Clinical Advances in Rehabilitation and Prevention

The present study investigated the effects of a series of 10 whole-body cryostimulation (WBC) sessions (3 min; −110 °C) on physiological and thermal responses to a submaximal exercise test in 17 elite athletes. Participants performed an exercise test twice at similar levels of intensity before and after a series of ten WBC sessions. Before and during the test, each participant’s oxygen uptake (VO₂), heart rate (HR), internal temperature (Ti), and skin temperature in selected areas of the skin were measured, and the mean arterial pressure (MAP), physiological strain index (PSI), and mean skin temperature (Tsk) were calculated. The results show that during exercise, increases in Ti and the PSI were significantly lower after the WBC sessions, and although there were no significant changes in HR or the MAP, the Tsk was significantly higher. Following exercise, an increase in skin temperature asymmetry over the lower-body muscles was detected. A series of WBC sessions induced a tendency toward a decrease in temperature asymmetry over the thigh muscles. In conclusion, a series of ten WBC sessions does not induce significant modifications in physiological variables but does influence the PSI and Ti during exercise. Moreover, a series of ten WBC sessions influences the distribution of skin temperature and the magnitude of temperature asymmetries in the early phase of recovery. Full article

The risk of pneumonia and death is higher in acute stroke patients with signs of pulmonary infection on chest computed tomography (CT) at admission. However, few reports have examined the incidence of pneumonia and its predictors in subacute stroke patients. The aim of this study was to examine factors related to post-stroke pneumonia in subacute stroke patients. A total of 340 subacute stroke patients were included. Univariable logistic regression analysis was performed using variables that may contribute to pneumonia, with the development of pneumonia as the dependent variable. Multivariable logistic regression analysis using the three independent variables with the lowest p-values on the univariable logistic regression analysis was also performed to calculate adjusted odds ratios. Twenty-two patients developed pneumonia during hospitalization. The univariable logistic regression analysis showed that the top three items were serum albumin (Alb), functional Oral Intake Scale (FOIS) score, and signs of pulmonary infection on chest CT at admission. Multivariable logistic regression analysis adjusted for these three items showed that the presence of signs of pulmonary infection on chest CT at admission was the independent variable (OR: 4.45; 95% CI: 1.54–12.9). When signs of pulmonary infection are seen on admission chest CT, careful follow-up is necessary because pneumonia is significantly more likely to occur during hospitalization. Full article

The aim of this study was to verify the effects of blood flow restriction on movement velocity and muscle activity during the back squat exercise. Methods: Twenty-four university students participated in this study. In two randomized sessions 72 h apart, participants performed a 4-set protocol consisting of 30-15-15-15 repetitions performed at 30% of their one-repetition maximum in the back squat exercise. In both sessions, neuromuscular function was monitored by surface electromyography (EMG) and movement velocity (mean propulsive velocity (MPV), peak concentric velocity (Vmax), and the effort index (EI)). Blood flow restriction (BFR) was applied during exercise in one of the experimental sessions with 80% of full arterial occlusion pressure over lower limbs. Results: The BFR condition showed higher (p < 0.05) EI, peak, and rooted mean square normalized EMG in Set 1 compared to Set 2. Similar MPV and Vmax were observed in each set for both the BFR and control conditions. No significant differences were observed between conditions in any set. Conclusions: BFR did not imply changes in neuromuscular performance during low-intensity resistance training, but it might induce greater intra-series velocity loss and less excitation of the muscles involved. Full article

Background: Studies on the biomechanical mechanisms of an anterior cruciate ligament (ACL) injury have been extensively studied, but studies on the neuromuscular control-related risk factors for an ACL injury in specific maneuvers have not been reported for badminton players. Study design: Controlled laboratory study. Methods: Sixteen badminton players (8 male, 8 female) performed a single-leg badminton ball landing task, and lower limb muscle activity, kinematic data, and ground reaction force were measured during this procedure using marker-based movement analysis, force plates, and electromyography (EMG). Gender differences in the lower limb kinematic data, mean values of normalized lower limb muscle activation (MVC%), and co-contraction values during the landing preparation phase (100 ms before initial contact) were analyzed using MANOVA. Results: In the badminton landing task, the knee valgus angle was greater in females than in males (6.27 ± 2.75 vs. 1.72 ± 3.20) in the pre-landing preparation position. Compared to male badminton players, females exhibited greater gluteus maximus (44.92 ± 18.00 vs. 20.34 ± 11.64), rectus femoris (41.56 ± 9.84 vs. 26.14 ± 10.46), and medial gastrocnemius (37.39 ± 17.31 vs. 19.11 ± 11.17) lateral gastrocnemius (36.86 ± 17.82 vs. 13.59 ± 2.71) muscle activity (MVC%). Conclusion: Female badminton players exhibit neuromuscular control strategies that may be inadequate for ACL protection and may be a potential risk factor for a high incidence of ACL injury In the future, when devising injury prevention plans for female badminton players, optimizing neuromuscular control during the pre-landing phase can be targeted. Full article

The rules governing mountain running force athletes to implement into their training programmes uphill and downhill running on unstable surfaces, which are demanding for hip and ankle as well as for the postural control system. The aim of the present cross-sectional study was to compare highly trained mountain runners (MR) and recreational active non-runners (NR) on range of motion (ROM) and strength in the hip and ankle, as well as dynamic postural control. Thirty MR and thirty-two NR were included in the study. ROM was assessed using a digital inclinometer. Strength was measured using a hand-held dynamometer. Postural control was evaluated using the lower quarter Y-balance test (YBT-LQ). The results showed that MR, in relation to NR, had statistically significant smaller hip external rotation ROM (p = 0.007), lower hip external rotator (p = 0.006) and extensor (p = 0.023) strength and greater normalised anterior reach in the YBT-LQ (p = 0.028). Mountain running training may reduce hip external rotation ROM as well as hip external rotator and extensor strength. Moreover, such training may improve postural control. MR should implement exercises targeted at developing hip ROM and strength. Furthermore, it seems that mountain running training may be a good way to improve postural control. Full article

Data obtained from routine clinical care find increasing use in a scientific context. Many routine databases, e.g., from health insurance providers, include records of medical devices and therapies, but not on motor function, such as the frequently used Gross Motor Function Measure-66 (GMFM-66) score for children and adolescents with cerebral palsy (CP). However, motor function is the most common outcome of therapeutic efforts. In order to increase the usability of available records, the aim of this study was to predict the GMFM-66 score from the medical devices used by a patient with CP. For this purpose, we developed the Medical Device Score Calculator (MDSC) based on the analysis of a population of 1581 children and adolescents with CP. Several machine learning algorithms were compared for predicting the GMFM-66 score. The random forest algorithm proved to be the most accurate with a concordance correlation coefficient (Lin) of 0.75 (0.71; 0.78) with a mean absolute error of 7.74 (7.15; 8.33) and a root mean square error of 10.1 (9.51; 10.8). Our findings suggest that the MDSC is appropriate for estimating the GMFM-66 score in sufficiently large patient groups for scientific purposes, such as comparison or efficacy of different therapies. The MDSC is not suitable for the individual assessment of a child or adolescent with CP. Full article

This study examined the potential for effect of a six-week gait aid training program for people with dementia on spatiotemporal gait outcomes, perception of use, and falls with gait aid use. The program utilised four 30-min physiotherapy home visits, scheduled at weeks 1/2/3/6, and was enhanced by carer-supervised practice. Falls and the physiotherapist’s clinical judgement of participants achieving safe gait aid use during and after the program were described. Perception ratings at each visit were measured using Likert scales which, along with the spatiotemporal outcomes using the gait aid (Time-Up-and-Go-Test, 4-m-walk-test, Figure-of-8-Walk-Test with/without a cognitive task) at weeks 1 and 6, and at weeks 6 and 12 (6-week post-program), were examined with ordinal logistic regression analyses. Twenty-four community-dwelling older people with dementia and their carers participated. Twenty-one (87.5%) older people achieved safe gait aid use. Twenty falls occurred, and only one faller was using their gait aid when they fell. Walking speed, step length, and cadence significantly improved when walking with the gait aid at week 6 compared with week 1. No significant improvements in spatiotemporal outcomes were retained at week 12. Physiotherapists were more likely to agree that gait aid use had improved walking safety among older people with dementia with subsequent training visits. Larger studies of the gait aid training program are needed for this clinical group. Full article

This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 ± 3.6 years; 175 ± 4 cm; 77.3 ± 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 ± 3.7 years; 177 ± 6 cm; 74.3 ± 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 ± 2.8 years; 178 ± 6 cm; 75.8 ± 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300°/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1–G2 = 48%, 38%, 14%; G1–G3 = 49%, 25%, 14%) and hamstring muscles (G1–G2 = 36%, 35%, 18%; G1–G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1–G2 = 262 J, 157 J; G1–G3 = 219 J, 179 J) and power (G1–G2 = 34 W; 11 W; G1–G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = −0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2–3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment. Full article

To evaluate the effects of visual feedback training on motor recovery in postoperative patients with a total knee replacement (TKR). The performance of 40 first-ever TKR patients (27 females; mean age: 70.5 (67.2–74.0) years) was evaluated in a single center, single-blind, randomized controlled study. The patients were randomly and equally distributed into two demographically/clinically matched groups undergoing experimental or traditional treatments. All patients have been treated in a 1 h session, 2/day for 5 days a week, for six consecutive weeks. The first group (“control”) underwent conventional physical therapy, whereas the experimental group received advanced knee training with visual feedback using the TecnoBody® device (Walker View 3.0 SCX, Dalmine (BG), Italy). The clinical scales and kinematic parameters coming from the gait analysis were evaluated to demonstrate the dynamic balance function in a standing position before and after each treatment. After the treatment, both experimental and control groups improved significantly and similarly, as measured by the clinical scales (Numeric Rating Scale for Pain and Barthel index). A significant boosting of the motor performance was detected in the experimental group with respect to the control group in the terms of symmetry index 84 (80.8–85.4) vs. 87.15 (84–92.8) p = 0.001 *; single stance support 34.9 (34.1–36.5) vs. 37.8 (36.6–38.9); p < 0.001; and obliquity parameters 58.65 (51.3–70.3) vs. 73 (62.3–82.1); p < 0.001. Applying visual feedback training in addition to traditional rehabilitation strategies improves the knee function and motor control in postoperative TKR patients. Full article

This study examined the effects of minimal and conventional running footwear on medial tibiofemoral cartilage mechanics and longitudinal failure probability. The current investigation examined twenty males who habitually ran in minimal footwear and 20 males who habitually ran in conventional footwear. Kinematic data during overground running were collected using a motion-capture system and ground reaction forces using a force plate. Medial tibiofemoral loading was examined using musculoskeletal simulation and cartilage failure probability via probabilistic modelling. In habitual minimal footwear users, peak medial tibiofemoral cartilage force, stress and strain were significantly greater in conventional (force = 7.43 BW, stress = 5.12 MPa and strain = 0.30), compared to minimal footwear (force = 7.11 BW, stress 4.65 MPa and strain = 0.28), though no significant differences in these parameters were evident in non-habitual minimal footwear users (conventional: force = 7.50 BW, stress = 5.05 MPa and strain = 0.30; minimal: force = 7.40 BW, stress = 4.77 MPa and strain = 0.29). However, in both habitual and non-habitual minimal footwear users, the probability of medial tibiofemoral cartilage failure was significantly greater in conventional (habitual = 47.19% and non-habitual = 50.00%) compared to minimal footwear (habitual = 33.18% and non-habitual = 32.81%) users. The observations from this investigation show that compared to minimal footwear, conventional footwear appears to have a negative influence on medial tibiofemoral cartilage health. Full article

Objective: The aim of the present study was to compare the fascicle length, pennation angle, muscle thickness and stiffness of the biceps femoris long head, and eccentric hamstring strength between injured dominant limbs, injured non-dominant limbs, uninjured dominant limbs and uninjured non-dominant legs in previously injured players, and between dominant and non-dominant legs in uninjured elite soccer players. Materials and Methods: Twenty elite soccer players participated in this study. Ultrasound imaging and MyotonPRO were used to determine the morphological and mechanical properties of the biceps femoris long head. Isokinetic and Nordic hamstring exercises were used to assess eccentric hamstring strength. Results: Previously injured players showed substantially lower fascicle length and muscle thickness, and significantly higher biceps femoris long head stiffness than uninjured players, without differences between limbs. Conclusion: The morphological and mechanical properties of elite soccer players with hamstring injury history were different from those in uninjured players. The lack of differences between limbs showed that these values are characteristics of individual players that must be considered in the design of programs to prevent BFlh injury. Full article

Introduction: Multiple myeloma (MM) is a hematological malignancy affecting older adults. One of the most common myeloma-defining events is the development of symptomatic lytic bone disease. The serum concentrations of calcium (Ca), inorganic phosphorus (P), and vitamin 25(OH)D₃ in the serum reflect bone metabolism. An enzyme lactate dehydrogenase (LDH) is a marker of muscle damage, but its serum activity also has an important prognostic value in MM. Myoglobin (Mb) is a small protein present in muscles; its serum level increases when myocytes are damaged. Objectives: In this study, the impact of a 6-week Nordic walking (NW) exercise program on blood parameters related to calcium-phosphate metabolism and damage of skeletal muscles was assessed. Patients and methods: A total of 33 patients with MM in the remission stage, without cytostatic treatment, were allocated and randomly assigned to one of two groups: 17 in the training group (NW) and 16 in the control group (CG). All patients were supplemented per os with vitamin D3 and calcium carbonate daily and received zoledronic acid every 4 weeks (intravenous). Nordic walking training sessions took place 3 times a week for 6 weeks, 1 h each. Blood samples were drawn before and after the 6 weeks of training sessions to assess the serum concentrations of vitamin 25(OH)D₃, P, Ca, Mb, and LDH. Results: Patients from the NW group showed a statistically significant decrease in mean serum myoglobin concentration (p = 0.018) and an increase in 25(OH)D₃ (p < 0.001) and total Ca (p = 0.001) concentrations. There were no statistically significant changes in the results obtained in CG. Between groups, after 6 weeks, Mb serum concentration was significantly lower in NW (p = 0.041), and 25(OH)D₃ was higher (p < 0.001) compared to CG. There was a correlation between the changes in myoglobin, phosphorus, 25(OH)D_3, and Ca concentrations after 6 weeks. Conclusions: NW training is a safe and beneficial form of physical exercise for patients with MM without inducing muscle damage. NW performed outside improves serum vitamin 25(OH)D₃ concentration. Full article

This study aimed to evaluate the relationship between injury risk, acute load (AL), acute chronic workload ratio (ACWR) and a new proposed ACWR. Design: a retrospective cohort study of the year 2018 was conducted on Argentine first-division soccer players. Participants: Data from 35 players (age = 26.7 ± 4.71 years; height = 176.28 ± 6.09 cm; mass = 74.2 ± 5.27 kg) were recorded; 12 players’ data were analyzed for 1 year, and 23 players’ data were analyzed for 6 months. Interventions: The mean difference of ACWR (MD = 0.22), high-density interval (HDI 95% = (0.07, 0.36)) and AL (MD = 449.23, HDI 95% = (146.41, 751.2)) between groups turned out to be statistically significant. The effect size between groups comparing ACWR and AL was identical (ES = 0.64). Results: The probability of suffering an injury conditioned by ACWR or random ACWR was similar for all estimated quantiles, and the differences between them were not statistically significant. Conclusions: The ACWR ratio, using internal load monitoring, is no better than a synthetic ACWR created from a random denominator to predict the probability of injury. ACWR should not be used in isolation to analyze the causality between load and injury. Full article

This study aimed to evaluate the effects of preceding anodal transcranial direct stimulation (a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) during the back squat exercise on movement velocity and surface electromyographic (sEMG) activity. Thirteen healthy, well-trained, male firefighters (34.72 ± 3.33 years; 178 ± 7.61 cm; 76.85 ± 11.21 kg; 26.8 ± 4.2 kg·m⁻²; back squat 1-repetition maximum 141.5 ± 16.3 kg) completed this randomised double-blinded sham-controlled crossover study. After familiarisation and basal measurements, participants attended the laboratory on two occasions separated by 72 h to receive either Sham or a-tDCS (current intensity of 2 mA for 20 min). Immediately after stimulation, participants completed three sets of 12 repetitions (70% of 1-RM) with three minutes of recovery between sets monitored with a linear position transducer. The sEMG of the rectus femoris (RF) and vastus lateralis (VL) of both legs were recorded. No significant differences were observed between a-tDCS and Sham interventions on mean concentric velocity at any set (p > 0.05). Velocity loss and effort index were significantly higher (p < 0.05) in set 3 compared to set 1 only in the a-tDCS group. The right-leg RM and right-leg VL elicited the greatest muscle activation during set 1 after a-tDCS and Sham, respectively (p < 0.05). Our results revealed that a-tDCS over the DLPFC might impact movement velocity or fatigue tolerance in well-trained individuals. Notwithstanding, significant differences in dominant-leg muscle activity were found both in a-tDCS and Sham. Full article

Background (1): Men’s football is a physically demanding contact sport that involves intermittent bouts of sprinting, jogging, walking, jumping and changes of direction. The physical demands of the game vary by level of play (amateur club, sub-elite and open club or international), but injury rates at all levels of the men’s football game remain the highest of all sports. Objective: The aim of this study is to conduct a systematic review of data from the epidemiological literature regarding the profile, severity and mechanisms of injuries and the frequency of recurrent injuries in professional and amateur football players. Methods (2): A systematic review, according to PRISMA guidelines, was performed up to June 2023 in the databases of PubMed, Web of Science, Google academic, Google scholar and the Diva portal. Twenty-seven studies that reported data on the type, severity, recurrence and mechanisms of injury in professional and amateur men’s football were selected and analyzed. Two reviewers independently audited data and assessed the study quality using the additional and adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): In professional male football players, the mean prevalence of muscle/tendon injuries was 39.78%, followed by joint and ligament injuries—21.13%, contusions—17.86%, and fractures—3.27%, and for amateur football players, the prevalence’s were 44.56% (muscle/tendon injuries), 27.62% (joint and ligament injuries), 15.0% (contusions) and 3.05% (fracture), respectively. The frequency of traumatic injuries was higher in amateur football players (76.88%) compared to professional football players (64.16%), the situation being reversed in the case of overuse injuries: 27.62% in professional football players and 21.13% in amateur football players. Most contact injuries were found in professional footballers (50.70%), with non-contact injuries predominating in amateur footballers (54.04%). The analysis of the severity of injuries showed that moderate injuries dominated in the two categories of footballers; the severe injuries in amateur footballers exceeded the severe injuries recorded in professional footballers by 9.60%. Recurrence proportions showed an inverse relationship with the level of play, being higher in amateur footballers (16.66%) compared to professional footballers (15.25%). Conclusions (4): Football-related injuries have a significant impact on professional and amateur football players and their short- and long-term health status. Knowing the frequency of severe diagnoses, such as strains, tears and cramps of the thigh muscles, ankle ligament sprains and hip/groin muscle strain requires the establishment of adequate programs to prevent them, especially in amateur football players, who are more prone to serious injuries. Full article

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men’s football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players. Full article

Physical rehabilitation and physical activity are known non-pharmacological methods of treating multiple sclerosis. Both lead to an improvement in physical fitness in patients with movement deficits while improving cognitive function and coordination. These changes occur through the induction of brain plasticity. This review presents the basics of the induction of brain plasticity in response to physical rehabilitation. It also analyzes the latest literature evaluating the impact of traditional physical rehabilitation methods, as well as innovative virtual reality-based rehabilitation methods, on the induction of brain plasticity in patients with multiple sclerosis. Full article