained females.

Limitations
The study was limited as it only compared block and
weekly non-linear periodization models for a relatively
short period of time. It is unclear whether other
models might be superior. Moreover, it is unclear
whether these differences would be maintained after a
longer duration.

Copyright Strength and Conditioning Research Limited, 2015

Page 13

Elastic bands in combination with free weights in


strength training: neuromuscular effects, by
Andersen, Fimland, Kolnes, and Saeterbakken, in The
Journal of Strength & Conditioning Research (2015)

Background
Elastic resistance-training using elastic resistance
bands (ERBs) is commonly-used in rehabilitation.
ERBs resist being lengthened and exert a tensile force
directed towards returning to their resting length.
Tensile force at any length depends upon the elastic
properties. Elastic properties are described by a
stress-strain relationship, where stress is the tensile
force per unit area and strain is the ratio of total
increase in length to starting length. The stress-strain
relationship provides a measure of the amount of
tensile force required to increase the length of the
band by a given distance. The slope of the stressstrain relationship is the elastic modulus. Stress is
plotted on the y-axis and strain on the x-axis, so a
larger elastic modulus implies a steeper gradient
wherein larger tensile forces are required for the same
increases in ERB length. Thus, stiffer ERBs have a
higher elastic modulus while less-stiff ERBs have a
lower elastic modulus. So using a stiffer ERB makes an
exercise harder. Also, the resistance that an ERB
provides at any given length increases with increasing
length. So an exercise is harder with a pre-stretched
ERB than with an initially-slack ERB. While ERBs are
inexpensive, versatile, lightweight, and unthreatening,
they have disadvantages. Firstly, when using ERBs, an
exercise will differ from a comparable exercise using
free weights as ERBs are a form of variable resistance.
The joint moments during elastic resistance training
are a function of the length of the ERB, which is itself
a function of joint angle in single-joint exercises and
of joint angles in multi-joint exercises. Whether
variable resistance is more or less effective than
isoinertial resistance training for increasing strength,
size and power is unclear. Secondly, when stretching
an ERB, most exercises involve taking the ERB from a
shortened state while the prime mover muscles are
lengthened to a lengthened state while the prime
mover muscles are shortened. Thus, since the tensile
force exerted by the ERB increases with increasing
length, the difficulty of the exercise is greatest when
the ERB is longest and the prime mover muscles are
shortened (i.e. contracted). This is in contrast to freeweights exercises, which tend to be most difficult
when the prime mover muscles are most lengthened.
Thus, given that regional hypertrophy is known to
occur in response to exercises where the muscles are
stimulated most at different muscle lengths, ERBs
could develop muscles in a different way from the
same exercise performed with free-weights. Thirdly,
ERBs differ from free weights in that it is not easy to
measure how much force is being exerted in order to
perform an exercise. Free weight exercises can be
quantified by reference to the load (in either pounds
or kilograms) but although ERBs are graded by color,
it is not easy to know how to progress the loading or
to compare the ERB exercise with a dumbbell exercise.

OBJECTIVE: To compare the effects of variable (using


ERBs) and constant load external resistance types on
changes in muscular strength (as measured by 6RM
back squat and knee extension maximal voluntary
isometric contraction (MVIC) force at 60, 90 and 120
degrees), athletic performance (as measured by
countermovement jump height from the same 3 joint
angles) and neural activation, (as measured by
electromyography [EMG] during the MVICs) after a
long-term resistance training program.
POPULATION: 32 resistance-trained females (aged
20 44 years), randomly allocated either to a variable
resistance or a constant load group.
INTERVENTION: Both groups performed a 10-week
period of resistance training, involving the back squat
and split squat, training 2 days per week. The
constant load group used standard barbell exercises
and the variable resistance group used the same
barbell exercises with the load split between free
weights and ERB resistance. The contribution to the
total resistance from the bands in the top position was
58% at the start of the program and 38% at the end
of the program, as load was added solely using free
weights, as the subjects increased in strength.

What happened?
Muscular strength
The researchers reported that knee extension MVIC
increased significantly in both groups at all 3 angles
(60, 90 and 120 degrees) but there was no significant
difference in respect of the increase between the 2
groups or between the 3 angles. Similarly, they
reported that 6RM back squat significantly increased in
both groups but there was no difference between the
2 groups.
Muscle activation
The researchers reported that muscle activity did not
change significantly as a result of the intervention in
either of the groups when measured during the MVIC
or during the 6RM back squat.
Countermovement jump height
The researchers reported that countermovement jump
height increased significantly in both groups at all 3
angles (60, 90 and 120 degrees) but there was no
significant difference in respect of the increase
between the 2 groups or between the 3 angles.

What did the researchers conclude?


The researchers concluded that the variable and
constant load external resistance types led to similar
increases in strength and athletic performance.

Limitations
The study was limited in that the researchers did not
measure change in muscle size. This was unfortunate,
as few, if any, studies have measured differences in
hypertrophy between programs involving exercises
using different types of external load.

Copyright Strength and Conditioning Research Limited, 2015

Page 14

Effects and mechanisms of tapering in maximizing


muscular strength, by Pritchard, Keogh, Barnes, and
McGuigan, in Strength & Conditioning Journal (2015)
OBJECTIVE: To review the literature in order to
discuss the effects of tapering on maximal strength.

The Review
Introduction
Tapering is a reduction in normal training load in order
to enhance performance at a competition or test. It
can be performed for any sporting performance and is
commonly used in many popular team sports as well
as in track and field and in the main strength sports
(Olympic weightlifting, strongman, and powerlifting).
Types of taper
The reviewers explain that there are at least 4
different models of taper: the step taper, the linear
taper, the slow exponential decay taper, and the fast
decay exponential taper. The step taper involves a
single, one-off reduction in training volume at a
particular date prior to the competition. The linear
taper involves a progressive reduction in volume from
a certain date through to the competition. Finally, the
exponential (fast and slow variations) taper involves a
non-linear reduction in volume that is faster at the
beginning than towards the end of the tapering period.
Unfortunately, as the reviewers note, these 4 different
tapering styles have not been compared for the
performance of maximal strength tests.

activity but did not assess voluntary activation as a


proportion of involuntary activation (e.g. using an
interpolated twitch). This study reported increased
muscle activity in line with increased force production.
In contrast, a different study that did measure true
voluntary activation found no changes as a result of
the taper. It is therefore unclear whether any neural
activity changes occur as a result of tapering that
might affect strength. The reviewers also note that a
small number of studies have assessed potential
changes in muscle architecture (fascicle length,
pennation angle and physiological cross-sectional
area) but these have all produced negative results.

What did the reviewers conclude?


The reviewers concluded that tapering is effective for
increasing maximal muscular strength temporarily for
a competition. They conclude that all tapering formats
appear to be effective and that the literature currently
does not allow for the optimal tapering method to be
identified. They note that volume reductions of around
30 70% have been used with success and that
maintaining high relative loads while reducing volume
seems to be the most beneficial strategy.

Limitations
The review was primarily limited by the small number
of studies that have been performed in this area.

Effects of tapering on maximal strength


The reviewers assessed the limited literature and
deduced that tapering of any kind appears to be
effective for improving maximal strength over a short
period of time but the exact type of taper that is
optimal remains unclear. They note that there is a
trend for superior results to be observed during tapers
where high relative loads are maintained while volume
is reduced in comparison with tapers in which relative
load is also reduced. They note that tapers that have
been studied involved volume reductions of between
30 70% but whether this reduction is optimal is as
yet unknown.
Possible mechanisms of tapering
The reviewers noted that the literature regarding
tapering is very limited. However, some indications
have emerged that provide clues regarding what
mechanisms underlie the beneficial effects that
tapering has on maximal strength. The reviewers note
studies in which tapers were reported and which
followed prior phases of heavy training loads. They
noted that elevated markers of overreaching were
seen in these heavy training load phases, including
increased cortisol-to-testosterone ratios, creatine
kinase levels, glutamate levels, and glutamate-toglutamine ratios. Such markers were then reduced
during the subsequent tapers. In addition, the
reviewers note studies in which tapers were performed
in which the researchers measured changes in neural
activation. One study reported increased muscle

Copyright Strength and Conditioning Research Limited, 2015

Page 15

Short-term effect of crunch exercise frequency on


abdominal muscle endurance, by Juan-Recio, LopezVivancos, Moya, Sarabia, and Vera-Garcia, in The
Journal Of Sports Medicine And Physical Fitness
(2015)

Background
Effect of training frequency on strength gains
Currently, the evidence indicates that training with
different volume-matched frequencies over the course
of a week has little effect on strength gains in
untrained individuals. This is on the basis of 6 longterm trials comparing >2 training groups, of which all
but one reported no differences between groups. On
the other hand, the evidence indicates that training
with a higher volume-matched frequency might
possibly be superior to training with a lower volumematched frequency for increasing strength in trained
individuals. However, this is on the basis of 3 longterm trials comparing >2 training groups, of which 1
reported a benefit in favor of training with a higher
frequency for at least one of the outcome measures
for strength while the other 2 trials reported no
differences between groups.
More detail
Effect of training frequency on size gains
Currently, the evidence indicates that training with
different volume-matched frequencies over the course
of a week has little effect on gains in muscular size in
untrained individuals. This is on the basis of 4 longterm trials comparing >2 training groups, of which all
but one reported no differences between groups. On
the other hand, the evidence indicates that training
with a higher volume-matched frequency might
possibly be superior to training with a lower volumematched frequency for increasing muscular size in
trained individuals. However, this is on the basis of 3
long-term trials comparing >2 training groups, of
which 1 reported a benefit in favor of training with a
higher frequency for at least one of the outcome
measures of muscular size while the other 2 trials
reported no differences between groups.

OBJECTIVE: To compare the effects of training using


the crunch exercise 1, 2 or 3 days per week on
abdominal muscle endurance (as measured by the
bench trunk curl, which involved performing the
maximum number of upper trunk flexion repetitions
possible in a 2 minute period), in untrained adolescent
subjects.
POPULATION: 118 untrained high-school students
(59 males and 59 females; aged = 16.98 1.17
years), randomly allocated into groups training 1 day
per week, 2 days per week, 3 days per week, or a
non-training control group.
INTERVENTION: Each training group performed a
workout involving the crunch and cross-crunch
exercises 1, 2 or 3 days per week for a period of 6
weeks. Each workout involved 2 sets of each exercise,
with 30 seconds of rest between sets.

What happened?
Bench trunk curl test performance
The researchers found that the 1, 2, and 3 day per
week groups all improved bench trunk curl test
performance significantly but there were no significant
differences between the groups. The performance
increases in each of the 1, 2, and 3 day per week
groups were: 21.5%, 13.5%, and 14.4%, respectively.

What did the researchers conclude?


The researchers concluded there was no difference
between the groups training 1, 2, or 3 days per week
in the increase in abdominal muscle endurance, as
measured by the bench trunk curl test. They therefore
suggested that a small amount of crunch training (1
day per week) might be sufficient for increasing
abdominal muscle endurance in adolescents.

Limitations
The study was limited as strength was not measured
and therefore it is unclear whether this metric was
affected by the training program.

More detail

Copyright Strength and Conditioning Research Limited, 2015

Page 16

The effect of long term isometric training on


core/torso stiffness, by Lee and McGill, in The Journal
of Strength & Conditioning Research (2015)

Background
Core stability has been subject to a large amount of
research, both with a view toward improving athletic
performance and to preventing and treating low back
pain (LBP). However, in the literature, there has been
considerable variety between studies in respect of
what is defined by both the core and by stability.
Moreover, stability requirements may differ under
different loading conditions, particularly as the core
can be subject to indirect forces applied from a variety
of different directions and also in response to forces of
varying durations and magnitudes. Thus, the concept
of core stability is extremely difficult to pin down
accurately. Core stability is thought to be important
for athletes because of the transfer of force from the
upper body segments to the lower body and from the
lower body segments to the upper body in a process
called sequential kinetic linking. Researchers have
previously outlined how the acts of baseball pitching
and batting follow a sequential kinetic chain. This
phenomenon describes motions that follow a proximalto-distal pattern, which are initiated by larger, central
body segments and then proceed outward to the
smaller, more distal segments, such as the arms.
Where optimal proximal-to-distal kinematic sequences
occur in throwing motions, the pelvis is rotated using
the leg and hip muscles. The pelvis initially accelerates
but then quickly decelerates as it transfers energy to
the torso. The same pattern is repeated with the torso
and the arm and then the arm and the hand or bat.
During this sequence, it is thought that the activation
of the core muscles acts to decelerate pelvic rotation
and accelerate rotation of the upper trunk. Not all
researchers have considered the important role of the
trunk muscles in such sequences when attempting to
define core stability for athletes. Many generic
definitions have been proposed defining core stability
as the integrated functioning of the spine and
surrounding muscles to maintain intervertebral range
of motion within a safe limit. Such definitions fall short
not only of taking the role of the trunk in athletic
movement into account but also in that they exclude
the abdominal musculature (with the key ones being
the transverse abdominis, rectus abdominis, external
oblique, and internal oblique), which are also thought
to have a key role in core stability. In possibly the
most important definition of core stability, Kibler et al.
(2006) described it as the ability to control the
position and motion of the trunk over the pelvis to
allow optimum production, transfer and control of
force and motion to the terminal segment in
integrated athletic activities. Nevertheless, it is highly
likely that the current failure to uncover meaningful
findings in this area of research is at least partly
caused by the failure to define terms appropriately.

OBJECTIVE: To compare the long-term effects of


dynamic and isometric training methods on changes in
active and passive core stiffness in untrained and
trained athletes. Active stiffness was measured by
reference to a quick release trial. The subjects sat in a
semi-seated position in a restraint jig that restricted
hip and lower limb motion but left the trunk free to
move in all directions. The subjects were then preloaded with a 16kg mass, which was then removed
without notice. The subjects used bracing techniques
to reduce movement upon the release of the mass.
Passive stiffness was measured through sagittal,
frontal, and transverse plane passive bending trials in
a special apparatus in which subjects were secured at
the hips, knees and ankles on a solid lower body
platform. Subjects were encouraged to relax while the
apparatus performed certain limited range of motion
movements.
POPULATION: 24 healthy, males (aged 23 3 years)
comprising 12 untrained subjects and 12 Muay Thai
athletes.
INTERVENTION: The subjects performed either
isometric or dynamic exercises for a 6-week period.
The isometric group used bracing cues during their
exercises. The isometric exercises included the plank,
bird dog, side plank, Pallof press, and inverted row.
The dynamic exercises included the superman, side
curl up, twisting curl up, back extension, and lateral
and rotational medicine ball throws.

What happened?
Active stiffness
No significant changes in active stiffness were found in
either trained or untrained subjects following either
the isometric or dynamic protocols.
Passive stiffness
The researchers found that passive stiffness increased
in both groups for several measures, although the
number of measures that increased and the size of the
increases was smaller in the dynamic group than in
the isometric group.

What did the researchers conclude?


The researchers concluded that isometric training is
superior for increasing passive core stiffness in
comparison with dynamic training, although neither
type of training appear to be able to increase active
stiffness.

Limitations
The study was limited in that it is unclear what
underlying mechanisms are responsible for the
observed changes in core stiffness in each training
group and whether they are similar or different.

Copyright Strength and Conditioning Research Limited, 2015

Page 17

Acute effects of antagonist static stretching in the


inter-set rest period on repetition performance and
muscle activation, by Miranda, Maia, Paz and Costa, in
Research in Sports Medicine (2015)

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

OBJECTIVE: To explore the effects of static stretching


of the antagonist muscles during the inter-set rest
period on the number of repetitions performed and on
the muscle activation of the biceps brachii, pectoralis
major and latissimus dorsi muscles (as measured by
electromyography [EMG]), in trained subjects.
POPULATION: 10 trained male subjects (22.4 0.9
years).
INTERVENTION: The subjects performed 3 sets of
the seated row exercise with 10RM to muscular failure
with a 2-minute inter-set rest period. In one condition,
the subjects rested passively during the inter-set rest
period. In another condition, a researcher applied a
passive stretch to the pectoralis major muscles for 40
seconds during the inter-set rest period.

What happened?
Number of repetitions
The researchers found that passive stretching of the
antagonist muscles in the inter-set rest periods led to
a significant increase in the number of repetitions that
were performed in set 1 (9.9 0.3 vs. 11.1 0.9
repetitions), in set 2 (9.2 0.6 vs. 10.6 1.0
repetitions), and in set 3 (8 0.6 vs. 9.6 0.5
repetitions). The increase in repetitions in each set led
to a greater overall training volume being performed
in the condition that involved passive stretching of the
antagonist muscles.
EMG activity
The researchers found significant increases in the EMG
activity of the latissimus dorsi and biceps brachii in the
condition involving passive stretching of the antagonist muscles compared to the control condition.

What did the researchers conclude?


The researchers found that passive stretching of the
antagonist muscles during the seated row exercise led
to a significant increase in the number of repetitions
performed as well as increased muscle activity of the
latissimus dorsi and biceps brachii muscles.

Limitations
The study was limited in that it is unclear whether the
same effect would be observed in other muscle groups
and for other exercises. It was also limited in that it is
unclear whether the findings could be replicated by
active stretching of the trainee themselves.

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Impact of limited hamstring flexibility on vertical


jump, kicking speed, sprint, and agility in young
football players, by Garca-Pinillos, Ruiz-Ariza, Moreno
Del Castillo, and Latorre-Romn, in Journal of Sports
Sciences (2015)

Background
Soccer or Association Football is the world's most
popular team sport and is played by more than 250
million people in over 200 separate countries. Through
this incredible popularity, it is known simply as
football in most parts of the world, despite the
existence of many other football codes, including
American Football, Australian Rules Football, Gaelic
Football, and Rugby. Soccer is played in teams of 11
players in two halves of 45 minutes in length with a
15-minute break between the two halves. Play runs
continuously within halves, such that the clock is not
stopped while the ball is out of play. There is usually a
15-minute half-time break between halves. Every four
years, the World Cup is held, in which around 200
national teams compete in qualifying tournaments in
the hope of becoming one of the 32 national teams
that compete in the 4-week competition. The most
recent World Cup was held in Brazil and was the
twentieth such competition. Germany beat Argentina
10 in the final to take their fourth title. Training for
soccer requires a focus on many different aspects,
including physical qualities, technical skills, and
tactical abilities. There are many different physical
qualities that are important for soccer, including
aerobic endurance, anaerobic endurance, strength,
power and flexibility. Traditionally, soccer teams placed
the most emphasis on aerobic endurance, noting that
players needed to be able to run long distances during
games. Indeed, there is a basic agreement that soccer
players travel around 9 14km in a single 90-minute
match, although the exact distance depends on the
position played. Training methods for improving
aerobic capacity include interval training, small-sided
games, game simulations, soccer-specific circuits,
repeated sprints, and agility drills. More recently,
soccer teams have begun to focus more on sprint
running ability, which appears to be crucial in allowing
soccer athletes to dominate situations during play.
This change in focus came out of the realization that
the nature of the activity performed by soccer players
during a game comprises long periods of low-intensity
walking or jogging, interspersed by short periods of
maximal or near-maximal effort, including accelerating
sprints. Some studies have found that players perform
many such accelerating sprints per match, for a total
distance of around 200m. Sprint running ability can be
improved by various training methods, including
sprinting, heavy load resistance-training, ballistic
resistance-training, plyometrics, and assisted and
resisted sprinting. There is currently no strong
consensus around which type of training is best,
although a recent meta-analysis concluded that novice
athletes benefit most from sprint running practice and
more advanced athletes benefit more from a varied
program.

OBJEC TIV E: To assess the impact of limited


hamstring flexibility (as measured by the unilateral
passive straight-leg raise test) on sprint running speed
over 5m, 10m and 20m, countermovement jump
height, agility (as measured by the Balsom agility
test), and ball speed during kicking with the dominant
and non-dominant legs in young soccer players.
POPULATION: 43 male football players (aged 14
18 years) from a semi-professional football academy,
allocated into two groups based on performance in the
hamstring flexibility test: flexible and inflexible.

What happened?
Differences between groups
The researchers reported no differences between the
two groups in relation to age, height, body mass, and
body mass index. However, they reported that the
group with superior hamstring flexibility displayed
superior sprint running ability over 5m (by 6.1%),
over 10m (by 4.1%) and over 20m (by 3.3%). They
noted that the flexible group also displayed superior
agility as measured by the Balsom agility test (by
4.1%), greater counter-movement jump height (by
10.5%), and greater ball speed during kicking with
both the dominant (by 6.9%) and non-dominant (by
8.0%) legs.

What did the researchers conclude?


The researchers concluded that hamstring flexibility is
important for sprint running performance, jumping
ability, agility, and ball speed during kicking in young
soccer players.

Limitations
The study was limited as it was cross-sectional and
therefore does not establish whether improving
flexibility would improve sprint running, jumping,
agility or ball speed during kicking in soccer athletes.

Copyright Strength and Conditioning Research Limited, 2015

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Half-squat or jump squat training under optimum


power load conditions to counteract power and speed
decrements in Brazilian elite soccer players during the
preseason, by Loturco, Pereira, Kobal, Zanetti, Gil,
Kitamura, and Nakamura, in Journal of Sports
Sciences (2015)

Background
Soccer or Association Football is the world's most
popular team sport and is played by more than 250
million people in over 200 separate countries. Through
this incredible popularity, it is known simply as
football in most parts of the world, despite the
existence of many other football codes, including
American Football, Australian Rules Football, Gaelic
Football, and Rugby. For an introduction to soccer and
the requirements of this popular sport, please see the
preceding study review.

OBJECTIVE: To compare the effects of jump squat


and half-squat training on the expected reductions in
sprint running performance (as measured over 5m,
10m and 20m), vertical jumping ability (as measured
by both squat and countermovement jump heights),
and power output during jump squats and half squats
that tend to occur following a 4-week pre-season
training period in soccer players.
POPULATION: 23 elite male soccer players, randomly
allocated into two groups: jump squat (aged 23.4
3.6 years) and half squat (aged 24.1 5.2 years).
INTERVENTION: The soccer players performed 10
power oriented training sessions during a 4-week, preseason training period. In sessions 1 4, the jump
squat and half squat groups both performed 6 sets of
8 repetitions with the jump squat or half squat
exercise using the optimum load for power. In
sessions 5 7, the groups used 6 sets of 6 repetitions
with 1.05 times the optimal load for power. In sessions
8 10, the groups used 1.10 times the optimal load
for power. Rest periods of 2 minutes were taken
between each set.

What happened?
Vertical jumping ability
Both jump squat and half squat groups increased
squat jump height but the increase in the jump squat
group was trivial, while the increase in the half squat
group was moderate (1.2% vs. 5.8%). The changes in
both groups in respect of countermovement jump
height were trivial (0.4% vs. -1.2%).
Power output during jump squats and half squats
The changes in power output during jump squats by
the jump squat and half squat groups were minimal
(0.0% vs. 0.1%). However, there were moderate
decreases in half squat power output in both training
groups (12.5% vs. 7.9%).
Sprint running speed and acceleration
Reductions in the jump squat and half squat groups
occurred for all measures of sprint running speed (5m,
10m and 20m), with the largest reductions occurring
in both groups over 5m. Reductions in both the jump
squat and half squat groups occurred for all measures
of sprint running acceleration (5m, 10m and 20m),
with the largest reductions occurring in both groups
over 0 5m and over 5 10m compared to over 10
20m. However, the reduction in the jump squat group
over 0 5m was small but the reduction in the half
squat group was moderate.

What did the researchers conclude?


The researchers concluded that the half squat appears
to be more beneficial for protecting squat jump ability
while the jump squat appears to be more beneficial for
preventing reductions in sprint running acceleration
over very short distances.

Limitations
The study was limited as it was performed over a very
short period of time (4 weeks).

Copyright Strength and Conditioning Research Limited, 2015

Page 20

Training for power and speed: effects of increasing or


decreasing jump-squat velocity in elite young soccer
players, by Loturco, Nakamura, Kobal, Gil, Cal,
Cuniyochi, and Roschel, in The Journal of Strength &
Conditioning Research (2015)

Background
Soccer or Association Football is the world's most
popular team sport and is played by more than 250
million people in over 200 separate countries. Through
this incredible popularity, it is known simply as
football in most parts of the world, despite the
existence of many other football codes, including
American Football, Australian Rules Football, Gaelic
Football, and Rugby. For an introduction to soccer and
the requirements of this popular sport, please see the
preceding but one study review.

OBJECTIVE: To compare the effects of two different


velocity-based jump training programs involving either
increasing or decreasing the jump squat velocity (by
increasing or reducing the external load) on countermovement jump height, mean propulsive velocity in
the jump squat, 1RM leg press, sprint running
performance (over 5m, 10m and 20m) and agility (as
measured by the zig-zag change of direction (COD)
test).
POPULATION: 24 elite under-20 soccer players,
randomly assigned to an increased bar velocity group
or a reduced bar velocity group.
INTERVENTION: All subjects performed a 6-week
period of jump squat training in a Smith machine,
training 3 times per week. The increased bar velocity
group trained using jump squats with some load
removed using elastic bands in order to increase bar
speed by 20%. The reduced bar velocity group trained
using added load to the Smith machine (mean extra
load = 41.4 9.5kg) in order to reduce bar velocity
by 20% from baseline. Velocities in the increased and
reduced bar velocity groups were 1.63 0.11m/s and
1.08 0.07m/s, respectively.

What happened?
Leg press 1RM strength
The researchers reported that although both groups
increased leg press 1RM strength significantly, the
increase in the increased bar velocity group was
greater than in the reduced bar velocity group (8.3%
vs. 5.4%).
Countermovement jump height
Both groups increased countermovement jump height
significantly but there was no difference between the
two groups.
Sprint running speeds
The increased bar velocity group increased sprint
running speeds over 5m, 10m and 20m but the
reduced bar velocity group only increased sprint
running speed over 20m only. Changes in the
increased bar velocity group were greater over 5m
(8.2% vs. 2.5%), 10m (6.1% vs. 1.9%) and 20m
(6.0% vs. 2.2%).
Agility
Both groups increased COD test performance and
there was a non-significant trend for the increased bar
velocity group to increase to a greater extent than
the reduced bar velocity group (6.3% vs. 2.9%).

What did the researchers conclude?


The researchers concluded that increasing bar velocity
during jump squat training was superior for increasing
sprint running and agility performance while maximum
strength was enhanced to a greater extent by
reducing velocity.

Limitations
The study was limited as it is unclear whether these
differences would occur when training >6 weeks.

Copyright Strength and Conditioning Research Limited, 2015

Page 21

Sport-specific training targeting the proximal


segments and throwing velocity in collegiate throwing
athletes, by Palmer, Uhl, Howell, Hewett, Viele, and
Mattacola, in Journal of Athletic Training (2015)

Background
Throwing is a key feature of human behavior and
appears to be one of the factors differentiating us
from other primates. Evidence for hominids taking
part in throwing activities stretches back before the
existence of homo sapiens and these facts suggest
that throwing may have played some role in the
evolution of modern humans, potentially through its
benefit for hunting and the consequent provision of
food or in defense against predators. In modern times,
throwing is now a key action in many sports, including
American Football, rugby, baseball, basketball and
cricket. Athletes who compete in these sports often
devote considerable effort to being able to throw with
greater force and accuracy. From the layman's
perspective, throwing is an activity that almost
exclusively involves the arm and shoulder. However,
researchers investigating the biomechanics of such
movements have uncovered that the act of throwing
involves the whole body in a sequential kinetic chain.
This phenomenon is where joint angular motions
follow a distinctive proximal-to-distal pattern of
activity. Movements are initiated by larger, central
body segments and then proceed outward to the
smaller, more distal segments, such as the arms and
hands. Where optimal proximal-to-distal kinematic
sequences occur in throwing motions, the pelvis is first
rotated as a result of force produced by the leg and
hip muscles. The pelvis therefore initially accelerates
but then quickly decelerates as it transfers this kinetic
energy to the torso. The same pattern is repeated
with the torso and the arm, and then the arm and the
hand, ultimately resulting in the object being thrown.
The exact factors that are associated with optimal
throwing ability are unclear but may include the
precise co-ordination of the sequential kinetic chain,
the strength of the key muscles involved, the ability to
store elastic energy in the shoulder joint during recoil,
and also the maximum and actual ranges of motion
(ROM) of each of the joint angles involved.

OBJECTIVE: To compare the effects of a core muscle


endurance-training program and a sport-specific
power-training program on the change in peak
throwing velocity (normalized for bodyweight) as well
as on the change in chop-and-lift power output
(normalized for bodyweight).
POPULATION: 46 healthy, National Collegiate Athletic
Association Division III athletes (age 20 1.3 years),
comprising 17 female softball athletes and 29 male
baseball players, randomly allocated into either a
traditional endurance-training group or a powerstabilitytraining group.
INTERVENTION: The subjects trained for 7 weeks
using different programs. The traditional core muscle
endurance-training group and the power-stability
training group. The core muscle endurance-training
group training was designed to improve spinal
stabilization and involved plank variations(prone,
supine, side), superman, curl-ups, dead bugs, and
bird dogs. The power-training program also involved
spinal stabilization but emphasized multi-planar,
rotational exercises targeting the proximal segments
in a way that is sport-specific to throwing. Exercises
included seated-to-standing rotation, in-line lunge
weighted-rotation, and standing weighted-rotation.

What happened?
Peak throwing velocity
The power-training group increased throwing velocity
to a greater extent than the core endurance group.
The core endurance group increased throwing velocity
from 108.62 18.61 to 108.30 18.81km/hr while
the power-training group increased from 108.30
21.41 to 113.71 21.41km/hr.
Chop and lift power outputs
The power-training group increased chop power
output to a greater extent than the core endurance
group. The core endurance group increased chop
power output from 536 202 to 557 199W while
the power-training group increased from 511 206 to
616 224W. Similarly, the power-training group
increased lift power output to a greater extent than
the core endurance group. The core endurance group
increased lift power output from 258 126 to 308
118W while the power-training group increased from
248 128 to 362 166W.

What did the researchers conclude?


The researchers concluded that a sport-specific powertraining regimen targeting the proximal segments was
superior to a traditional core endurance training
routine for improving both throwing velocity and
power output during the chop and lift test.

Limitations
The study was limited in that it is unclear to what
extent the training program was affected by the
inclusion of the various exercises involved.

Copyright Strength and Conditioning Research Limited, 2015

Page 22

Peripheral heart action (PHA) training as a valid


substitute to high intensity interval training to
improv e res ting c ardiov as c ular c hanges and
autonomic adaptation, by Piras, Persiani, Damiani,
Perazzolo, and Raffi, in European Journal of Applied
Physiology (2015)

Background
Interval training was first developed by track and field
athletes in the middle of the last century to help
improve middle- and long-distance running
performance. Track running performance, like
performance in other endurance sports, is dependent
upon three main physiological factors: aerobic
capacity, lactate threshold, and work economy.
Together, these variables can explain the large
majority of the difference in endurance performance
between individuals in both heterogenous (varied) and
homogenous (similar) groups. In contrast, each of the
variables alone is only able to explain the majority of
the difference in endurance performance between the
individuals in heterogenous groups. Aerobic capacity is
measured using VO2-max, which is the volume of
oxygen that the body can take in and use effectively in
a given period of time, usually measured relative to
bodyweight as ml/kg/min. Lactate threshold is
measured by reference to blood lactate. During an
incremental exercise test, blood lactate initially
remains close to its resting value. At a certain exercise
intensity, however, it rises above the resting value and
this exercise intensity is called the lactate threshold.
Running economy (strictly work economy if including
other exercise modalities) is a measurement of the
efficiency of the athlete. Economy is most commonly
described in terms of how much oxygen it takes to run
a given distance at a given speed. Traditionally, the
e x c l u s i v e m e t h o d f o r d e v e l o p i n g e n d u ra n c e
performance was steady-state exercise. Indeed,
researchers have found that steady-state exercise can
improve endurance performance in untrained
individuals. However, improvements in already welltrained individuals are small. Consequently, studies
exploring the effects of steady-state exercise in
trained subjects have often failed to find significant
increases in endurance performance or in any of the
underlying physiological factors (aerobic capacity,
lactate threshold, and work economy). More recently,
high-intensity interval training (HIIT) has been
developed as a tool for increasing endurance
performance. HIIT can be broadly defined as repeated
bouts of short-to-moderate duration exercise (i.e. 10
seconds to 5 minutes) at an intensity greater than the
anaerobic threshold. These exercise bouts are divided
by short bouts of either low-intensity work or
inactivity that allow either a partial or a full recovery.
Researchers have found that HIIT can improve
endurance performance in untrained individuals. The
increases are often larger than those following from
steady-state interventions of similar duration.
Moreover, research has often found significant
increases in endurance performance in trained
individuals following HIIT exercise interventions.

OBJECTIVE: To compare the effects of Peripheral


Heart Action Training (PHAT) and HIIT on muscular
strength (as measured by reference to 1RM in each of
the pectoral machine, knee extension machine, lat
pull-down, leg curl, shoulder press, and calf raise
exercises), maximal aerobic capacity (as measured by
a cycle ergometer-based VO2-max test) and on
autonomic regulation (as measured by time series of
beat-to-beat intervals for heart rate variability (HRV),
and baroreflex sensitivity).
POPULATION: 18 young adults (9 females and 9
males), aged 24 3 years, randomly allocated either
to an HIT group or to a PHAT group.
INTERVENTION: Both groups performed 30 training
sessions over a 12-week period. In each session, the
HIIT group performed 5 intervals of 1-minute hard
effort and 2-minutes of easy cycling. The 1-minute of
hard effort was performed at 100% of VO2-max. The
PHAT group performed 4 circuits of 6 resistance
training exercises: pectoral machine, knee extension
machine, lat pull-down, leg curl, shoulder press, and
calf raise exercises. In each circuit, 15 repetitions of
each exercise were performed with minimal rest
between each exercise. The only rest was the time
required to move between machines. Each circuit was
interspersed with 1 minute of rest.

What happened?
Maximal aerobic capacity (VO2-max)
Although both groups increased VO2-max, the
researchers found that the HIIT group increased VO2max to a greater extent than the PHAT group (18.7%
vs. 8.0%).
Muscular strength
The researchers found that both groups increased
muscular strength in the lower body exercises but only
the PHAT group increased muscular strength in the
upper body exercises.
Autonomic regulation
The researchers found that baroreflex sensitivity
increased in both groups but showed a greater
increase after HIIT than after PHAT (18.2% vs.
11.0%). The researchers noted that while there were
significant changes in HRV in both groups, there were
no significant differences between groups. However,
they noted a non-significant trend for a reduction of
markers of sympathetic activity in the PHAT group
(normalized units of high vs. low frequency domains)
but an increase of the same markers in the HIIT
group.

What did the researchers conclude?


The researchers concluded that PHAT caused increases
in muscular strength and maximal aerobic capacity
while having potentially beneficial health effects on
autonomic regulation.

Limitations
The study was limited in that the extent to which HRV
can be used to assess autonomic regulation is unclear.

Copyright Strength and Conditioning Research Limited, 2015

Page 23

Strength and Conditioning Research

2. BIOMECHANICS AND MOTOR CONTROL

Copyright Strength and Conditioning Research Limited, 2015

Page 24

Strength and Conditioning Research

Control of propulsion and body lift during the first two


stances of sprint running a simulation study, by
Debaere, Delecluse, Aerenhouts, Hagman, and
Jonkers, in Journal of Sports Sciences (2015)

Background
Sprint running is a key athletic quality that is
contested in its own right in track and field, as well as
being critical for success in many team sports, such as
soccer, rugby, and both Australian Rules and American
Football. Consequently, many researchers have
performed extensive work into sprint running, both
overall and in respect of certain specific aspects,
including kinematics (joint angles) kinetics (forces and
moments), stiffness, electromyographic (EMG)
activity, and the transfer of training to sprint running.
As a result, there is a large body of knowledge in
respect of the features that are characteristic of elite
sprinters and also of the training methods that may
lead to best results. Sprint running performance is
determined by the combination of stride length and
stride frequency. Observational research indicates that
some athletes rely on stride length for increased
speed while others rely more on stride frequency for
increased speed. Analysis of biomechanics suggests
that for improving stride length, hopping, bounding
and stepping drills may be able to develop different
aspects of force production during the sprint running
gait cycle. Analysis of experimental trials suggests
that sprint training, resistance training, plyometrics
and resisted sprint training all produce significant
improvements in stride length. The effectiveness of
plyometrics may be related to observations that the
storage of elastic energy is important for sprint
running performance. Indeed, researchers have found
that this elastic energy storage becomes more
important with increasing sprinting speed. This
indicates that drop jumps and other vertical
plyometric exercises might be among the most
effective training tools. Indeed, since biomechanical
analysis suggests that the main role of the knee
extensors is one of shock absorption and increased
joint stiffness upon ground contact, this further
supports a role for reactive plyometric training that
stresses this muscle group, such as drop jumps.
Related to this idea are the results of musculoskeletal
modeling research, which has reported that the
limiting factor for sprint running performance is
muscle contraction velocity. This suggests that training
rate of force development for the key running muscles
may be the single most important factor in developing
sprint running performance. This probably requires a
mix of training involving low loads with high velocities
(which can be achieved using plyometrics) and high
loads with low velocities. For improving stride
frequency, both experimental trials and biomechanical
analysis indicate that combined heavy and explosive
training along with overspeed running, using either a
downhill slope or towing are all effective.

OBJECTIVE: To explore the contribution of lower body


joint moments (measured using the combined data
produced from a motion analysis system and from
force plates) and the contribution of individual muscle
forces (estimated by musculoskeletal modeling) to the
vertical and horizontal acceleration of the body center
of mass during the first two steps of a track sprint in
trained track sprinters.
POPULATION: 7 well-trained sprinters (2 males and
5 females) aged 19.75 3.01 years. The males had
personal best times over 100m of 11.10s and 11.77s
and the range of times in females was 12.05 12.36s.

What happened?
Contribution of joint moments
Through inverse dynamics, the researchers calculated
the joint moments and found that the ankle joint of
the stance leg contributed most to center of mass
horizontal propulsion, contributing 67% in the first
stance phase and 93% in the second stance phase. In
contrast, they found that all three joints contributed
more evenly to vertical lift of the center of mass in the
first stance phase, with the hip, knee and ankle joints
each contributing 12%, 38% and 50%, respectively.
However, the second stance phase only involved knee
and ankle joint moments, with contributions being
24% and 76%, respectively.
Contribution of muscle forces
Through musculoskeletal modeling, the researchers
estimated the muscle forces and found that each of
the ankle plantar flexors of the stance leg appeared to
contribute similarly to horizontal propulsion, with the
gastrocnemius contributing 25% and 29% in first and
second stance phases and the soleus contributing
32% and 27% in the first and second stance phases.
Similarly, they found that the ankle plantar flexors of
the stance leg appeared to contribute similarly to
vertical lift, with the gastrocnemius contributing 20%
and 24% in first and second stance phases and the
soleus contributing 36% and 28% in the first and
second stance phases.

What did the researchers conclude?


The researchers concluded that the ankle plantar
flexors are key muscles in driving sprint athletes out
of the blocks at the start of a race, being the primary
contributors to joint moments during the first two
steps.

Limitations
The study was limited in that it was unclear to what
extent the joint moments were affected by the process
of sequential kinetic linking, in which kinetic energy is
produced by proximal segments and then transmitted
to more distal segments in order to produce a more
efficient and powerful co-ordinated action.

Copyright Strength and Conditioning Research Limited, 2015

Page 25

Selected determinants of acceleration in the 100m


sprint, by Makaa, Fostiak, and Kowalski, in Journal
of Human Kinetics (2015)

Background
Sprint running is a key athletic quality that is
contested in its own right in track and field, as well as
being critical for success in many team sports, such as
soccer, rugby, and both Australian Rules and American
Football. For an introduction to sprint running and the
relevant research regarding this athletic movement,
please see the preceding study review.

OBJECTIVE: To explore the associations between


muscular strength (as measured by 1RM back squat
and isokinetic trunk flexion torque) jumping ability (as
measured by standing long jump, standing 5-jumps,
and standing 10-jumps) and both accelerating sprint
speed (as measured by 10m speed) and maximal
sprint speed (as measured by 30m speed) in welltrained track sprinters.
POPULATION: 22 male subjects, aged 21.7 1.08
years, including 11 competitive male sprinters, with a
mean personal best time of 10.96 0.36s for 100m
track sprint, and 11 recreationally trained students,
with a mean personal best time of 12.20 0.39s for
100m with 11.80s fastest time).

What happened?
Correlations with 10m and 30m sprint speeds
In the track sprinters, the researchers reported strong
correlations between 10m sprint speed and the
following performance tests: standing long jump (r =
0.77), standing 5-jump (r = 0.66), standing 10-jump
(r = 0.72), and 1RM back squat (r = 0.66). However,
30m sprint speed was only strongly correlated with
the following performance tests: standing long jump (r
= 0.68) and standing 10-jump (r = 0.62). Stride
length and stride frequency measured over 10m were
not correlated with 10m sprint time. However, stride
frequency measured over 30m was correlated with
30m sprint time (r = -0.82).
Correlations with 100m sprint speed
In the track sprinters, the researchers similarly
reported strong correlations between 100m sprint
speed and the following performance tests: standing
long jump (r = 0.82), standing 5-jump (r = 0.80),
standing 10-jump (r = 0.83), and 1RM back squat (r
= 0.73). Stride length measured over 10m was
correlated with 100m sprint time (r = -0.61) while
stride frequency measured over 30m was correlated
with 100m sprint time (r = -0.67).

What did the researchers conclude?


The researchers concluded that in most cases, the
horizontal jumps (standing long jump, standing 5jump, and standing 10-jump) were correlated strongly
with 10m, 30m and 100m sprint running performance.
There was also a strong correlation between 1RM back
squat and sprint running performance over all three
measured distances.

Limitations
The study was limited in that it was cross-sectional
and therefore it is unclear whether the attributes
displayed by the more successful sprinters were
causally related to their greater sprint running ability
or incidental.

Copyright Strength and Conditioning Research Limited, 2015

Page 26

Physical principles demonstrate that the biceps


femoris muscle relative to the other hamstring
muscles exerts the most force implications for
hamstring muscle strain injuries, by Dolman, Verrall,
and Reid, in Muscles, Ligaments and Tendons Journal
(2015)

Background
Like the quadriceps, the hamstrings muscle group
comprises four individual muscles located on the
thigh. However, the anatomy and muscle architecture
of the hamstrings muscle group are much more
complex than those of the quadriceps. There are three
two-joint hamstring muscles that cross both the hip
and the knee joints (which are the biceps femoris
(long head), semimembranosus, and semitendinosus)
and one single-joint hamstring muscle that only
crosses the knee joint (the biceps femoris (short
head)). The two-joint hamstring muscles all have their
origin on the ischial tuberosity of the pelvis. The
single-joint hamstring muscle has its origin on the
lower half of the linea aspera and the lateral condyloid
ridge. Thus, three of the hamstrings perform both
knee flexion and hip extension and one performs only
knee flexion. Additionally, the hamstrings can be
divided into lateral and medial muscles. The lateral
muscles comprise the two heads of the biceps femoris
while the semi-membranosus, and semitendinosus are
the medial muscles. The lateral muscles insert on the
lateral condyle of the tibia and on the head of the
fibula, while the medial muscles insert on the medial
surface of the tibia and on the medial condyle. The
biceps femoris (long head) is the largest hamstring by
anatomical cross-sectional area but the semim e m b ra n o s u s i s t h e l a r g e s t b y w e i g h t a n d
physiological cross-sectional area. The semitendinosus
has the longest normalized fiber length when
compared to the other hamstrings while the
semimembranosus has the greatest pennation angle.
Muscles with more complex pennation arrangements
tend to have shorter normalized fiber lengths but
larger pennation angles and more fibers. The
semitendinosus is the only hamstring muscle that is
fusiform in shape. It has longitudinal muscle fibers
that are intersected by an intramuscular, tendinous
septum which separates the muscle into proximal and
distal regions. In contrast, the semimembranosus is
hemi-pennate. The muscle fibers lie in a parallel
arrangement, connecting the tendon at the origin on
the deep side and the tendon at the insertion on the
superficial side of the muscle. The biceps femoris
(long head) is also hemi-pennate. The muscle fibers
lie in a parallel arrangement, connecting the tendon at
the origin on the deep side and the tendon at the
insertion on the superficial side of the muscle. The
biceps femoris (short head) takes the form of a
trapezoid, with longer muscle fibers on the proximal
side and shorter ones on the distal side. Some groups
of researchers have suggested that the muscle
architectural arrangements of the hamstring muscles
may be important for identifying injury risk.

OBJECTIVE: To calculate the relative forces of each of


the two-joint hamstring muscles during a typical
lengthening contraction as performed during running
movements, by combining data from cadaver studies
regarding the muscle architecture of each muscle and
data from sprint running motion analysis studies
regarding the joint angle changes during running.
These data were incorporated into a single simplified
musculoskeletal, spring-based model for analysis.

What happened?
Hamstrings muscle lengths
The researchers input the muscle lengths of the
semimembranosus, semitendinosus, and of the biceps
femoris (long head) based on cadaver studies at
26.4cm, 31.6cm, and 28.1cm, and total muscletendon lengths of 44.3cm, 43.9cm, and 43.8cm.
Hamstrings muscle elongations and forces
Using their musculoskeletal model, the researchers
calculated that the stretch of the semimembranosus,
semitendinosus, and of the biceps femoris (long head)
muscles was 7.4% (3.3cm), 8.1% (3.6cm), and 9.5%
(4.2cm), respectively. They found that these increases
in length corresponded to muscle forces that were 1.1
times greater in the semitendinosus than in the
semimembranosus and 1.3 times greater in the biceps
femoris (long head) than in the semimembranosus.

What did the researchers conclude?


The researchers concluded that the additional changes
in length that are required of the biceps femoris (long
head) muscle during lengthening contractions as
performed during sprint running provide indirect
support for its status as the most commonly-injured
hamstring muscle in sport.

Limitations
The study was limited as it was based upon the
creation of a simplified musculoskeletal model and
may have ignored certain assumptions or contained
errors in the data used. For example, it may not be
valid to model muscles as individual, simple springmass systems.

Copyright Strength and Conditioning Research Limited, 2015

Page 27

Kinematic and sEMG analysis of the back squat at


different intensities with and without knee wraps, by
Gomes, Brown, Soares, Da Silva, De Oliveira Silva,
Serpa, and Marchetti, in The Journal of Strength &
Conditioning Research (2015)

Background
The back squat is an exercise performed with a barbell
resting on the upper trapezius. It is the standard
exercise for developing lower body strength and size
for both athletes and bodybuilders. A great deal of
research has been performed into the back squat.
Long-term trials have established that it is effective
for improving lower body strength and power as well
as vertical jumping and sprint running performance.
Biomechanics studies have found that there are
several key exercise technique variables that make a
difference to the effect of the exercise on the working
musculature. In particular, it has been found that the
load has a more pronounced effect than squat depth
on the force required from the ankle plantar-flexors,
that depth is a more significant factor than load for
the force required of the knee extensors, and that
both depth and load are key for determining the force
required from the hip extensors. Thus, both squat
depth and load should be considered as variables in
using squats depending on which muscle groups are to
be strengthened and to what extent. In terms of other
technique variables, researchers have found that
stance width and foot position make little difference to
most of the lower body muscles except the gluteus
maximus. Therefore, despite the claims of some
popular strength coaches and bodybuilders, using
different stance widths during squats are unlikely to
develop different parts of the quadriceps and stressing
individual quadriceps muscles or different parts of the
quadriceps will likely require more careful exercise
selection. However, using a wider stance does appear
to increase gluteus maximus activity during squats.

OBJECTIVE: To assess the acute effects of knee


wraps on knee and hip joint angle movements (as
measured by a single camera system tracking the
sagittal plane movements of 8 markers placed on key
anatomical locations) and on muscle activity of the
vastus lateralis and gluteus maximus (as measured by
electromyography [EMG]) during the back squat
exercise at two different relative loads. EMG activity
data were normalized to maximum voluntary isometric
contraction (MVIC) levels.
POPULATION: 14 resistance-trained males, age 24
4 years, with 3 1 years of back squat resistancetraining experience.
INTERVENTION: The subjects performed 1 set of 3
repetitions of the back squat to below 90 degrees of
knee joint flexion. There were 4 different conditions as
there were 2 variables: knee wraps vs. no knee wraps
and either low (60% of 1RM) or high (90% of 1RM)
relative load.

What happened?
Muscle activity
The researchers found that increasing the load from
60% of 1RM to 90% of 1RM increased the EMG
activity in both vastus lateralis and gluteus maximus
muscles. Knee wraps increased EMG activity in both
muscles at 60% of 1RM but decreased EMG activity in
the vastus lateralis at 90% of 1RM and left gluteus
maximus EMG activity unchanged at 90% of 1RM.
Joint angle movements
The researchers found that increasing the load from
60% of 1RM to 90% of 1RM led to significantly
reduced peak hip flexion angle in the no knee wraps
condition and reduced peak knee flexion angle in the
knee wraps condition. These reductions in joint angle
were accompanied by reduced vertical bar distance
traveled.

What did the researchers conclude?


The researchers concluded that increasing relative
load with and without knee wraps during the squat
exercise leads to increased muscle activity in the
vastus lateralis and gluteus maximus. They noted that
the use of knee wraps with high relative loads led to
reduced muscle activation of the vastus lateralis but
not in the gluteus maximus. They suggested that this
reduction in muscle activity might be caused by the
storage of elastic energy in the knee wraps that
makes the movement easier to perform.

Limitations
The study was limited in that only a single 1RM
measure was used (no knee wraps) and also in that
the researchers did not compare the level of muscle
activity between the vastus lateralis and gluteus
maximus. Therefore, it is unclear whether using knee
wraps caused a shift in the contribution of each
muscle to the overall lift performance.

Copyright Strength and Conditioning Research Limited, 2015

Page 28

Lower extremity strength and the range of motion in


relation to squat depth, by Kim, Kwon, Park, Jeon,
and Weon, in Journal of Human Kinetics (2015)

Background
The back squat is an exercise performed with a barbell
resting on the upper trapezius. It is the standard
exercise for developing lower body strength and size
for both athletes and bodybuilders. For an introduction
to this exercise, see the preceding study review.

OBJECTIVE: To ascertain whether flexibility and


muscular strength are each associated with squat
depth (as measured using motion analysis software).
Flexibility was measured by reference to joint range of
motion (ROM) of hip flexion, hip internal rotation, hip
external rotation, ankle dorsiflexion with an extended
and flexed knee joint, using a universal goniometer.
Muscular strength was measured by reference to two
key stabilizing muscle groups using a hand-held
dynamometer: the hip flexors and the ankle dorsiflexors. Associations were calculated using Pearson
product moment correlations and multiple stepwise
regression analysis was performed to identify the key
variables associated with squat depth.
POPULATION: 101 healthy, untrained subjects (64
males, aged 25.69 5.93 years; and 37 females,
aged 21.95 2.17 years).

What happened?
Correlations between squat depth and flexibility
The researchers reported that in males there was a
significant, negative correlation between squat depth
and hip flexion ROM, hip internal rotation ROM, and
ankle dorsiflexion ROM (with and without an extended
knee). The strength of the correlation ranged from
very small to moderate (r = -0.24 to r = -0.62). The
researchers also reported that in females only ankle
dorsiflexion ROM (with and without an extended knee)
was significantly negatively correlated with squat
depth and these correlations were small (r = -0.49 to
r = -0.46).
Correlations between squat depth and strength
The researchers reported that in males there was no
correlation between muscle strength and squat depth.
However, in females, they found a significant, negative
correlation between ankle dorsiflexor strength and
squat depth (r = 0.28).
Multiple regression analysis
The researchers reported that their multiple regression
model found that ankle dorsiflexion with a flexed knee
and hip flexion ROM were significantly associated with
squat depth in male subjects (R-squared = 0.44) and
ankle dorsiflexion with an extended knee and ankle
dorsiflexor strength were significantly associated with
squat depth in females (R-squared = 0.32).

What did the researchers conclude?


The researchers concluded that ankle dorsiflexion ROM
with a flexed knee and hip flexion are important
factors for enabling deep squatting in males, while
ankle dorsiflexion with an extended knee and ankle
dorsiflexor strength are important factors for enabling
deep squatting in in females. This may indicate that
increasing ankle dorsiflexion ROM, increasing hip
flexion ROM, and increasing ankle dorsiflexor strength
might lead to improved squat depth.

Limitations
The study was limited as it is unclear whether any
interventions involving the above recommendations
can actually improve squat depth.

Copyright Strength and Conditioning Research Limited, 2015

Page 29

Effects of an unstable load on force and muscle


activation during a parallel back squat, by Lawrence
and Carlson, in The Journal of Strength & Conditioning
Research (2015)

Background
Instability training has become a popular method for
simultaneously developing the core musculature as
well as certain prime movers. Indeed, researchers
have found that when standard upper- or lower-body
exercises are performed under unstable conditions,
this generally leads to increased core muscle activity,
as measured by electromyography (EMG). However,
acute studies exploring the prime movers in lowerbody exercises have generally found that unstable
variations lead to lower EMG activity than their stable
equivalents. Similar studies investigating the prime
movers during upper-body exercises have found
slightly more conflicting results, with some studies
showing benefits of instability training, others showing
no benefit, and others showing a detrimental effect.
However, A recent long-term investigation found that
instability training with a range of exercises using a
suspension device was able to produce similar gains in
strength to a set of similar, stable exercises for the
upper-body and for the lower-body in previously
untrained males. Thus, it may be the case that
instability training is similarly effective as traditional
resistance-training for the upper- and lower-body
prime movers in untrained subjects. Whether it is
capable of achieving similar gains in trained
individuals, however, is uncertain.

OBJECTIVE: To compare the ground reaction forces


and muscle activity produced during a parallel back
squat with and without an unstable load (using
weights suspended from the bar by an elastic band),
in trained subjects. Ground reaction forces were
measured using a force plate and muscle activity of
the rectus femoris, vastus lateralis, vastus medius,
biceps femoris, soleus, rectus abdominis, external
oblique, and erector spinae muscles was measured
using EMG.
POPULATION: 15 resistance-trained males, aged
24.2 3.4 years, with 8.1 4.3 years resistancetraining experience, and a 1RM parallel back squat of
131.4 21.4kg.
INTERVENTION: Subjects performed 10 repetitions
of the back squat with 60% of 1RM parallel back squat
under both stable and unstable conditions. Squat
depth was standardized for each condition by having
subjects touch a box that was set to a height such
that the crease at the hip was below the top of the
knee.

What happened?
Muscle activity
The researchers reported that the unstable condition
produced significantly greater EMG activity in the
external obliques, rectus abdominis, and soleus
muscles than the stable condition.
Ground reaction forces
The researchers reported that the unstable condition
produced significantly less peak vertical ground
reaction force, although this was a small absolute
reduction (3.9%).

What did the researchers conclude?


The researchers concluded that back squats performed
with an unstable load (in this case using weights
suspended from the bar by an elastic band) can be
used to increase activation of the abdominal muscles
and while peak vertical ground reaction forces are
reduced, the size of the reduction is not substantial.

Limitations
The study was limited in that it is unclear how the load
used by the subjects in the unstable condition related
to the 1RM back squat with an unstable load. The
differences between the unstable and stable conditions
may therefore relate mainly to differences in relative
load.

Copyright Strength and Conditioning Research Limited, 2015

Page 30

Effects of isometric quadriceps strength training at


different muscle lengths on dynamic torque production
by Noorkiv, Nosaka, and Blazevich, in Journal of
Sports Sciences (2015)

Background
Muscle architecture is the organization of the muscle
fibers within the muscle with respect to the line of
pull. The line of pull is the line drawn through the
origin and the insertion of the muscle. Muscle
architecture is one of the least well-researched
subjects when it comes to how muscles work. Despite
this, most researchers regard it as the single most
important factor when it comes to determining a
muscles function, force production capacity and
contraction velocity. Muscle architecture comprises
three main aspects: fiber or fascicle length, pennation
angle, and physiological cross-sectional area (PCSA).
Together, these three factors can be used to describe
any given muscle or muscle compartment. Fascicle
length is the average length of the muscle fascicles
within the muscle. It is often used instead of the more
correct measurement of muscle fiber length because it
is far easier to calculate. Changes in fascicle length
have a marked effect on the ability of a muscle to
produce force. This is because longer fibers contract at
higher velocities than shorter fibers. Longer fascicles
contract more quickly than shorter fascicles because
all of the sarcomeres in a single muscle fiber contract
at the same time. Since sarcomeres in a single muscle
fiber are arranged in series, this produces a greater
relative reduction in size from the same starting
length. Indeed, researchers have observed that
muscle fascicle length tends to be longer in elite 100m
sprinters than long-distance runners as well as in lesswell-trained sprinters. Muscle fiber length, or more
accurately, normalized fiber length, is the length of the
muscle after correcting for the average length of the
sarcomeres within it. This normalization process is
used so that muscles can be compared even when
they are stretched or contracted. An increase in
normalized fiber length therefore tells us that the
number of sarcomeres in series has increased (by a
process called sarcomerogenesis). Pennation angle is
the angle of the muscle fibers within the muscle with
respect to the angle of pull. Most muscles contain
fibers that are at an angle of between 0 30 degrees.
Pennation angle is the aspect of muscle architecture
that changes most with training. As the pennation
angle increases, more muscle fibers are able to fit into
the same anatomical cross-sectional area (ACSA),
although the PCSA in fact increases, because this is
measured at right angles to the line of pull. As
pennation angle decreases the force that each muscle
fiber can produce, increasing pennation angle is
therefore a trade-off between increasing the number
of muscle fibers but reducing the mechanical
advantage. It should therefore be clear that PCSA is
not quite the same as ACSA. ACSA is measured at
right angles to the angle of pull whereas PCSA is
measured at right angles to the pennation angle.

OBJECTIVE: To compare the effects of isometric


training at short (knee angle between 30 to 50
degrees), and long (knee angle between 70 to 100
degrees) muscle lengths, on gains in muscular
strength (as measured by concentric knee extension
isometric and isokinetic torque at 60, 90, 120, 180,
240 and 300 degrees/s) and size (as measured by
cross-sectional area and volume by way of magnetic
resonance imaging (MRI) scans) and to assess
whether the changes in strength are associated with
alterations in muscle fascicle length (as measured
using B-mode ultrasound).
POPULATION: 16 men, randomly allocated into
either short (8 subjects) or long (8 subjects) groups.
INTERVENTION: Subjects trained 3 times per week
for 6 weeks, using a protocol of 5 sets of 5 maximal
voluntary isometric contractions (MVICs) of 5 seconds
in duration per session, with a 5-second interrepetition rest and a 60-second inter-set rest.

What happened?
Muscular strength
Muscular strength, as measured by concentric knee
extension torque at a range of isokinetic velocities,
increased significantly after training only in the long
length group (by 12 13%) and did not increase in
the short length group.
Muscular size and volume
The researchers reported that muscle size and volume
increased after training only in the long length group
and not in the short length group.
Muscle architecture
The researchers reported that the increase in vastus
lateralis fascicle length increased in both groups (5.4
4.9%) but this change was not correlated with
changes in strength (as measured by concentric knee
extension torque) in either group.

What did the researchers conclude?


The researchers concluded that isometric training at
long muscle lengths caused significant increases in
muscular strength and size whereas isometric training
at short muscle lengths did not. However, both groups
training at short and long muscle lengths caused
significant increases in muscle fascicle length, which
were not correlated with changes in strength.

Limitations
The study was limited as it was performed using
isometric muscle actions, which may not be directly
comparable to more conventional training methods,
which typically involve dynamic movements.

Copyright Strength and Conditioning Research Limited, 2015

Page 31

Inhomogeneous quadriceps femoris hypertrophy in


response to strength and power training, by Earp,
Newton, Cormie, and Blazevich, in Medicine & Science
in Sports & Exercise (2015)

Background
Muscular hypertrophy is the increase in cross-sectional
area or size of a muscle. Regional hypertrophy was
originally defined as a change in the shape of a muscle
for the purposes of bodybuilding. More recently, the
term has been used in sports and exercise science to
refer to differences in hypertrophy along the length of
a muscle, where different sections may display greater
or less increases in size from one another. Such
differences in hypertrophy over sustained periods of
time may lead to changes in the shape of a muscle.
There are two main mechanisms according to which
regional hypertrophy might occur. Firstly, it has been
suggested that the compartmentalization of muscles
could mean that certain areas were activated to
perform certain ranges of motion of a joint action or
certain movements at a joint where multiple
movements are possible (such as at the hip or
shoulder). For example, a recent study of the gluteus
medius reported that, on the basis of anatomy and
innervation, the gluteus medius has potentially up to 4
compartments (anterior, anterior-middle, posteriormiddle, and posterior). These compartments have
different nerve branches and varying pennation angles
(+33.1, +13.2, -9.9, and -29.5 degrees), which
means that they are best suited to slightly different
tasks. Indeed, on the basis of the anatomy, it has
been proposed that the horizontal arrangement of the
posterior fascicles of the gluteus medius relative to the
femoral neck means that they probably act primarily
to stabilize the head of the femur in the acetabulum.
In contrast, the other fibers of the gluteus medius,
which are arranged more vertically with respect to the
femur, are better positioned to perform hip abduction.
Secondly, it has been observed that there are
differences in muscle fiber type between one region of
a muscle and another. This could mean that different
rep ranges or muscle actions could provide different
stimuli to the varying regions. For example, some
researchers have noted that type I muscle fibers are
predominant in the deep vastus lateralis, while type II
muscle fibers are predominant in the superficial vastus
lateralis. Other researchers have noted differences
between regions from proximal-to-distal as well as
between regions from deep-to-superficial. This means
that where different repetition ranges are used and
thereby target different muscle fiber types, this could
lead to preferential growth in certain parts of a
muscle. Indeed, researchers recently confirmed that
differences in electromyography (EMG) activity in
certain parts of a muscle correlated with the increases
in muscular size.

OBJECTIVE: To compare the effects of heavy-loadslow-speed with light-load-fast-speed strength training


on regional hypertrophy within the quadriceps (as
measured by ultrasound, proximally to distally).
P O P U L A T I O N : 36 untrained males, randomly
allocated to 4 groups: parallel-depth heavy squat
training (using loads of 75 90% of 1RM), paralleldepth jump squat training (using loads of 0 30% of
1RM), volitional-depth (smaller range of motion than
parallel) jump squat training (using loads of 0 30%
of 1RM), and a non-training control group.
INTERVENTION: All subjects trained 3 times per
week for 8 weeks using a non-linear, daily undulating
periodization model.

What happened?
Total quadriceps hypertrophy
All three training groups increased muscular size of
the quadriceps summed across all regions similarly,
with the heavy, light (parallel) and light (volitional)
groups increasing by around 14 15% in total.
Regional differences caused by relative load
The researchers found that the heavy and light
(parallel) groups increased region-specific hypertrophy
similarly in the proximal (15.4 7.7% vs. 11.5
8.5%), middle (13.3 9.7% vs. 13.6 9.6%) and
distal (15.4 7.4% vs. 19.5 13.1%) regions of the
quadriceps. However, there was a non-significant
trend for the heavy group to increase the size of the
proximal region to a greater extent than the light
group, while there was a non-significant trend for the
light group to increase the size of the distal region to a
greater extent than the heavy group. However, in
respect of the individual quadriceps, there was a
significantly greater increase in the heavy group for
the vastus intermedius proximally and for the vastus
medialis in the middle region compared to the light
group,
Regional differences caused by ROM
The researchers found no differences in regional
hypertrophy between the two jump squat groups
training with different squat depths.

What did the researchers conclude?


The researchers concluded that there was evidence of
differences in the regional hypertrophy of the
individual quadriceps muscles following squat training
with heavy loads and slow speeds compared to with
light loads and fast speeds. They proposed that the
specific changes in muscle size at different muscle
lengths might be required for force production at
different muscle lengths or at different joint angle
positions.

Limitations
The study was limited in that the findings in relation to
ROM are conflicting with the findings of previous
literature and it is unclear why this occurred.

Copyright Strength and Conditioning Research Limited, 2015

Page 32

Influence of bench angle on upper extremity muscular


activation during bench press exercise, by Lauver,
Cayot, and Scheuermann, in European Journal of
Sport Science (2015)

Background
The bench press is a difficult lift to progress and can
be uncomfortable for some lifters to train regularly.
Consequently, many trainees make use of different
exercises to train the same muscles, including bench
press variations (incline, decline, dumbbell, etc.) and
machines. The research comparing the different bench
press exercise variations is limited. However, studies
using electromyography (EMG) have been performed
suggesting that the barbell bench press is superior to
the (Smith) machine bench press for developing the
anterior and middle deltoids and these two exercises
are similarly effective for developing the pectoralis
major and triceps brachii. Additionally, it has been
reported that the horizontal bench press can be used
for specifically targeting the lower part of the
pectoralis major (i.e. the sternocostal head), while the
lower part of the pectoralis major (i.e. the sternocostal
head) can be further targeted by selecting a narrow
rather than a wide grip. The decline bench press can
be used for specifically working the very lowest
portion of the pectoralis major, the lower sternocostal
portion, although it does not appear to be equally
effective for the upper part of the sternocostal portion.
Furthermore, using a wide grip during bench press
variations has been found to reduce the involvement
of the triceps brachii, while using a narrow grip can
increase their involvement. Finally, studies have
reported that the use of unstable surfaces for bench
press variations, such as balance cushions or Swiss
balls, is not recommended, as it leads to reduced
potential for developing the pectoralis major and
triceps brachii although not for the anterior deltoids.
In addition to the above research exploring the EMG
activity in the various muscles during different bench
press variations, researchers have also assessed the
exact location of the sticking region. It has been
reported that the sticking region is very likely not
caused by adverse changes in the external moment
arms at either the shoulder or the elbow, nor by
changes in neural drive to the prime movers, as
measured by EMG activity. It has been speculated that
the sticking region in the bench press is caused by the
gradual reduction in stored elastic energy as a result
of the eccentric phase prior to the lift. However, there
is little evidence for this and it therefore requires
further investigation. It is possible that titin may
provide very large amounts of passive elastic force
contribution at the bottom of the lift and it is possible
that the sticking region in the bench press starts at
the point where titin contribution to the concentric
phase reduces significantly.

OBJECTIVE: To compare the muscle activity (as


measured by EMG with surface electrodes) of the
upper and lower pectoralis major, anterior deltoid and
triceps brachii muscles during the concentric and
eccentric phases of a free-weight barbell bench press
performed at 0, +30, +45 and 15 degrees of bench
angle. EMG was normalized to the levels observed
during maximum voluntary isometric contractions
(MVICs).
POPULATION: 14 healthy, resistance-trained males,
aged 21.4 0.4 years.
INTERVENTION: The subjects performed 1 set of 6
repetitions for each bench press condition at 65% of
1RM.

What happened?
Upper pectoralis
The researchers found that upper pectoralis major
EMG activity was greater during +30 degree incline
bench (117.5 49.2%) compared to during the 15
degree bench (102.6 27.7%) across the whole
concentric muscle action.
Lower pectoralis
The researchers found that the EMG activity of the
lower pectoralis was greater during the 15 degree
bench (100.4 5.7%), +30 degree bench (86.6
4.8%) and horizontal bench (100.1 5.2%)
compared to the +45 degree bench (71.9 4.5%)
across the whole concentric muscle action.
Anterior deltoids
The researchers found that EMG activity of the
anterior deltoid was less during the 15 degree bench
(58.3 30.7%) than the horizontal bench (76.0
37.0%), +30 degree bench, (90.9 44.3%), and +45
degree bench (97.5 39.3%).
Triceps brachii
The researchers found that EMG activity of the triceps
brachii was greater in the +30 degree bench (114.3
26.3%) and +45 degree bench (117.8 28.5%)
conditions compared to the 15 degree bench (102.2
26.5%) condition. Additionally, they found that the
+45 degree bench (117.8 28.5%) produced greater
EMG activity compared to the horizontal bench (106.0
28.7%).

What did the researchers conclude?


The researchers concluded that a horizontal bench is
optimal for maximizing the muscle activity of both the
upper and lower heads of the pectoralis major.

Limitations
The study was limited in that it was an acute
investigation and it is unclear how training for long
periods of time with each of the lifts would affect gains
in muscular strength and size of the various different
muscles.

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Training-related changes in the EMG-moment


relationship during isometric contractions: further
evidence of improved control of muscle activation in
strength-trained men? By Amarantini and Bru, in
Journal of Electromyography and Kinesiology (2015)

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

OBJECTIVE: To investigate the effect of long-term


strength training on the relationship between muscle
activity and force production, by reference to the
EMG-moment relationship during both isometric knee
flexion and extension muscle actions (measured while
seated in a chair with the feet on a force plate), in
both resistance-trained male athletes and untrained
male participants.
POPULATION: 10 males, including 5 untrained
subjects (aged 21.8 2.28 years) and 5 resistancetrained athletes (aged 24.6 3.25 years).

What happened?
Relationship between force and muscle activity
The researchers found a very strong, linear isometric
EMG-moment relationship for most muscles and joint
actions in the strength-trained group. For example,
the relationship between ankle plantar flexion moment
and gastrocnemius activity was extremely strong (Rsquared = 0.95), as was the relationship between
knee flexion moment and biceps femoris activity (Rsquared = 0.99). In contrast, the researchers found
that the isometric EMG-moment relationship was
curvilinear (quadratic) for the untrained group.
Agonist-antagonist co-activation
The researchers found differences in the co-activation
values between trained and untrained subjects, as well
as between the knee extension and knee flexion
actions. They noted that co-activation was generally
significantly greater in the untrained subjects than in
the trained subjects (63 3% vs. 40 3%,
respectively) and that it was significantly greater in
knee extension than in knee flexion (59 4% vs. 44
3%, respectively.

What did the researchers conclude?


The researchers concluded that there is a linear
relationship between muscle activity (as measured by
EMG) and joint moments in strength trained males but
that the EMG-moment relationship was curvilinear
(quadratic) in untrained males. In addition, they
reported that co-activation values were much lower in
trained subjects than in untrained subjects.

Limitations
The study was limited as it was cross-sectional and
the differences between subjects could have arisen
because of genetic factors leading the athletes to
become athletes rather than the environmental factors
(strength training over a long-term period).

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Dissociated time course of muscle damage recovery


between single and multi-joint exercises in highly
resistance trained men, by Soares, Ferreira-Junior,
Pereira, Cleto, Castanheira, Cadore, and Bottaro, in
The Journal of Strength & Conditioning Research
(2015)

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

OBJECTIVE: To compare the effects of multi- and


single-joint exercises on the speed of recovery from
muscle damage in resistance-trained males. Recovery
was measured indirectly through strength levels (by
reference to maximum voluntary isometric contraction
(MVIC) elbow flexion torque) and also through the
sensation of DOMS by reference to a visual analog
scale, compared at baseline, 10 minutes post-exercise
and after 24, 48, 72 and 96 hours.
POPULATION: 16 resistance-trained males (aged
24.5 5.5 years) with >3 years of continuous
strength training experience (mean = 6.1 2.7
years).
INTERVENTION: All subjects performed 8 sets of
10RM for a unilateral seated row exercise with one
arm and 8 sets of 10RM unilateral biceps preacher curl
exercise using the contralateral arm.

What happened?
Strength recovery
The researchers found a significant decrease in MVIC
elbow flexion torque 10 minutes after both the multiand single-joint exercise sessions. However, the
reduction decrease was significantly greater after the
single-joint exercise compared to after the multi-joint
exercise (26.8% vs. 15.1%). After 24 hours, MVIC
elbow flexion torque was still lower in the single-joint
condition but returned to baseline in the multi-joint
condition.
DOMS recovery
The researchers found a significant increase in DOMS
at 24, 48 and 72 hours after the single-joint exercise.
DOMS returned to baseline at 96 hours. However, for
multi-joint exercise, DOMS was significant increased
at 24 and 48 hours and returned to baseline at 72
hours. In addition, the severity of DOMS was greater
after single-joint exercise than after multi-joint
exercise at 24, 48 and 72 hours post-exercise.

What did the researchers conclude?


The researchers concluded that strength and muscle
soreness recovery is dissimilar between single-joint
and multi-joint exercises in resistance-trained males.
Strength and muscle soreness take longer to recover
after single-joint exercises than after multi-joint
exercises.

Limitations
The study was limited as it is unclear whether the
same results would be observed with other muscles or
exercises.

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Muscle fascicle behavior during eccentric cycling and


its relation to muscle soreness, by Peailillo, Blazevich
and Nosaka, in Medicine & Science in Sports &
Exercise (2015)

Background
Delayed onset muscle soreness (DOMS) is frequently
experienced by athletes and recreational trainees
when exposed to either novel resistance-training
workouts or a large volume of eccentric muscle
actions. For an introduction to DOMS, see the
preceding study review.

OBJECTIVE: To compare the effects of unaccustomed


and accustomed eccentric cycling on DOMS (by
reference to the visual analog scale) and on strength
recovery (as measured by reference to maximal
voluntary isometric contraction (MVIC) knee extension
torque) in the 48 hours post-exercise, and to explore
whether any differences were associated with the
changes in muscle activity (as measured by electromyography [EMG]) or changes in vastus lateralis
fascicle length during exercise (as measured using
ultrasonography). EMG activity was normalized to
MVIC levels.
POPULATION: 11 untrained males, aged 27.1 7.0
years.
INTERVENTION: All subjects performed 2 bouts of
eccentric cycling (the first being unaccustomed and
the second being accustomed) separated by 2 weeks.
Each bout of cycling was performed for 10 min at 65%
of maximal concentric workload.

What happened?
Differences in DOMS and strength recovery
The researchers found that DOMS was greater after
the second (accustomed) bout of eccentric cycling.
However, they noted that there were no differences in
strength recovery between groups.
Differences in muscle activity
The researchers noted that muscle activity during the
two bouts was not significantly different between the
first (25.6 15.5%) and second bouts (24.4 7.9%).
This may suggest that the repeated bout effect,
which describes how one bout of eccentric exercise
protects against soreness in a subsequent bout, is not
caused by neural adaptations.
Differences in muscle fascicle length changes
The researchers noted that fascicle elongation was
16% less in the first bout (unaccustomed) than in the
second bout (6.7 3.2 vs. 8.0 2.6cm). This may
suggest that the repeated bout effect is caused by
an alteration in fascicle strain. Since no change in
optimum length for torque was observed (suggesting
that sarcomerogenesis did not occur), this may imply
that remodeling of muscle extracellular matrix took
place, increasing muscle stiffness.

What did the researchers conclude?


The researchers concluded that the repeated bout
effect is not caused by neural adaptations but rather
might be caused by an alteration in fascicle strain
subsequent to remodeling of the muscle extracellular
matrix, which in turn increases muscle stiffness.

Limitations
The study was limited in that the researchers did not
directly assess whether any remodeling of the
extracellular matrix in fact occurred between the two
bouts of eccentric cycling.

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Verbal instructions acutely affect drop vertical jump


biomechanics implications for athletic performance
and injury risk assessments, by Khuu, Musalem, and
Beach, in The Journal of Strength & Conditioning
Research (2015)

Background
Coaching instructions can direct the focus of attention
externally or internally. An external focus is one that
directs the athletes attention away from their body
and towards the effects of their movement on the
environment. On the other hand, an internal focus
directs the athletes attention to their own body
movements. Previous research into the area of
attentional focus has found that an external focus of
attention is superior to either no focus of attention or
an internal focus of attention for improving the
objective performance of the movement (i.e. greater
jumping distance or height, greater power output,
etc.). Therefore, external cues are thought to be
beneficial for improving athletic performance both
acutely and during a long-term training program,
because of the greater loads or speeds involved. In
contrast, an internal focus has been found to lead to
reductions in objective performance compared to
either an external focus or no attentional focus but
they may simultaneously cause an increase in the
recruitment of specific muscles. In this context, it is
interesting to note that bodybuilders have been using
internal cues and internal focus with the mind-muscle
connection for many years in order to enhance
muscular hypertrophy, which is believed to follow from
greater muscle activity during a specific exercise.

OBJECTIVE: To compare the effects of different


verbal instructions on vertical jump height, joint angle
movements, and ground reaction forces and power
outputs during drop jumps.
POPULATION: 20 recreational athletes (10 males,
aged 20.8 1.4 years; 10 females, aged 20.8 2.0
years) from local volleyball, basketball, figure skating,
and track and field teams.
INTERVENTION: The athletes performed drop jumps
under various conditions, which differed by the type of
instruction that was given. The 3 different instructions
comprised: minimize ground contact time, maximize
jump height, and synchronously extend the lower
extremity joints.

What happened?
Differences between verbal instructions
The researchers found that almost all measured
variables were significantly between conditions, when
measured as a main effect. However, when comparing
variables between pairs of conditions, it was found
that there were no differences between the latter two
conditions (maximize jump height vs. synchronously
extend the lower extremity joints), which indicated
that it was the first instruction (minimize ground
contact time) that was responsible for causing the
differences.
Effect of minimizing ground contact time
Specifically analyzing the effects of the instruction
minimize ground contact time, the researchers found
that they landed more stiffly (i.e. performed less
sagittal plane trunk, hip, knee, and ankle motion) and
achieved lower maximum jump heights.

What did the researchers conclude?


The researchers concluded that the precise nature of
verbal instructions does affect joint angle movements
and performance during drop jumps. Specifically,
instructing athletes to minimize ground contact time
leads to stiffer landings and lower jump heights. Since
reduced sagittal plane joint angle ranges of motion
during jump landings have been linked to increased
injury risk, this may imply that using this cue could
lead to adverse movement patterns being developed
in athletes.

Limitations
The study was limited in that it was an acute
investigation and it is unclear what the long-term
implications of training with each of the various cues
might be.

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Differences in end range of motion vertical jump


kinetic and kinematic strategies between trained
weightlifters and elite short track speed skaters, by
Haug, Spratford, Williams, Chapman, Drinkwater,
Haug, Leverrier Street, in The Journal of Strength &
Conditioning Research (2015)

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

OBJECTIVE: To identify whether there are any


differences in jumping movement patterns (as
measured by the joint angle movements tracked
through a 15 camera motion analysis system linked to
a force plate) between resistance-trained and vertical
jump-trained athletes and controls.
POPULATION: 15 subjects, including 4 weightlifters
(aged 27.25 4.6 years), 5 short track speed skaters
(aged 19.0 2.4 years), and 6 untrained controls
(aged 25.0 2.1 years).
INTERVENTION: Subjects performed 6 squat jumps
and 6 countermovement jumps with no external load.

What happened?
Squat jump
For the squat jump, the researchers found a large
difference between the weightlifters and the short
track speed skaters in respect of the time before toeoff of peak vertical velocity. They also found a large
difference between the same groups for the decrease
between peak and toe-off vertical velocity.
Countermovement jump
For the countermovement jump, the researchers
found a large difference between the weightlifters and
the short track speed skaters in respect of the time
before toe-off of peak vertical velocity and for the
decrease between peak and toe-off vertical velocity.

What did the researchers conclude?


The researchers concluded that Olympic weightlifters
display different jumping movement patterns from
short track speed skaters even though both groups
are resistance-trained.

Limitations
The study was limited in that it is not completely clear
whether the strategies adopted by the weightlifters
were superior to those adopted by the short track
speed skaters or whether they were a function of the
types of movements that the athletes had performed
in the past.

Copyright Strength and Conditioning Research Limited, 2015

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Strength and Conditioning Research

3. ANATOMY, PHYSIOLOGY, AND NUTRITION

Copyright Strength and Conditioning Research Limited, 2015

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Extracellular matrix remodeling and its contribution to


protective adaptation following lengthening
contractions in human muscle, by Hyldahl, Nelson,
Welling, Groscost, Hubal, and Parcell, in The FASEB
Journal (2015)

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

OBJECTIVE: To assess whether extracellular matrix


remodeling contributes to the repeated bout effect
during eccentric training by taking muscle biopsies 3
hours, 2 days, and 27 days after an initial bout of
eccentric training and 2 days after a repeated bout, in
order to assess differences in the elevation of
extracellular matrix structural, matricellular and
molecular signaling transcripts.
POPULATION: 14 healthy, untrained adult subjects
(7 males, aged 23.3 2.1 years; 7 females, aged
25.6 2.5 years).
INTERVENTION: All subjects performed 2 bouts of
eccentric training for the knee extensors, separated by
28 days. Each bout comprised 30 sets of 10 maximal
isokinetic eccentric knee extension muscle actions
through a range of motion between 30 110 degrees
of knee angle at 120 degrees/s, with 1 minute rest
between sets.

What happened?
Acute measures of extracellular matrix remodeling
The researchers found that in an acute exploration of
the molecular responses to eccentric training, the
highest responding transcripts in the network were
those that encoded for proteins with known functions
of de-adhesion (including tenascin C (TNC), which
increased 11.6 times) and transcriptional regulation
and signaling, including connective tissue growth
factor (CTGF), which increased 7.6 times, and
transforming growth factor-2 ( TG F -2), which
increased 7.8 times.
Repeated bout effect
The researchers found that TNC activity increased
significantly after the first bout but not after the
second bout. Also, the activity of this marker of
extracellular remodeling was positively correlated with
the reduction in strength post-exercise (R-squared =
0.45). TNC facilitates cell de-adhesion, which reduces
the strength of the connections between the extracellular matrix and the integrins that connect it to the
cell membrane, which permits remodeling.

What did the researchers conclude?


The researchers concluded that extracellular matrix
remodeling does appear to be associated with the
repeated bout effect.

Limitations
The study was limited in that it is unclear precisely
what remodeling of the extracellular matrix is being
undertaken and what the implications of this process
are for long-term strength gains.

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Is it time to turn our attention toward central


mechanisms for post-exertional recovery strategies
and performance? By Rattray, Argus, Martin, Northey,
and Driller, in Frontiers in Physiology (2015)
O B J E C T I V E : To discuss how certain recovery
strategies might be used to reduce mental fatigue and
thereby offer an opportunity for improving repeated
performance.

The Review
Introduction
The reviewers observe that traditionally, discussion of
post-exercise recovery has almost exclusively focused
on combatting peripheral fatigue. However, research
has demonstrated that central fatigue also occurs.
Therefore, it is possible that strategies might be
adopted to address central fatigue specifically and
thereby enhance overall performance recovery.
Moreover, they observe that it is possible that many of
the strategies that have been devised in order to
assist with peripheral recovery may also exert their
effects via central mechanisms.
Nutritional strategies
The reviewers note that it has long been well-known
that carbohydrate is effective for enhancing recovery
when consumed post-exercise. However, it has only
more recently been observed that mouth-rinsing with
carbohydrate also has a beneficial (and immediate)
effect on reducing fatigue. Interestingly, they also
note that this occurs before the elevation of blood
glucose. To explain this phenomenon, it has been
suggested that carbohydrate acts by influencing
neurotransmitter precursors (such as tryptophan) that
cross the blood-brain barrier and elevate levels of
neurotransmitters (such as serotonin). It has in fact
been observed that carbohydrate reduces the amount
of tryptophan crossing the blood-brain barrier during
exercise, which could feasibly therefore alter serotonin
levels, which have been found to impact on mood and
sleepiness. In addition to carbohydrate, the reviewers
note that it is also well-known that the ingestion of
protein post-exercise is beneficial for recovery. Again,
they note that there are reasons to believe that there
may be some central mechanisms involved in this
process of recovery. Specifically, since branched chain
amino acids are carried by the same system as
tryptophan, the consumption of protein is thought to
be able to modulate levels of this key neurotransmitter precursor and thereby act in order to alter
serotonin levels.

cognitive tasks can lead to reduced performance in


physical endurance tasks, such as 5km running time
trials. Such trials typically report that the rating of
perceived exertion (RPE) is greater following the
condition performed after the mentally-fatiguing task.
Investigations in this area have suggested that
alterations in the anterior cingulate cortex may occur
subsequent to cognitive effort. The anterior cingulate
cortex is an area of the prefrontal cortex that is highly
activated by cognitive effort. Researchers working in
this new field have suggested a model in which fatigue
during endurance performance is affected by the
balance of two competing psychological factors:
perceived exertion and potential motivation. Thus,
factors that either increase the rating of perceived
exertion or increase the benefits associated with
success might be expected to reduce or increase the
effects of fatigue, respectively. Indeed, motivational
self-talk and the presence of an attractive audience
during testing have both been found to increase
endurance performance.

What did the reviewers conclude?


The reviewers concluded that many post-exercise
strategies that are intended to enhance peripheral
recovery may also improve central recovery through
different mechanisms. However, they note that there
may also be other interventions that could be
performed in order to enhance central recovery that
have not yet been explored. Further research should
be performed in this area.

Limitations
The narrative review was performed by one group of
researchers who may not share the opinions of all of
the researchers working in this field. In addition, there
has been limited research performed assessing the
central mechanisms of recovery from strenuous and
fatiguing exercise.

Mental fatigue
The reviewers note that the concept of enhancing
recovery from mental fatigue has rarely been explored
in either research or practice. Mental fatigue can occur
as a result of any cognitive task and results in a
change in psychological state that impacts on the
ability to perform in future tasks and causes adverse
changes in mood and feelings of tiredness. Of great
importance are recent studies showing that mental
fatigue generated through the performance of purely

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Does regular post-exercise cold application attenuate


trained muscle adaptation? By Yamane, Ohnishi, and
Matsumoto, in International Journal of Sports
Medicine (2015)

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

OBJECTIVE: To assess the effects of regular postexercise cold application on gains in muscular size (by
reference to wrist-flexor thickness using B-mode
ultrasound) and strength (by reference to maximal
isometric wrist flexion force) as a result of a long-term
resistance training program.
POPULATION: 14 recreationally active male subjects
aged 20.2 0.9 years, randomly allocated into either
a cold application group (7 subjects) or a control
group (7 subjects).
INTERVENTION: All subjects participated in a
resistance training program of 5 sets of 8 machinebased wrist-flexion exercises at 7080% of 1RM, 3
times a week for 6 weeks. The cold application group
immersed their forearms in cold water (10 1
degrees C) using constant temperature water bath
unit for 20 minutes post-exercise. The control group
did not experience cold application post-exercise.

What happened?
Muscular strength
The researchers found that maximal isometric wristflexion force increased significantly only in the control
group and not in the cold application group.
Muscular size
The researchers found that wrist-flexion thickness
increased significantly in both groups but the control
group increased significantly more than the noncooled group.

What did the researchers conclude?


The researchers concluded that performing regular
post-exercise cold application to exercised muscles
appears to attenuate adaptations to long-term
resistance training.

Limitations
The study was limited in that only one small muscle
group was tested and in that it was performed only in
untrained subjects. Different results might be
observed in other populations or in other muscles.

Copyright Strength and Conditioning Research Limited, 2015

Page 42

Mental fatigue does not affect maximal anaerobic


exercise performance, by Martin, Thompson, Keegan,
Ball, and Rattray, in European Journal of Applied
Physiology (2014)

Background
Conventionally, muscular fatigue is subdivided into
two aspects, central and peripheral. Central fatigue
refers to processes that occur proximally to the
neuromuscular junction, while peripheral fatigue refers
to processes that occur distally to the neuromuscular
junction. It is most straightforward to think of central
fatigue as occurring spinally or supra-spinally and
peripheral fatigue as occurring within the muscle itself.
In order to investigate these two different types of
fatigue, researchers have developed a range of tools.
Central fatigue is commonly explored using the twitch
interpolation technique, which involves evoking
muscular twitches through electrical stimulation during
maximal voluntary contractions (MVCs). However,
there are various other methods that can be used to
explore both central and peripheral fatigue.
Transcranial magnetic stimulation (TMS) is a method
that is often used, and allows researchers to measure
corticospinal excitability with motor evoked potentials
(MEPs) and also the superimposed twitch responses.
In general, previous studies have found that the size
of MEPs increases as a result of exercise-induced
muscle fatigue. However, not all studies have found
this same result. The central activation ratio (CAR)
and evoked peak twitch force (PTF) can also separate
out the central fatigue (i.e. motor neuron firing) and
peripheral fatigue (e.g. excitation-contraction
coupling) elements of overall fatigue. PTF is typically
calculated as the peak change in force during
passively stimulated muscular contractions (i.e. the
muscle is relaxed prior to the electrical stimulus) from
the pre-stimulated values recorded in a dynamometer.
CAR is typically calculated in a similar way but is
different in two key respects. Firstly, the electrical
stimulation of the muscle is performed while the
muscle is contracting and not relaxed. Secondly, it is
calculated as the ratio of peak voluntary force (prior to
the stimulation) to the peak electrically stimulated
force and not as the change. These measurements are
useful in this context, as it is possible that heavy,
moderate and light loads lifted with maximal velocity
could lead to different components of overall fatigue
and therefore give rise to differing responses.

OBJECTIVE: To assess the effects of mental fatigue


on tests of athletic performance (by reference to
countermovement jump height assessed by a linear
position transducer), muscular strength (by reference
to maximum isometric knee extension torque) and
anaerobic capacity (by reference to a 3-minute all-out
cycling test). In addition, psychological variables were
assessed, including mood (by reference to the POMS
inventory) and rating of perceived exertion (RPE).
POPULATION: 12 athletically-trained subjects (7
males and 5 females), aged 23 3 years.
INTERVENTION: All subjects were tested after either
a mentally fatiguing task, comprising 90 minutes of
the computer-based Continuous Performance Task or
after a control treatment involving 90 minutes of
watching emotionally neutral documentaries.

What happened?
Performance variables
The researchers found no difference between the two
conditions in respect of athletic performance, muscular
strength or anaerobic capacity tests.
Psychological variables
Although there was no difference in any of the
performance variables, the researchers did note that
RPE was non-significantly higher in the mentally
fatigued condition compared to the control (19 1 vs.
18 1). They also noted that intrinsic motivation was
non-significantly lower in the mentally fatigued
condition (11 4 vs. 13 6). Whether these findings
are meaningful is unclear as the results were not
significant.

What did the researchers conclude?


The researchers concluded that since there were no
effects of mental fatigue on any of the athletic
performance, muscular strength or anaerobic capacity
tests, this implies that peripheral mechanisms are
primarily responsible for the regulation of maximal
anaerobic exercise.

Limitations
The study was limited in that it is unclear whether
similar results would be observed in subjects who
were trained to perform jumping activities or who
were accustomed to high-intensity short-duration
efforts in a competitive environment, such as track
cycling.

Copyright Strength and Conditioning Research Limited, 2015

Page 43

High-protein, low-fat, short-term diet results in less


stress and fatigue than moderate-protein, moderatefat diet during weight loss in male weightlifters: a pilot
study, by Helms, Zinn, Rowlands, Naidoo, and Cronin,
in International Journal of Sport nutrition and Exercise
Metabolism (2014)

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

OBJECTIVE: To compare the effects of two different


carbohydrate-matched diets (high-protein and low-fat
vs. moderate-protein and moderate-fat) on changes in
anthropometrics and muscular strength (by reference
to isometric mid-thigh pull). Also, the researchers
measured changes in mood (by reference to the
Profile of Mood States (POMS) inventory and stress
(by reference to The Daily Analysis of Life Demands of
Athletes (DALDA) score).
POPULATION: 14 resistance-trained males, aged 20
43 years, randomly allocated into either a highprotein and low-fat group or a moderate-protein and
moderate-fat group. The groups were tested in a
randomized, cross-over design.
INTERVENTION: All subjects performed resistancetraining for 2 days per week during the 2 weeks of the
study. Each group followed a carbohydrate-matched
diet. The high-protein low-fat group consumed 2.8g
per kg of bodyweight of protein per day (with fat
accounting for 15.4% of total calories) while the
moderate-protein moderate-fat group consumed just
1.6g per kg of bodyweight of protein per day (with fat
accounting for 36.5% of calories). The groups were
blinded by providing meal plans and making up the
difference in macronutrient requirements through the
use of protein supplement powders.

What happened?
Muscular strength and anthropometrics
The researchers reported that changes in muscular
strength anthropometrics were likely trivial.
Psychological variables
The researchers reported that there were likely larger,
adverse changes on the DALDA test items for the
moderate-protein moderate-fat group than for the
high-protein low-fat group. The DALDA predominantly
assesses elements of stress. Similarly, they reported
likely or possibly larger adverse changes on the POMS
test items for the moderate-protein moderate-fat
group than for the high-protein low-fat group. The
POMS predominantly assesses elements of fatigue and
mood disturbance.

What did the researchers conclude?


The researchers concluded that measures of stress
and fatigue were higher during a moderate-protein
moderate-fat diet than during a high-protein low-fat
diet.

Limitations
The study was limited by the short duration of the
diets and different results might be observed if the
diets had been conducted for longer periods of time.

Copyright Strength and Conditioning Research Limited, 2015

Page 44

Independent effects of endurance training and weight


loss on peak fat oxidation in moderately overweight
men: a randomized controlled trial, by Nordby,
Rosenkilde, Ploug, Westh, Feigh, Nielsen, and
Stallknecht, in Journal of Applied Physiology (2015)

Background
Obesity and overweight are rapidly rising phenomena
worldwide and are both important contributors to
mortality and ill health. Weight loss is the primary
technique for addressing both of these conditions.
Weight loss is essentially achieved by means of
altering the balance between the amount of calories
consumed and expended. At its most basic, therefore,
weight loss can be achieved either by reducing
calories consumed, increasing calories expended, or a
combination of both. However, there are many ways in
which calorie intake can be increased and in which
calorie expenditure can be increased. Calorie intake
can be reduced directly by conscious dietary
modifications or indirectly by bariatric surgery,
pharmacology, and even psychological protocols.
Conscious dietary modifications can themselves be
further subdivided into either (1) a reduction in food
volume without changes in macronutrient ratios or
food choices or (2) a change in dietary patterns to
alter either macronutrient ratios or food choices.
Calorie expenditure can be increased either by
physical activity or by specific exercise protocols. The
majority of individuals in the general population
appear to instinctively identify diet as the primary way
to lose weight although many also include exercise as
an adjunct. However, there are widely varying
opinions regarding the optimal ways to lose weight
and experts have made recommendations regarding
the optimal macronutrient ratios, food choices,
exercise protocols (i.e. aerobic steady state vs.
anaerobic intervals vs. resistance training, etc.) and
target rate of weight loss to achieve over a set period
of time. The extent to which these recommendations
have been supported by long-term trials, however, is
unclear. In addition, the extent to which different
types of weight loss intervention lead to different
results in males and females is also currently
unknown.

OBJECTIVE: To compare the effects of endurance


training (with or without weight loss) with diet-induced
weight loss on peak fat oxidation (as measured by
standard stoichiometric equations for respiratory
gaseous exchange during sub-maximal exercise tests)
and skeletal muscle mitochondrial proteins involved in
fat oxidation (by taking muscle biopsies from the
vastus lateralis).
POPULATION: 60 moderately overweight, sedentary
males, randomly allocated to either endurance training
with weight loss, endurance training without weight
loss (through increased caloric intake), diet, or nontraining or diet control groups.
INTERVENTION: All subjects performed 12 weeks of
endurance training, diet, or no activity, depending on
their group.

What happened?
Weight loss
The researchers observed a similar weight loss in the
endurance training with weight loss (-5.9 0.7kg)
and diet (-5.2 0.8kg) groups while endurance
training without weight loss (-1.0 0.5kg) and control
(+0.1 0.6kg) groups did not lose weight.
Peak fat oxidation
The researchers found peak fat oxidation increased to
a similar extent in the endurance without weight loss
group and the endurance with weight loss groups
(41% vs. 42%) compared to the control group.
However, peak fat oxidation did not increase in the
diet group.

What did the researchers conclude?


The researchers concluded that endurance training
increases peak fat oxidation in moderately overweight
males, irrespective of weight loss. Since a high level of
peak fat oxidation during exercise is associated with a
metabolically healthy phenotype, this may underpin
some of the health benefits of exercise over and above
weight loss for the treatment of obesity.

Limitations
The study was limited in that it is unclear whether
altering peak fat oxidation levels in sedentary males
has any specific long-term health benefits.

Copyright Strength and Conditioning Research Limited, 2015

Page 45

The impact of neuromuscular electrical stimulation on


recovery after intensive, muscle damaging, maximal
speed training in professional team sports players, by
Taylor, West, Howatson, Jones, Bracken, Love, and
Kilduff, in Journal of Science and Medicine in Sport
(2014)

Background
Neuromuscular electrical stimulation (NMES) training
has previously been proposed as a tool to help reduce
losses in muscle mass during periods of limb
immobilization. NMES involves the invoking of
involuntary, isometric contractions of specific muscle
groups at a relatively low intensity. This technique can
be used even in the injured limb under certain
circumstances. Researchers have found that by using
a relatively high frequency (100Hz) and pulse width
(400s) the otherwise significant muscle atrophy that
occurs in the first 5 days of limb immobilization can be
avoided or at least reduced by means of using twicedaily, 30-minute sessions of NMES. Additionally,
studies have reported that muscular strength can be
improved using NMES during periods of rehabilitation
even where limbs are not immobilized, such as
following surgery for an injury. While NMES is
generally performed in conjunction with isometric
muscle actions, it is also possible to use it in
combination with either concentric or eccentric muscle
actions, which may be more beneficial for improving
full joint range-of-motion strength measures.

OBJECTIVE: To assess the effects of NMES on 24hour recovery (as measured by countermovement
jump height, perceived muscle soreness, blood lactate
and creatine kinase levels, and salivary testosterone
and cortisol levels) post-exercise in professional soccer
and rugby players.
POPULATION: 28 male professional rugby and soccer
academy players, aged 20 4 years.
INTERVENTION: All subjects completed 6 50m
maximal sprints, with 5 minutes rest between sprints.
After one sprint session, the subjects wore a NMES
device for 8 hours post-exercise over the peroneal
nerve behind the knee, delivering an electrical current
of 27mA at a frequency of 1Hz, with a pulse width of
140s. The researchers noted that this setting
produced visible contractions in the calf muscle but did
not cause discomfort.

What happened?
The researchers found that countermovement jump
height was reduced by significantly less in the NMES
condition than in the control condition (3.2 3.2 vs.
7.2 3.7%), creatine kinase concentrations were
elevated by significantly less in the NMES condition
than in the control condition, perceived soreness was
elevated by significantly less in the NMES condition
than in the control condition, and there was no
difference between conditions in respect of either
blood lactate or salivary testosterone and cortisol
responses.

What did the researchers conclude?


The researchers concluded that NMES can be used to
improve 24-hour recovery in soccer players, as
measured by reference to countermovement jump
height ability, creatine kinase levels, and perceived
soreness.

Limitations
The study was limited as it is unclear by what
mechanism the improved recovery was effected.
Future research might benefit from using some means
of sham treatment to assess whether there is a
placebo effect in operation.

Copyright Strength and Conditioning Research Limited, 2015

Page 46

The impact of high-intensity interval training versus


moderate-intensity continuous training on vascular
function: a systematic review and meta-analysis, by
Ramos, Dalleck, Tjonna, Beetham, and Coombes in
Sports Medicine (2015)

Background
Interval training was first developed by track and field
athletes in the middle of the last century to help
improve middle- and long-distance running
performance. Track running performance, like
performance in other endurance sports, is dependent
upon three main physiological factors: aerobic
capacity, lactate threshold, and work economy.
Together, these variables can explain the large
majority of the difference in endurance performance
between individuals in both heterogenous (varied) and
homogenous (similar) groups. In contrast, each of the
variables alone is only able to explain the majority of
the difference in endurance performance between the
individuals in heterogenous groups. Aerobic capacity is
measured using VO2-max, which is the volume of
oxygen that the body can take in and use effectively in
a given period of time, usually measured relative to
bodyweight as ml/kg/min. Lactate threshold is
measured by reference to blood lactate. During an
incremental exercise test, blood lactate initially
remains close to its resting value. At a certain exercise
intensity, however, it rises above the resting value and
this exercise intensity is called the lactate threshold.
Running economy (strictly work economy if including
other exercise modalities) is a measurement of the
efficiency of the athlete. Economy is most commonly
described in terms of how much oxygen it takes to run
a given distance at a given speed. Traditionally, the
e x c l u s i v e m e t h o d f o r d e v e l o p i n g e n d u ra n c e
performance was steady-state exercise. Indeed,
researchers have found that steady-state exercise can
improve endurance performance in untrained
individuals. However, improvements in already welltrained individuals are small. Consequently, studies
exploring the effects of steady-state exercise in
trained subjects have often failed to find significant
increases in endurance performance or in any of the
underlying physiological factors (aerobic capacity,
lactate threshold, and work economy). More recently,
high-intensity interval training (HIIT) has been
developed as a tool for increasing endurance
performance. HIIT can be broadly defined as repeated
bouts of short-to-moderate duration exercise (i.e. 10
seconds to 5 minutes) at an intensity greater than the
anaerobic threshold. These exercise bouts are divided
by short bouts of either low-intensity work or
inactivity that allow either a partial or a full recovery.
Researchers have found that HIIT can improve
endurance performance in untrained individuals. The
increases are often larger than those following from
steady-state interventions of similar duration.
Moreover, research has often found significant
increases in endurance performance in trained
individuals following HIIT exercise interventions.

OBJECTIVE: To perform a systematic review and


meta-analysis of the literature comparing the effects
of HIIT with moderate-intensity continuous training
(MICT) on vascular adaptations (as measured by
reference to brachial artery flow-mediated dilation).
Artery flow-mediated dilation is a proxy measure for a
true vascular function measure, which is the ability of
the endothelial and smooth muscle cells to relax in
response to a stimulus.
STUDY SELECTION: All randomized trials (controlled
or not controlled) comparing the effect of HIIT and
MICT exercise protocols on vascular function, as
measured by brachial artery flow-mediated dilation,
with program durations of >2 weeks.

What happened?
Study selection
The researchers identified 7 randomized trials, which
involved a total of 182 patients.
Vascular function
The researchers reported that their meta-analysis
found brachial artery flow-mediated dilation improved
significantly by 4.3% and 2.2% after HIIT and MICT,
respectively. The HIIT programs were significantly
more beneficial than the MICT programs. To explain
these differences, the reviewers proposed that since
HIIT includes rest periods, this might reduce some of
the adverse effects on the vasculature that may occur
following continuous exercise training while retaining
the beneficial effects of the exercise.

What did the researchers conclude?


The researchers concluded that HIIT is more effective
than MICT for improving vascular function, as
measured by brachial artery flow-mediated dilation.

Limitations
The study was limited in that it is unclear whether
reducing measures of brachial artery flow-mediated
dilation lead to meaningful changes in health status
over long-term periods of time.

Copyright Strength and Conditioning Research Limited, 2015

Page 47

4. PHYSICAL THERAPY AND REHABILITATION

Copyright Strength and Conditioning Research Limited, 2015

Page 48

The preventive effect of the Nordic hamstring exercise


on hamstring injuries in amateur soccer players a
randomized controlled trial, Van der Horst, Smits,
Petersen, Goedhart, and Backx, in Injury Prevention
(2014)

Background
Hamstring strains are a common injury in many
popular team sports and they lead to the loss of many
hours of training and competition, as well as a very
high re-injury rate. Hamstring strains account for 12
16% of all injuries in athletes across a range of
popular team sports, including rugby, soccer, American
Football, and Australian Rules Football. The re-injury
rate for hamstring strains ranges from 16 34%,
depending upon the sport. Running activities account
for most hamstring strains, with 57 68% of strains
occurring during running. The traditional model for
hamstring strain injury is that there are various
factors that could cause an injury to occur, including:
flexibility, strength, fatigue, core stability, muscle
architecture, and damage resulting from previous
injury. A modern, more sophisticated approach has
suggested that while these factors could individually
lead to an injury, it is more likely that they interact
with each other in order to create multi-factorial
scenarios that raise injury risk. Some researchers
have suggested that there are at least two different
types of hamstring strain injury: those caused by
stretching activities and those caused by high-speed
running movements. The hamstring strain injury
caused by high-speed running is thought to occur
most normally in the long head of biceps femoris,
typically involves the proximal muscle-tendon
junction, displays a greater reduction in strength
following injury than those following stretching
movements, and leads to a relatively long recovery
time to reach pre-injury levels of performance (e.g.
around 50 weeks). The biceps femoris (long head) is
generally thought to be the most commonly-injured
hamstring muscle, although some researchers have
suggested that this perception might be incorrect
because of inherent errors in common diagnostic
approaches. Biomechanically, however, there are good
reasons for assuming that the biceps femoris might be
most at risk. Firstly, this muscle increases in length by
more than the other hamstring muscles during
sprinting. Secondly, the moment arm lengths of the
biceps femoris in the sagittal plane increase in the late
swing position compared to the anatomical position.
Previous research has identified that hamstring strains
occur most frequently either in the late swing or early
stance phases of gait. Late swing involves the greatest
strain in the muscle, while early stance involves the
largest joint moments. There is good evidence to
suggest that hamstring strain injuries can be reduced
by eccentric hamstring training but not by flexibility
training alone. This has encouraged many strength
coaches to incorporate the Nordic hamstring curl into
hamstring strain prevention programs. However, there
is only limited evidence to suggest that hamstring
weakness predicts strain injury risk.

OBJECTIVE: To assess whether the Nordic hamstring


curl can reduce the incidence and severity of
hamstring injuries in male amateur soccer players.
POPULATION: Male amateur soccer players, aged
24.5 3.8 years, from 40 teams, randomly allocated
into either a Nordic hamstring curl group (20 teams,
292 players) or a non-training control group (20
teams, 287 players).
INTERVENTION: The Nordic hamstring curl group
performed 25 sessions of a workout involving the
Nordic hamstring curl exercise over a 13-week period.
The exercise, which is an eccentric hamstring curl,
was performed as part of a workout 1 2 times per
week, for 2 3 sets of 5 10 repetitions.

What happened?
Hamstring strain injury incidence
The researchers reported that overall injury incidence
rate was 0.7 per 1,000 player hours. This differed
between training (0.33 per 1,000 player hours) and
competition (1.2 per 1,000 player hours). In addition,
it differed between groups, with the Nordic hamstring
curl group experiencing 0.25 injuries per 1,000 player
hours and the non-training group experiencing 0.80
injuries per 1,000 player hours.
Odds ratios
The researchers found that the risk of hamstring strain
injuries (as calculated by the odds ratio) was
significantly lower in the Nordic hamstring curl group
compared with the non-training group (0.28 times).
Compliance
The researchers found that the compliance with the
Nordic hamstring curl protocol was 91%, indicating
that the soccer players were capable of undertaking
this additional training without difficulty. The instances
of failed compliance occurred partly as a result of
players complaining of delayed onset muscle soreness
from the exercise.

What did the researchers conclude?


The researchers concluded that regularly performing
the Nordic hamstring curl exercise during training
significantly reduces hamstring injury incidence in
amateur soccer players.

Limitations
The study was limited in that it was performed in
amateur soccer players and it is unclear whether the
same results would be observed in other populations.

Copyright Strength and Conditioning Research Limited, 2015

Page 49

Eccentric hamstring strength and hamstring injury risk


in Australian Footballers, by Opar, Williams, Timmins,
Hickey, Duhig, and Shield, in Medicine & Science in
Sports & Exercise (2014)

Background
Hamstring strains are a common injury in many
popular team sports and they lead to the loss of many
hours of training and competition, as well as a very
high re-injury rate. For a detailed introduction to
hamstring strains, see the preceding study review.

OBJECTIVE: To assess prospectively whether low


hamstring strength and between-limb imbalances in
eccentric strength, as measured by reference to the
Nordic hamstring curl, are risk factors for hamstring
strain injury in elite Australian Football athletes.
POPULATION: 210 elite Australian Footballers, aged
23.3 3.7 years, from 5 different teams.

What happened?
Hamstring strain injury incidence
The researchers reported that 28 hamstring strains
occurred. They noted that 79% were observed in the
biceps femoris long head, 18% occurred in the
semimembranosus, and just 3% were observed in the
semitendinosus. They found that high-speed running
was the most common mechanism of injury (61%)
followed by kicking (18%) and finally running while
bent over to collect the ball (7%).
Effect of hamstring strength
The researchers noted that low eccentric hamstring
strength, as defined by knee flexion force of <256N at
the start of the preseason during the Nordic hamstring
curl, was associated with a 2.7 times greater risk of
hamstring strain in the season, as assessed by the
relative risk. Similarly, having low eccentric hamstring
strength, as defined by knee flexion force of <279N at
the end of preseason was associated with a 4.3 times
greater risk of hamstring strain in the season, as
assessed by the relative risk.

What did the researchers conclude?


The researchers concluded that having low levels of
eccentric hamstring strength as measured during the
Nordic hamstring curl was associated with an
increased risk of future hamstring strain injury.

Limitations
The study was limited by the cross-sectional design.
Longitudinal studies are required to demonstrate the
beneficial effects of eccentric hamstring training on
the incidence of hamstring strain injury.

Copyright Strength and Conditioning Research Limited, 2015

Page 50

Immediate combined effect of gastrocnemius


stretching and sustained talocrural joint mobilization
in individuals with limited ankle dorsiflexion: a
randomized controlled trial, by Kang, Oh, Kwon,
Weon, An, and Yoo, in Manual Therapy (2015)

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

OBJECTIVE: To compare the effects of static


stretching of the gastrocnemius with static stretching
combined with joint mobilization on ankle dorsiflexion
passive range of motion (ROM) using a goniometer
and ankle joint angle movements during normal
walking (as measured by an 8-camera motion analysis
system on an 8m walk-way).
POPULATION: 24 males with limited ankle dorsiflexion passive ROM, as defined by having <10
degrees of ankle dorsiflexion passive ROM with knee
extended but >10 degrees of ankle dorsiflexion
passive ROM with the knee flexed and >5 degrees in
difference in ankle dorsiflexion passive ROM between
the knee flexed and knee extended positions, either
unilaterally or bilaterally.
INTERVENTION: All subjects performed static
stretching of the gastrocnemius and a combined
condition comprising both static stretching of the
gastrocnemius combined with joint mobilization, in
two different conditions. The static stretching was
performed against a wall and the talocrural joint
mobilization was performed by an examiner.

What happened?
Passive ankle dorsiflexion ROM
The researchers found that ankle dorsiflexion passive
ROM was significantly increased after both the static
stretching only and combined conditions. While there
was no significant difference between the conditions,
there was a non-significant trend for the combined
condition to display greater increase in ROM than the
static stretching only condition (3.72 vs. 2.25.
degrees).
Joint angle movements during walking
The researchers observed that the combined group
displayed greater increases in the time to heel-off
during walking than the static stretching only group.
In addition, they observed that the combined group
displayed greater increases in peak ankle dorsiflexion
ROM during the stance phase of gait than the static
stretching only group.

What did the researchers conclude?


The researchers concluded a combined intervention
comprising both static stretching and talocrural joint
mobilization was more effective than static stretching
only for increasing ankle dorsiflexion and the time to
heel-off during walking gait. They also noted that
there was a non-significant trend for greater passive
dorsiflexion ROM following the combined treatment.

Limitations
The study was limited insofar as it is unclear whether
improving ankle dorsiflexion ROM during gait has any
meaningful beneficial effects.

Copyright Strength and Conditioning Research Limited, 2015

Page 51

Immediate effects of neurodynamic sliding versus


muscle stretching on hamstring flexibility in subjects
with short hamstring syndrome, by CastelloteCaballero, Valenza, Puentedura, Fernndez-de-lasPeas, and Alburquerque-Sendn, in Journal of Sports
Medicine (2014)

Background
Manual therapies are widely used in order to increase
flexibility. However, the means by which these
techniques increase joint range of motion is very
unclear. For a detailed introduction to this area, see
the preceding study review.

OBJECTIVE: To compare the effects of an isolated


neurodynamic sciatic sliding technique with static
stretching and with a placebo on hamstring flexibility
(as measured by reference to passive straight leg
raise test) in otherwise asymptomatic individuals with
limited hamstring flexibility (also known as short
hamstring syndrome).
POPULATION: 120 subjects (60 males and 60
females), aged 33.4 7.4 years, with short hamstring
syndrome (as defined by a range of motion (ROM) of
<80 degrees on the passive straight leg raise test),
randomly allocated to 1 of 3 groups: neurodynamic
sliding, static stretching, and placebo.
INTERVENTION: Subjects in the static stretching
group received an acute intervention involving passive
straight leg raise in the supine position performed by
an examiner for 6 sets of 30 seconds each. The
neurodynamic sliding comprised the same volume of
concurrent hip flexion and knee flexion movements,
alternating dynamically with concurrent hip extension
and knee extension movements, also in the supine
position. Finally, the placebo group received passive
mobilization of the intrinsic foot joints in the supine
position, for the same volume of time.

What happened?
Hamstring flexibility
The researchers reported that passive straight leg
raise test ROM increased to a greater extent in the
neurodynamic and static stretching groups compared
to the placebo group. However, they also found that
the neurodynamic group increased passive straight leg
raise test ROM to a greater extent than the static
stretching group.

What did the researchers conclude?


The researchers concluded that neurodynamic sliding
techniques appear to be able to improve hamstring
flexibility at least as well as static stretching, if not to
a greater extent.

Limitations
The study was limited in that it was an acute
investigation and it is unclear whether long-term
benefits of neurodynamic sliding would be similar to
those observed following long-term programs of static
stretching.

Copyright Strength and Conditioning Research Limited, 2015

Page 52

Short term effectiveness of neural sliders and neural


tensioners as an adjunct to static stretching of
hamstrings on knee extension angle in healthy
individuals: a randomized controlled trial, by Sharma,
Balthillaya, Rao, and Mani, in Physical Therapy in
Sport (2015)

Background
Manual therapies are widely used in order to increase
flexibility. However, the means by which these
techniques increase joint range of motion is very
unclear. For a detailed introduction to this area, see
the preceding but one study review.

OBJECTIVE: To compare the effects of two different


combined neural and static stretching treatments with
static stretching only on changes in hamstring
flexibility (as measured by passive knee extension
angle) in individuals with low hamstring flexibility.
POPULATION: 60 healthy subjects, aged 22 2.4
years with low hamstring flexibility, randomly allocated
to 3 groups, receiving a combined treatment of static
stretching and neurodynamic sliders, a combined
treatment of static stretching and a neurodynamic
tensioner, or static stretching only.
INTERVENTION: All groups received a treatment of
static stretching, comprising a 30-second hold
performed by an examiner with the subject supine and
starting in 90 degrees of hip and knee flexion with the
foot in plantar flexion before performing assisted
passive knee extension. The neurodynamic slider is a
type of neural mobilization in which the subject begins
seated, with the hands placed behind the back. The
cervical spine was extended passively by an examiner
while the subjects actively extended both knees while
performing maximum ankle dorsiflexion. Then the
cervical spine was flexed passively by the examiner
while the subjects flexed both the knees. The
neurodynamic tensioner was performed in a similar
way to the neurodynamic slider but tension was
applied to the ankle by the examiner during the
movement.

What happened?
The researchers found that all treatments led to
significantly increased passive knee extension angle.
They found that both combined treatments were
significantly superior to the static stretching only
intervention but there were no significant differences
between the two combined treatments.

What did the researchers conclude?


The researchers concluded that both neural sliders and
neural tensioners are more effective for increasing
hamstring flexibility compared with static stretching
alone. However, they also concluded that neither
neural mobilization technique was superior to the
other.

Limitations
The study was limited in that it was unclear whether
there was no difference between the two neural
mobilization techniques because they produced similar
effects through different mechanisms or because they
produced similar effects by the same mechanism.

Copyright Strength and Conditioning Research Limited, 2015

Page 53

Effectiveness analysis of active stretching versus


active stretching plus low-frequency electrical
stimulation in children who play soccer and who have
the short hamstring syndrome, by PiquerasRodrguez, Palazon-Bru, and Gil-Guilln, in Clinical
Journal of Sport Medicine (2015)

Background
Pain management is a key feature of many cases
presenting to physical therapists and sports medicine
physicians. Traditionally, analgesic medication has
been the primary treatment for most types of pain.
However, some medications have side effects that are
undesirable, such as non-steroidal anti-inflammatory
drugs (NSAIDs), which are thought to interfere with
adaptations to exercise. Transcutaneous electrical
nerve stimulation (TENS) is a non-invasive method for
pain relief. TENS units can be purchased by individuals
without prescription in many countries around the
world. The TENS unit transmits pulsed electrical
signals across the surface of the skin via self-adhesive
electrodes. Pulse durations tend to be around 50
250s, while frequencies tend to range from 1 200
pulses per second. Research into the potential
mechanisms underlying the analgesic effects of TENS
units suggests that they may reduce ongoing
nociceptive cell activity and sensitization in the central
nervous system for <2 hours, when applied acutely.
Research into the pain-relieving effects compared to a
placebo have reported some degree of effectiveness,
even when compared with a directly comparable sham
treatment. However, the extent to which these
findings are clinically meaningful is uncertain.

OBJECTIVE: To compare the effects of static


stretching with a combined treatment of active
stretching plus TENS on hamstring flexibility (as
measured by reference to passive straight leg raise
test, passive knee extension test, and toe-touch test)
in young athletes with limited hamstring flexibility.
POPULATION: 51 young soccer players (aged 10
16 years) with limited hamstring flexibility (as
measured by reference to <70 degrees in the passive
straight leg raise test or >15 degrees in the passive
knee extension test), otherwise known as short
hamstring syndrome, randomly allocated to either an
active stretching group, an active stretching plus TENS
group, or a normal activity group.
INTERVENTION: The subjects took part in 8
treatment sessions over an 8-week program of static
stretching or active stretching plus TENS or a control
group who continued normal activities, which included
some stretching. The active stretching program
comprised 2 sets of 6 repetitions of each of 3
commonly-used hamstring static stretching exercises
performed to the maximum tolerable range of motion
without pain for 15 seconds, with 15 seconds of rest
between stretches.

What happened?
Combined static stretching plus TENS
The researchers found that the combined group
improved passive straight leg raise test by 12.3
degrees on the right and 10.0 degrees on the left
compared to the control. They reported that passive
knee extension test improved by 12.9 degrees on the
right and 8.6 degrees on the left compared to the
control. Finally, they found that the combined group
improved toe touch distance by 8.8cm compared to
the control group.
Static stretching only
The researchers found that the stretching-only group
improved passive straight leg raise test by 6.8 degrees
on the right and 5.8 degrees on the left compared to
the control. They reported that passive knee extension
test did not improve compared to the control. Finally,
they found that the stretching-only group improved
toe touch distance by 6.7cm compared to the control
group.

What did the researchers conclude?


The researchers concluded that a long-term program
of active stretching plus TENS was superior to a longterm program of active stretching only for increasing
hamstring flexibility.

Limitations
The study was limited in the control group also
performed some stretching activities as part of their
normal soccer training.

Copyright Strength and Conditioning Research Limited, 2015

Page 54

The structural and mechanical properties of the


Achilles tendon 2 years after surgical repair, by
Geremia, Bobbert, Nova, Ott, De Aguiar Lemos, De
Oliveira Lupion, and Vaz, in Clinical Biomechanics
(2015)

Background
Tendons are connective tissue structures that connect
muscle to bone and permit the transference of tensile
force from the muscle to its associated joint. However,
tendons are not simply inactive structures that
transmit muscle force. They have specific mechanical
characteristics that affect movement and function.
Despite being non-contractile tissues, they perform a
role in human movement by means of energy
conservation and material deformation. More
specifically, they have viscoelastic properties, which
means that they display both elastic and viscous
characteristics, depending on the amount of load
applied and on time for which this load is applied. The
elastic properties of tendons have been of particular
interest to researchers working in sport science. For
example, it has been noted that the Achilles tendon
functions as a biological spring during locomotion.
During the early stance phase of gait, these tendons
have been found to store elastic energy and
subsequently release it in the late phase, thereby
enhancing efficiency of movement. Increasing the
ability of tendons to store and release energy during
movements would be highly valuable to athletes, as a
tendon that stored and released a greater amount of
energy per foot stride would lead to greater propulsion
for the same amount of muscular force. Anatomically,
tendons are comprised in a hierarchical format of
individual collagen structures. Similar to the structure
of muscles, tendons are comprised of single strands of
fibrils, made of collagen, which are bundled together
making increasingly larger structures: many fibrils
become fibers, many fibers become fascicles, which
ultimately become the constituents of the whole
tendon complex. Each bundle is tightly packed and
surrounded by a connective sheath, known as an
endotendon. Tendons are mostly made from type I
collagen material, which is considered to be
responsible for the strength of the material against
deformation, although tendons do also contain other
types of collagen, most obviously type III collagen,
which has been implicated in the healing process of
tendon, but also seems to weaken the tendon
structure if too much is present. Additionally, the
exact components of a tendon depend upon its precise
location in the body. Tendons seem to respond to
certain mechanical loading protocols by increasing
their size, measured as cross-sectional area. For
example, some researchers have observed changes in
tendon cross-sectional area following long-term
programs of resistance training. However, the exact
implications of such changes are not entirely clear.

OBJECTIVE: To compare the effects of early and


traditional immobilization rehabilitation programs on
the mechanical properties of injured and surgically
repaired Achilles tendons, 2 years post-repair. The
mechanical properties investigated were assessed by
measuring tendon cross-sectional area, tendon resting
length, and tendon elongation as a function of torque
in maximal voluntary isometric contraction (MVIC)
plantar-flexion by ultrasound. These measurements
allowed the calculation of length-tension and stressstrain relationships.
POPULATION: 18 males who had suffered previous
Achilles tendon rupture, including 9 subjects who had
received early mobilization treatment and 9 subjects
who had received traditional immobilization with a
plaster cast.

What happened?
Length-tension relationship
The length-tension relationship of tendons describes
how much they elongate in response to applied force.
The researchers found that the previously injured
tendons displayed lower force for the same elongation
by ~21% (effect size = 1.4). However, they found no
differences between rehabilitation treatment methods.
Stress-strain relationship
The stress-strain relationship of tendons is similar to
the length-tension relationship and also describes how
much they elongate in response to applied force but
controls for the cross-sectional area (stress rather
than force) and the resting length (strain rather than
length). The researchers found that the previously
injured tendons displayed lower stress for the same
strain by ~20% (effect size = 1.1). However, they
found no differences between rehabilitation treatment
methods.

What did the researchers conclude?


The researchers concluded that the mechanical
properties of previously ruptured and surgically
repaired tendons 2 years post-repair are not affected
by the type of rehabilitation method that is conducted
immediately after surgery. They therefore suggest
that early mobilization treatment is as appropriate as
traditional rehabilitation.

Limitations
The study was limited in that it is unclear whether
there is a rehabilitation approach that can be
performed that will indeed allow tendons to revert
back to their original state of mechanical function.

Copyright Strength and Conditioning Research Limited, 2015

Page 55

Human tendon adaptation in response to mechanical


loading: a systematic review and meta-analysis of
exercise intervention studies on healthy adults, by
Bohm, Mersmann and Arampatzis, in Sports Medicine
Open (2015)

Background
Tendons are connective tissue structures that connect
muscle to bone and permit the transference of tensile
force from the muscle to its associated joint. However,
tendons are not simply inactive structures that
transmit muscle force. They have specific mechanical
characteristics that affect movement and function. For
a detailed background to tendons, see the previous
study review.

OBJECTIVE: To perform a systematic review and


several meta-analyses of the literature in relation to
the effects of long-term mechanical loading on
asymptomatic human tendons.
STUDY SELECTION: Studies were included that
described the effects of long-term exercise programs
(8 weeks) in healthy humans aged 18 50 years on
the mechanical, material or morphological properties
of tendons. Mechanical properties were predominantly
reported in relation to tendon stiffness; material
properties were predominantly reported in relation to
the stress-strain relationship; and the morphological
properties were predominantly reported in relation to
tendon cross-sectional area.

What happened?
Study selection
The reviewers identified 27 studies with 37 separate
interventions on either the Achilles or patellar tendon,
including a total of 264 subjects.
Effects of mechanical loading on tendons
The researchers observed that mechanical loading has
significant effects on tendon stiffness (effect size =
0.70), the stress-strain relationship (effect size =
0.69) and on tendon cross-sectional area (effect size
= 0.24). They noted that there was significant
heterogeneity between study protocols for tendon
stiffness and for the stress-strain relationship but not
for tendon cross-sectional area.
Analysis of program characteristics
The researchers assessed which exercise program
characteristics were driving the heterogeneity of the
results found in the main meta-analyses for tendon
stiffness and for the stress-strain relationship. They
found that tendon stiffness was markedly affected by
relative load, with loads >70% of maximum voluntary
isometric contraction (MVIC) being superior to loads
<70% of MVIC. However, there was no effect of
contraction type (e.g. isometric vs. dynamic). They
also found that tendon stiffness was markedly affected
by the duration of the intervention, with durations of
>12 weeks being superior to durations of <12 weeks.

What did the researchers conclude?


The researchers concluded that tendons respond to
increased mechanical loading by altering mechanical,
material, and morphological properties. They also
concluded that more effective training interventions
involve high relative loads (>70% of MVIC) over
longer durations (>12 weeks).

Limitations
The meta-analysis was limited in that it is unclear to
what extent changing the mechanical, material, and
morphological properties of tendons in the ways
observed in the included studies is beneficial for sports
performance or general health.

Copyright Strength and Conditioning Research Limited, 2015

Page 56

Preventive interventions for tendinopathy: a


systematic review, by Peters, Zwerver, Diercks,
Elferink-Gemser, Van den Akker-Scheek, in Journal of
Science and Medicine in Sport (2015)

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

OBJECTIVE: To carry out a systematic review of the


efficacy of preventive interventions for tendinopathy at
the ankle, knee, hip, groin, shoulder and elbow.
STUDY SELECTION: Studies were included that
assessed the preventive effects of an intervention for
tendinopathy (as measured by either the incidence or
prevalence of either tendinopathy itself or of tendon
abnormalities) in a specific tendon of the ankle, knee,
hip, groin, shoulder or elbow.

What happened?
Study selection
The researchers identified 10 articles that involved 3
types of intervention: stretching and exercise, shoe
adaptations, and other unclassified interventions.
These articles included 4 investigations of stretching
and exercise, 3 explorations into the effects of shoe
adaptations, and 2 other unclassified interventions.
The studies explored 9 preventive interventions for
Achilles tendinopathy, 2 preventive interventions for
patellar tendinopathy, and 1 preventive intervention
for groin tendinopathy.
Efficacy of preventative interventions
The researchers found that of the 4 investigations of
stretching and exercise, only 1 reported a beneficial
effect, which was the use of soccer-specific balance
training. They noted that of the 3 investigations into
shoe adaptations, only 1 reported a beneficial effect,
which was the use of shock-absorbing insoles for
preventing Achilles tendinopathy. The unclassified
category included one study that assessed the effect
of Hormone Replacement Therapy (HRT), which
seemed to be beneficial, and one study that assessed
the benefit of information provision, which did not.

What did the researchers conclude?


The researchers concluded that there is limited
evidence that a long-term intervention of soccerspecific balance training may be effective for
preventing patellar and Achilles tendinopathy, while
shock absorbing insoles may also be effective for
preventing Achilles tendinopathy. They noted that HRT
seems to reduce the risk of Achilles tendinopathy in
post-menopausal women.

Limitations
The review was limited by the relative paucity of
literature in this area.

Copyright Strength and Conditioning Research Limited, 2015

Page 57

Six weeks of core stability training improves landing


kinetics among female capoeira athletes: a pilot
study, by Araujo, Cohen, and Hayes, in Journal of
Human Kinetics (2015)

Background
Core stability has been subject to a large amount of
research, both with a view toward improving athletic
performance and to preventing and treating low back
pain (LBP). However, in the literature, there has been
considerable variety between studies in respect of
what is defined by both the core and by stability.
Moreover, stability requirements may differ under
different loading conditions, particularly as the core
can be subject to indirect forces applied from a variety
of different directions and also in response to forces of
varying durations and magnitudes. Thus, the concept
of core stability is extremely difficult to pin down
accurately. Core stability is thought to be important
for athletes because of the transfer of force from the
upper body segments to the lower body and from the
lower body segments to the upper body in a process
called sequential kinetic linking. Researchers have
previously outlined how the acts of baseball pitching
and batting follow a sequential kinetic chain. This
phenomenon describes motions that follow a proximalto-distal pattern, which are initiated by larger, central
body segments and then proceed outward to the
smaller, more distal segments, such as the arms.
Where optimal proximal-to-distal kinematic sequences
occur in throwing motions, the pelvis is rotated using
the leg and hip muscles. The pelvis initially accelerates
but then quickly decelerates as it transfers energy to
the torso. The same pattern is repeated with the torso
and the arm and then the arm and the hand or bat.
During this sequence, it is thought that the activation
of the core muscles acts to decelerate pelvic rotation
and accelerate rotation of the upper trunk. Not all
researchers have considered the important role of the
trunk muscles in such sequences when attempting to
define core stability for athletes. Many generic
definitions have been proposed defining core stability
as the integrated functioning of the spine and
surrounding muscles to maintain intervertebral range
of motion within a safe limit. Such definitions fall short
not only of taking the role of the trunk in athletic
movement into account but also in that they exclude
the abdominal musculature (with the key ones being
the transverse abdominis, rectus abdominis, external
oblique, and internal oblique), which are also thought
to have a key role in core stability. In possibly the
most important definition of core stability, Kibler et al.
(2006) described it as the ability to control the
position and motion of the trunk over the pelvis to
allow optimum production, transfer and control of
force and motion to the terminal segment in
integrated athletic activities. Nevertheless, it is highly
likely that the current failure to uncover meaningful
findings in this area of research is at least partly
caused by the failure to define terms appropriately.

OBJECTIVE: To assess the effects of a core stability


intervention on landing ground reaction forces (using
a force plate) during a drop jump test (from a box
height of 40cm) in trained individuals.
POPULATION: 16 female capoeira athletes, aged
27.3 3.7 years.
INTERVENTION: All subjects performed static and
dynamic core stability exercises, 3 times per week for
6 weeks. Exercises included the plank, the side plank,
the supine bridge, the abdominal crunch, the Russian
twist, and the split leg scissors, all of which were
performed for 3 sets of 30 45-second holds or 3 sets
of 20 45 repetitions, as appropriate.

What happened?
Vertical ground reaction forces
The researchers observed a significant reduction in
relative vertical ground reaction force upon landing for
both the first landing phase (3.40 0.78 vs. 2.85
0.52N per N of bodyweight) and also for the second
landing phase (5.09 1.17 vs. 3.02 0.41N per N of
bodyweight).
Jump height
The researchers observed that jump height was not
significantly altered as a result of the core stability
program.

What did the researchers conclude?


The researchers concluded that trunk dominant core
stability training reduces ground reaction forces during
landing without altering jump height in female
athletes, which may in turn reduce lower body injury
risk.

Limitations
The study was limited as it is unclear which exercises
in the battery were most effective at bringing about
the beneficial effects.

Copyright Strength and Conditioning Research Limited, 2015

Page 58

Core strength training for patients with chronic low


back pain, by Chang, Lin, and Lai, in Journal of
Physical Therapy Science (2015)

Background
Low back pain (LBP) can be defined as pain that is
localized to the lumbar area, below the inferior ribcage
and above the waistline, although the definition is also
often extended to include radiating leg pain such as
sciatica. LBP is a common and growing problem. It
leads to a large number of physician-related visits in
both the United States and worldwide. In the United
States in 1990, around 15 million visits were recorded
for mechanical LBP, causing this problem to rank as
the fifth most likely out of all physician visits.
Economically, the burden of LBP is severe. Direct and
indirect costs of LBP have been estimated as around
$50 $100 billion per annum, with 75% of these
costs being attributable to the 5% of people who
become disabled. Additionally, a great deal of time
and money appears to be spent on procedures that
are ineffective. Reviews of the various treatments
currently in use for individuals with LBP have often
concluded that patients are receiving an increasing
number of treatments that are poorly supported by
evidence. Such treatments often come accompanied
by complications. When analyzing LBP, it is thought to
be important to distinguish between acute and chronic
LBP, although the literature itself can be conflicting in
this regard. Commonly acute LBP is defined as that
lasting <6 weeks, sub-acute LBP is usually defined as
6 12 weeks, and chronic LBP is usually defined as
>12 weeks. In respect of acute LBP, researchers have
generally found that no intervention is more successful
than the simple advice to remain active. This is indeed
the recommendation of current guidelines. Also, these
same guidelines suggest that the vast majority of
incidences of acute LBP resolve in <6 weeks. However,
a recent meta-analysis found that while cases of acute
LBP did improve markedly within 6 weeks, the speed
improvement after this point slowed and low-tomoderate levels of pain and disability were still
present >1 year later. Chronic LBP is very different
from acute LBP both in the prognosis and in the
availability of effective treatments. Unlike acute LBP,
researchers have generally found that exercise
interventions lead to both statistically significant and
clinically useful differences in outcomes in comparison
with other treatments, including usual treatment by
general practitioners. Additionally, unlike acute LBP,
the recurrence rate for chronic LBP is very high, with
many people suffering repeated episodes over long
periods of time.

OBJECTIVE: To perform a systematic review of the


new literature in relation to the effectiveness of core
training for improving pain, function and quality of life
in patients with chronic LBP.
STUDY SELECTION: Studies published after 2008
that explored the effects of long-term core training
interventions on direct measures of LBP severity were
included.

What happened?
Study selection
The researchers only identified 4 relevant studies in
the period from 2008 onwards, although these were
all high quality per the Jadad scores. These studies
each used different training approaches, as follows:
trunk strengthening, core stabilization, segmental
stabilization of the deep core muscles, and motor
control exercises. The studies also assessed the
effects of training on different outcome measures. For
pain measurements the Visual Analog Scale for pain
(VAS) and the McGill pain questionnaire were used.
For function measurements, the range minimum query
(RMQ), Oswestry disability questionnaire (OSWDQ)
and the back performance scale (BPS) were used. For
quality of life, the Short Form-12 (SF-12) physical and
mental sections were used.
Effects of core training
The researchers found that pain measurements were
improved by all core training methods, as measured
by either the VAS or McGill pain questionnaire test
results. However, the improvement may have been
simply in line with the natural course of the condition,
as these effects were not different from the nontraining control groups. The researchers also noted
that function and quality of life were improved by core
training and these effects were greater than the nontraining control groups.

What did the researchers conclude?


The researchers concluded that a range of commonlyused core training methods can help improve function
and quality of life (and possibly reduce pain) in cases
of LBP, although it is unclear whether any specific core
training method is superior.

Limitations
The review was limited in that only recent studies
were incorporated, which may present an unbalanced
view of the literature.

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Exercise-based performance enhancement and injury


prevention for firefighters: contrasting the fitnessand movement-related adaptations to two training
methodologies, by Frost, Beach, Callaghan, and
McGill, in The Journal of Strength & Conditioning
Research (2015)

Background
The Functional Movement Screen (FMS) is a test in
which 7 different movements are graded from 1 3
points. The sum of these tests is taken to create a
total score out of 21 points. Researchers have shown
that when using a cut-off point of 14 points, it is
possible to use the sum score to predict injury risk,
albeit with a relatively low degree of accuracy. Using
the cut-off of 14 points, the ability of the FMS to
predict correctly individuals who will incur an injury
(i.e. sensitivity) is in fact on average across a range of
studies quite poor (i.e. ~50%, which is the same as a
coin toss). On the other hand, the ability to predict
correctly those individuals who will not incur an injury
(i.e. specificity) is much better. This suggests that the
FMS is superior for identifying individuals who will not
be injured than it is for identifying at-risk cases. Thus,
the FMS might serve best as a screen for clearing
athletes from unnecessary injury prevention training
rather than as an injury risk detection screen. Several
studies have found that the inter-rater and intra-rater
reliability of the FMS is good-to-excellent, particularly
where experienced raters perform the tests. However,
the use of the sum score of the FMS to predict injury
has been questioned by researchers who have
assessed its validity. In one investigation, the factor
structure of the FMS test was explored and it was
found that there was poor correlation between the
outcomes of the various individual component tests,
meaning that the validity of combining the scores of
each test within the FMS to produce a sum score to
predict injury risk is questionable. Despite these
concerns, the FMS sum score continues to be widelyused as a test of injury risk. Conventionally, where
individuals score poorly on the FMS, exercise
interventions are recommended to improve the score
and, it is believed, reduce future injury risk. Indeed, it
is well-known that exercise, particularly resistancetraining, does lead to alterations in joint angle
movements observed during multi-joint movements,
such as drop landings. Many studies have assessed
the ability of different exercise intervention programs
to improve the FMS score in various populations. And
almost all have found that exercise can improve FMS
score. However, these studies were of relatively low
quality and the only high-quality study was the single
one that reported that exercise was not able to
improve FMS score in relation to a control group.
However, in the studies that have compared corrective
or functional exercise with traditional resistance
training, the FMS recorded no differences in
improvement in FMS score between the two training
programs.

OBJECTIVE: To compare the effects of two different


training programs on both fitness and movement
adaptations. Fitness was assessed by reference to
several tests, including: an incremental treadmill test
for aerobic fitness, a grip test for muscular strength
(measured using a hand dynamometer), dynamic
muscular endurance (measured by reference to the
maximum number of push-ups), static muscular
endurance for the core (front plank, side plank and
Bierring-Sorensen back extension) tests, lower-body
power (by reference to the proxy of countermovement jump height, and lower-body flexibility (as
measured in the modified sit-and-reach test).
Movement was assessed by reference to the degree of
spinal movement and frontal plane knee movement in
5 tasks: a box lift, a bodyweight squat, a lunge, a
one-arm push with a split stance, and a one-arm pull
with a split stance. These movements were performed
under 4 conditions: low-load and low-velocity, highload and low-velocity, low-load and high-velocity, and
high-load and high-velocity.
POPULATION: 52 firefighters randomly allocated to a
movement-guided fitness group, a conventional fitness
group, or a non-training control group. The subjects in
each group were tested with the FMS and all had
similar scores.
INTERVENTION: The subjects in the training groups
performed 12-week exercise programs.

What happened?
The researchers found that only the movement-guided
group displayed significant improvements in spine and
frontal plane knee motion in each of the 5 tasks.
However, while the group displayed significant
improvements in each of the tasks when performed
with at least one combination of load and velocity,
they did not display significant improvements in all
conditions of load and velocity similarly.

What did the researchers conclude?


The researchers concluded that a long-term program
of movement-based coaching can alter how subjects
perform certain standardized tasks.

Limitations
The study was limited in that it was unclear precisely
what aspects of the movement-guided fitness program
might have contributed to the beneficial effects
observed in the tests.

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Balancing hands-on with hands-off physical


therapy interventions for the treatment of central
sensitization pain in osteoarthritis, by Girbs, Meeus,
Baert, and Nijs, in Manual Therapy (2014)

Background
Osteoarthritis is a chronic, progressive, degenerative
joint disorder. It is characterized by constellation of
damaging structural changes in a joint, including the
areas of articular cartilage and subchondral bone,
which can be observed on X-ray imaging scans. These
changes are thought to be instrumental in the
development of pain and functional impairment.
Originally, osteoarthritis was thought to be entirely a
disease of the articular cartilage but more recent
research has revealed that the condition is a
multifactorial disease of the whole joint, with a
complex pathogenesis involving interactions between
various joint tissues. Osteoarthritis is an extremely
common condition and is becoming more prevalent,
most likely because of the worldwide aging population.
The pathogenesis of osteoarthritis is unclear but risk
factors are thought to include age, race, gender, joint
trauma and life-style factors including obesity. Several
studies have found that athletes and individuals
partaking in sports are more likely to incur
osteoarthritis in comparison with non-athletic controls.
It has been proposed that this is because athletes
more frequently sustain joint injuries compared with
non-athletic controls rather than because of the
greater amount of physical activity. Indeed, previous
ligament injuries and meniscal tears are strongly
associated with the subsequent progression of
osteoarthritis whereas exercise is typically associated
with amelioration of symptoms in affected individuals.
The primary symptoms of osteoarthritis are joint pain
and stiffness, which typically lead to reduced
movement and subsequent disuse atrophy of the
related musculature. Treatment of osteoarthritis is
limited but generally includes physiotherapy, exercise,
weight loss, and the relief of symptoms with local
corticosteroid injections, and the administration of
analgesics and non-steroidal anti-inflammatory drugs
(NSAIDs).

OBJECTIVE: To discuss the available desensitizing


strategies that are available to physical therapists and
how they can be applied when treating patients with
chronic osteoarthritis-related pain.

What did the researchers find?


Balance between hands-on and hands-off therapy
The researchers note that there is evidence that
central sensitization plays a key role in the pain
experienced by individuals with osteoarthritis, which
may benefit from being addressed directly through
psychosocial treatments. But they also observe that
this does not discount the presence of ongoing
peripheral joint pathology that may benefit from more
traditional, locally-focussed interventions.
Benefits of pain science education
The researchers note that education can play a key
role in addressing central sensitization, although the
standard materials tend to involve the provision of
biomedical information, which can increase fear and
reinforce belief in a pathological, anatomical source of
pain, which aggravates the condition. The researchers
therefore suggest pain science education, which is
targeted towards a reconceptualization of pain that is
intended to change pain beliefs, thereby desensitizing
the central nervous system.
Clarifying the mechanisms of manual therapy
The researchers suggest that care be taken during the
provision of manual therapy to avoid referring to
unjustified mechanisms of action that imply structural
changes are occurring. In this way, manual therapy
can be seen as an intervention to help improve
flexibility transiently and also to provide temporary
pain relief through the activation of descending
inhibitory pain mechanisms.

What did the researchers conclude?


The researchers concluded that while there may be
some problems in combining manual therapy and pain
science education for addressing central sensitization
in individuals with chronic osteoarthritis-related pain,
it is possible to combine these effectively.

Limitations
The review was limited in that was based upon the
opinions of the reviewers and may not reflect the
views of all researchers working in this field.

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Loss of range of motion of the hip joint: a hypothesis


for etiology of sports hernia, by Rambani and
Hackney, in Muscles, Ligaments and Tendons Journal
(2015)

Background
Hip extension is very probably the most important
joint action in all of sports and is also key to being
able to perform functional activities of daily living.
Although the hip joint is a ball-and-socket joint and is
capable of movement in every direction, hip extension
(and flexion) is the joint action that occurs in the
sagittal plane and facilitates the activities of walking
and running. Hip extension range-of-motion (ROM) is
often lost in injured or elderly people. Indeed, studies
have reported that hip extension ROM is the only form
of hip ROM to decrease significantly with age and that
a reduction in hip extension ROM occurs between the
25 39 and 40 59 years age groups, which amounts
to ~6 degrees over the whole 50-year duration of
adult life. Additionally, active hip extension ROM is
lower in elderly people who have a history of falling
compared to elderly people who do not have a history
of falling. This may be because the lack of hip
extension ROM makes it more difficult to solve
movement problems or it may be because reduced hip
extension ROM leads to reduced hip extension
strength: studies have found that a lack of hip
extension ROM is associated with reduced hip
extension strength and that mobilization of the hip
joint by a physical therapist can improve hip extension
strength in subjects with normal hip extension ROM.
In addition, lower back pain is correlated with
significantly reduced hip extension ROM, irrespective
of the knee flexion angle and hip abduction angle.
However, studies have reported that the end ranges in
the frontal plane appear to produce the greatest
problems for lower back pain sufferers. In normal
people, research indicates that hip extension ROM can
vary widely. Some studies indicate that there is
significant hip extension ROM of ~15 20 degrees,
while studies indicate that hip extension ROM is much
less. This may reflect large variability between groups
of subjects or it may be a function of different
measurement methods leading to varying results. Of
course, hip extension ROM is generally greater in
females than in males. However, it is important to
note that during combined forward hip and spine
flexion actions, such as the sit-and-reach test, there
are also other sex differences in respect of the various
joints. This makes combined flexibility tests like the
sit-and-reach test problematic for assessing hip
extension in populations comprising both males and
females. Hip extension range-of-motion (ROM) from
the neutral position, or hip hyper-extension, can be
significantly affected by the degree of hip abduction
and knee flexion. Reducing knee flexion from 80
degrees down to 0 degrees allows much greater hip
extension ROM. Similarly, increasing the abduction
angle of the hip allows for significantly greater hip
extension ROM.

OBJECTIVE: To assess whether a loss of range of


motion of at the hip joint is associated with a greater
risk of sports hernia, potentially as a contributory
factor to stress across the symphysis pubis leading to
instability.
POPULATION: 25 athletes with sports hernia and 25
age-, sex-, physical or sports activity- and comorbidity-matched athletes without sports hernia.

What happened?
Hip flexion and extension ROM
The researchers found that in the sports hernia and no
sports hernia groups, the hip flexion ROM was similar
(122.30 vs. 122.20 degrees) and the hip extension
ROM was similar (10.30 vs. 11.40 degrees).
Hip adduction and abduction ROM
The researchers found that in the sports hernia and no
sports hernia groups, the hip adduction ROM was
similar (27.10 vs. 26.20 degrees) and the hip
abduction ROM was similar (35.20 vs. 35.90 degrees).
Hip internal and external rotation ROM
The researchers found that when comparing the sports
hernia and no sports hernia groups, the hip internal
rotation ROM was significantly less in the sports hernia
group (17.40 vs. 40.90 degrees) and the hip external
rotation ROM was also significantly less in the sports
hernia group (26.20 vs. 45.10 degrees).

What did the researchers conclude?


The researchers concluded that the loss of hip internal
and external rotation ROM might be a predisposing
factor for greater risk of sports hernia.

Limitations
The study was limited in that it was retrospective and
cross-sectional and it is therefore unclear whether the
loss of ROM was a causal factor for injury.

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