Search Results (111)

Great toe strength (GTS) is critical for gait, balance, and mobility, yet reliable assessment methods are lacking. This scoping review aims to evaluate and synthesize the direct methods of GTS assessment and their corresponding measurement protocols to guide clinical and research applications. Following the Joanna Briggs Institute methodology, five databases were searched: PubMed, CINAHL, Embase, Web of Science, and IEEE Xplore. All publications on or before 16 December 2024 were included in this review. Studies were included if they quantified isolated great toe strength in human participants using direct measurement tools with non-normalized force outcomes, while exclusion criteria included non-human models, indirect assessments (e.g., electromyography), and multi-digit or dynamic tasks. Following the initial screening of the results, the information from the included articles were extracted into Excel for analyses and synthesis. Two independent reviewers screened titles/abstracts and full texts using Covidence. Conflicts were resolved via consensus or consultation with a third reviewer. We identified 55 studies involving 2821 participants that met our inclusion criteria. Four types of direct GTS assessment methods were identified: dynamometry (56%), manual muscle testing (11%), force transducers (13%), and load cells/strain gauges (18%). Dynamometry was the most common but showed variable reliability due to non-standardized protocols. Healthy individuals exhibited higher GTS (95.01 N) than those with conditions like hallux injury (6.1 N), though plantar fasciitis/plantar heel pain populations showed unexpectedly high GTS (133.27 N). No clear age-related GTS trend emerged, likely due to methodological variability. Less than 11% of studies measured extension strength, highlighting a critical research gap. This review emphasizes the need for standardized protocols to enhance GTS assessment reliability and clinical utility. Full article

Quadriceps muscle and tendon injuries are a significant cause of impairment of the knee extensor mechanism, ranging from minor muscle strains to complete tendon ruptures and extensive defects following oncologic resections. This narrative review provides a comprehensive analysis of contemporary concepts in anatomy, biomechanics, diagnosis, surgical management, and rehabilitation, with a particular focus on reconstructive techniques and functional outcomes. While most muscle injuries respond well to conservative management, complete quadriceps tendon ruptures typically require surgical repair to restore extensor continuity. Both transosseous suture techniques and suture anchor fixation demonstrate reliable outcomes, with no clear superiority in clinical results. Chronic ruptures present additional challenges due to tendon retraction and poor tissue quality, often necessitating advanced reconstruction methods such as V–Y tendon lengthening and augmentation with autografts, allografts, or synthetic materials. In cases of large defects, especially following soft-tissue sarcoma resection, free functional muscle transfer (FFMT) has emerged as a key reconstructive strategy. Common donor muscles include the latissimus dorsi, gracilis, rectus abdominis, and vastus lateralis, each offering specific biomechanical advantages. Functional recovery is strongly influenced by the extent of quadriceps preservation, with better outcomes observed when at least two muscle heads remain functional. Rehabilitation protocols vary depending on the surgical approach. Early controlled mobilisation is generally recommended after tendon repair, whereas FFMT requires a more cautious and prolonged rehabilitation process to allow for flap integration and reinnervation. Overall, optimal outcomes depend on a multidisciplinary approach combining appropriate surgical technique, individualized rehabilitation, and careful patient selection. Full article

Frisbee has gained increasing popularity and is characterized by high-intensity running, rapid changes in direction, jumping, and indirect physical contact, exposing players to a risk of injury. This study aimed to determine the epidemiology of musculoskeletal injuries in frisbee athletes who participated in the World Beach Ultimate Championship in Portugal, and the risk factors associated with these injuries. The sample included 484 athletes aged 18–64 years, of whom 275 (56.8%) were male. Data was collected using a digital questionnaire. Across their frisbee practice, 391 (80.8%) athletes reported at least one injury, totalling 1685 injuries. A total of 49 (10.1%) athletes reported an injury in the last 7 days. Over the past 12 months, 211 (43.6%) athletes sustained injuries, totalling 358 cases. The injury proportion was 0.44 (95% CI: 39.2–48.0), and the injury rate was 0.67 injuries per 1000 h of training. The most frequent injuries were muscle strains (18.86%) and sprains (13.43%), mainly affecting the ankle (62; 17.71%) and knee (54; 15.43%). Repetitive movements (84; 22.11%) and changes in direction (62; 16.32%) were the most common mechanisms. Athletes with equal or more than 11 years of practice had a higher injury risk (OR = 1.84; 95% CI: 1.16–2.91; p = 0.009). Frisbee athletes present a considerable risk of injuries. Preventive strategies are recommended. Full article

Rotator cuff injuries are among the most common musculoskeletal conditions that affect shoulder function and can ultimately impact quality of life. While physical therapy is essential in the care of rotator cuff injuries, the ideal dose of therapeutic exercises continues to be a significant clinical dilemma because of the generalized nature of rehabilitation protocols. This pilot study proposes a machine learning approach to personalize rehabilitation using surface electromyography (sEMG) data collected from eight healthy individuals by testing four key shoulder movements: scaption, internal rotation, external rotation, and external rotation at 90° abduction. In this research, the XGBoost algorithm was used to model muscle activation patterns by achieving a high predictive accuracy (R² = 0.5325; MSE = 0.0084 μV²). Because sEMG reliably measures superficial muscle activity, a linear programming model was used to divide a 60 min therapy session in a way that increases activation of superficial muscles (such as deltoid and trapezius) while reducing strain on deep muscles (such as supraspinatus and infraspinatus). Three optimization scenarios were tested by reflecting a different clinical goal: prioritizing superficial muscles, minimizing deep muscle strain, or balancing both. Optimized time allocations assigned more time to external rotation at 90° abduction and scaption. This research demonstrates the potential for data-driven methods to transform rotator cuff rehabilitation through personalized and evidence-based treatment plans. The results enhance clinical practice by enabling adaptive rehabilitation planning and show that machine learning can support decision-making in complex muscle activation analysis with strong performance and low latency. Full article

Objectives: To characterize urodynamic findings after lower-level spinal cord injury (LSCI) and to evaluate a new pressure-based classification framework—the bladder–sphincter dyscoordination syndrome (BSDS)—for describing voiding patterns. We also introduce a descriptive “neurogenic bladder outlet obstruction” (NBOO) phenotype for straining-dependent voiding difficulty. Methods: We retrospectively analyzed the first urodynamic studies (December 2020–August 2024) in 81 men with LSCI (injury at T10 or below). Key urodynamic measures included detrusor and intravesical pressures during filling and voiding, bladder volumes (first desire to void and capacity), compliance, maximum flow rate (Q_max), post-void residual (PVR), voiding efficiency, and the ratio of detrusor to abdominal pressure rise (ΔPdet/ΔPabd). We compared cases with detrusor overactivity (DO) versus those without DO. Among those with voiding discoordination, we distinguished classical detrusor–sphincter dyssynergia (DSD) from a proposed NBOO phenotype (characterized by abdominal straining pressure ≥ 40 cmH₂O, detrusor pressure < 20 cmH₂O, incomplete emptying, and no anatomic obstruction). We further classified discoordination cases using the BSDS framework into four subtypes—dual high-pressure (DHP), detrusor-muscle predominant (DMP), dual low-pressure (DLP), and abdominal-pressure predominant (APP)—based on reference pressure thresholds (detrusor 20 cmH₂O; abdominal 40 cmH₂O). Results: Patients with DO (43.2%) showed significantly higher detrusor pressures during filling (at first desire to void and at capacity) and a lower first desire volume than non-DO patients, while maximum capacity was similar (p = 0.105). During voiding, DO cases had lower PVR and higher emptying rates, although the detrusor-vs-abdominal pressure contribution (ΔPdet/ΔPabd) was comparable between groups. Among 63 patients with voiding discoordination, 32 (50.8%) met NBOO criteria; these NBOO cases exhibited lower detrusor and intravesical voiding pressures but worse emptying (higher PVR) compared to classical DSD cases. Overall, 76 of 81 patients (93.8%) fit within the BSDS classification—distributed as 22 DHP, 13 DMP, 15 DLP, and 26 APP patterns. Conclusions: The BSDS framework (and the NBOO descriptor when conventional indices cannot be applied) offers a novel way to describe voiding patterns after LSCI. It links urodynamic observations to potential management strategies (by identifying whether the bladder or outlet is the primary issue). Prospective studies are needed to validate this framework against outcomes such as upper tract integrity, continence, and dependence on catheterization. Full article

The aim of this study was to examine temporal changes in eccentric hamstring strength, impulse-based mechanical outputs, and interlimb asymmetry in professional football players performing a football-specific eccentric hamstring training program. Forty male football players (18–25 years) from two teams competing in the Turkish Second Professional Football League participated in this longitudinal cohort study. Eccentric hamstring performance was assessed at three time points (pre-, mid-, and post-season) using the NordBord Hamstring Testing System. Mixed-design repeated-measures ANOVA revealed significant main effects of time and significant time × Team interactions for left and right maximal impulse values (p < 0.05). In contrast, maximal eccentric force variables showed no significant time effects, although significant time × Team interactions were observed for both limbs (p < 0.05). Interlimb maximal force asymmetry and mean asymmetry demonstrated significant time effects, while Team effects and interaction terms were not significant. Overall, these findings indicate that temporal changes in eccentric hamstring performance in professional football players may be more clearly reflected in force–time–dependent metrics, particularly impulse, rather than peak force outputs. Accordingly, impulse-based measures may provide additional insight into eccentric hamstring performance changes in professional football players. Full article

Background: Titin (TTN), a giant structural and signaling protein of striated muscle, participates in intracellular signaling networks and cytoskeletal organization, potentially influencing cell activation, trafficking, and interactions with other tissues, including the heart. Methods: In this pilot study, 29 patients with acute myocarditis and 10 healthy individuals were prospectively enrolled. Peripheral blood was obtained on the first day of hospital admission, total RNA was isolated from peripheral blood mononuclear cells (PBMCs), and TTN mRNA expression was quantified. Results: TTN expression in PBMCs was significantly higher in patients with acute myocarditis compared with healthy controls (p = 0.015), corresponding to a 2.8-fold median increase. Moreover, TTN expression showed a strong positive correlation with global longitudinal strain impairment (Spearman’s r = 0.576, p < 0.001), a moderate positive correlation with peak hs-cTnI levels (r = 0.435, p = 0.021; and a moderate inverse correlation with baseline LVEF (r = −0.421, p = 0.025). Conclusions: These findings support a pathophysiological link between TTN-related pathways in peripheral immune cells and myocardial injury in acute myocarditis and raise the hypothesis that TTN expression in PBMCs may serve as a novel biomarker of disease severity and long-term ventricular remodeling. Further studies in larger cohorts are warranted to validate these results and to elucidate the mechanistic role of titin in immune–cardiac cross-talk. Full article

Background/Objectives: This study investigated the systemic metabolic effects of two probiotic strains, Lacticaseibacillus paracasei MG5012 and Bifidobacterium animalis subsp. lactis MG741, on metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity-related muscle dysfunction in high-fat-diet (HFD)-induced obese mice. Methods: Obesity was induced in C57BL/6 mice via high-fat diet (HFD) feeding for 6 weeks. Subsequently, the mice were orally administered MG5012 or MG741 for 8 weeks. We assessed systemic metabolic parameters, including body weight, adiposity, and serum biomarkers. Additionally, histological and molecular analyses were performed to evaluate hepatic steatosis, intestinal barrier integrity, and muscle oxidative status. Results: Both strains significantly attenuated body weight gain and adiposity, reduced serum liver injury markers (γ-GTP, ALT, AST), and improved systemic metabolic parameters by restoring serum GLP-1 levels and reducing hyperinsulinemia. Crucially, MG5012 and MG741 strengthened intestinal barrier integrity by upregulating the tight junction proteins Occludin and Claudin-1. In the liver, histological analyses revealed reductions in hepatic steatosis and triglyceride content, accompanied by the downregulation of lipogenic genes (SREBP-1c, FAS). Furthermore, the probiotics preserved skeletal muscle integrity; while muscle weight remained unchanged, the strains increased muscle fiber cross-sectional area (CSA) and reduced serum markers of muscle damage (CPK, LDH). This protective effect was associated with significantly enhanced expression of antioxidant enzymes (SOD, CAT, GPx) in muscle tissue. Conclusions: These findings suggest that MG5012 and MG741 confer systemic metabolic benefits through the modulation of the gut–liver–muscle axis and may serve as promising functional food ingredients for the management of MASLD and obesity-associated muscle atrophy. Full article

Background: Yoga has gained popularity worldwide and is generally considered a safe physical activity. However, injuries associated with yoga practice are increasingly reported, while data on cases requiring emergency care remain limited. Methods: A retrospective single-center study was conducted, analyzing cases of yoga-related injuries treated at a Swiss emergency department between 2013 and 2023. Medical records of 67 adult patients (aged ≥16 years) were reviewed for demographics, injury characteristics, management, and clinical outcomes. The study population consisted predominantly of females (76.1%), with a median age of 35 years. Results: Most injuries were musculoskeletal in nature and predominantly affected a single body region (95.5%). The most frequently involved areas were the head (29.9%), lower extremities (25.4%), and spine (19.4%). Soft tissue injuries, particularly muscle and tendon strains as well as contusions, were most common. Injury patterns differed across subgroups: older patients were more likely to sustain head injuries, whereas younger individuals more frequently presented with extremity injuries, including the rare cases of fractures and dislocations. Conservative treatment was sufficient in 94% of cases, although 20.9% of patients required hospitalization. Conclusion: Yoga-related injuries presenting to emergency care are generally minor and mainly involve soft tissues; however, injury patterns vary across demographic subgroups. Older adults appear more susceptible to balance-related and head injuries, while younger practitioners are more prone to acute extremity trauma. Recognizing these population-specific differences may support targeted prevention strategies and safer yoga practice. Full article

Coxsackievirus A16 (CVA16), a major etiological agent of hand, foot, and mouth disease, is increasingly contributing to neurological complications, with no vaccines or virus-specific antivirals currently available. To identify CVA16-restricting host factors, we investigated the role of the interferon-stimulated gene shiftless (SHFL), previously implicated in the control of other RNA viruses. Using CRISPR–Cas 9, we generated SHFL knockout rhabdomyosarcoma cells and assessed viral replication, cytopathic effects, and replication stage dynamics. We evaluated disease progression and tissue injury in neonatal mice infected with a mouse-adapted CVA16 strain. SHFL expression was strongly induced during CVA16 infection and was inducible by exogenous interferon-β treatment, and its loss markedly increased infectious virus production, accelerated early replication, and exerted severe cytopathic effects. In vivo, SHFL deficiency led to rapid weight loss, pronounced neurological signs, increased viral burden across multiple tissues, and uniform mortality, together with high viral loads and extensive pathological damage in the central nervous system, lungs, and skeletal muscle. Transcriptomic analyses revealed SHFL-dependent modulation of adhesion- and mitogen-activated protein kinase-related pathways. Overall, our results suggest SHFL as a key determinant of host resistance to CVA16, acting mainly at the post-transcriptional stage to limit viral spread and tissue injury, and highlight SHFL-linked pathways as promising host-directed antiviral targets. Full article

Objectives: The purpose of this study was to determine whether hamstrings’ passive and active shear moduli measured before and after a fatigue task are correlated. Studying the correlation between passive and active shear moduli is important because, if correlated, passive SWE could provide a quicker assessment without requiring fatigue-inducing voluntary contractions. Methods: Forty-seven football players with no history of hamstring strain injury participated. Muscle shear modulus was assessed only in the dominant lower-limb (dominance defined as the preferred kicking limb) using ultrasound-based shear wave elastography at rest and during isometric contractions at 20% of maximal voluntary isometric effort before and immediately after a 10 × 30 m repeated sprint protocol. Results: Regarding sprint performance, a significant decrease of 8.3% was seen between the first and the last sprints (first: 7.14 ± 0.27 m/s; last: 6.60 ± 0.31 m/s; p < 0.001; dz = 1.88 [1.40–2.35]). In relation to the peak torque normalized to bodyweight, a significant decrease of 9.2% was seen between pre and post (pre: 1.98 ± 0.30 Nm/kg; post: 1.83 ± 0.31 Nm/kg; p < 0.001; dz = 0.89 [0.78–0.95]). Regarding the correlation analysis, none of the passive and active shear moduli measures was significantly correlated in any condition (Bonferroni correction for multiple comparisons, significance threshold set at p < 0.004). Conclusions: The results suggest that the hamstrings’ passive and active shear moduli are not correlated after a fatigue task. Full article

Toe-in (inward) and toe-out (outward) foot alignments significantly affect gait, posture, and joint stress, causing issues like abnormal gait, joint strain, and foot conditions such as plantar fasciitis and high arches. Addressing these alignments is crucial for improving mobility and comfort. This study introduces IoTToe, a wearable IoT device designed to detect and monitor gait patterns by using six ADXL345 sensors positioned on the foot, allowing healthcare providers to remotely monitor alignment via a webpage, reducing the need for physical tests. Tested on 45 participants aged 20–25 years with diverse BMIs, IoTToe proved suitable for both children and adults, supporting therapy and diagnostics. Statistical tests, including ICC, DFA, and ANOVA, confirmed the device’s effectiveness in detecting gait and postural control differences between legs. Gait variability results indicated that left leg showed more adaptability (DFA close to 0.5), compared to the right leg which was found more consistent (DFA close to 1). Postural control showed stable and agile standing with values between 0.5 and 1. Sensor combinations revealed that removing sensor B (on the gastrocnemius muscle) did not affect data quality. Moreover, taller individuals displayed smaller ankle angle changes, highlighting challenges in balance and upper body stability. IoTToe offers accurate data collection, reliability, portability, and significant potential for gait monitoring and injury prevention. Future studies would expand participation, especially among women and those with alignment issues, to enhance the system’s applicability for foot health management, safety and rehabilitation, further supporting telemetric applications in healthcare. Full article

Musculoskeletal injuries involving volumetric muscle loss remain difficult to treat due to limited regenerative capacity and the lack of physiologically relevant experimental models. This study introduces a computer-controlled ex vivo mouse hindlimb culturing platform that applies dynamic mechanical loading to evaluate muscle regeneration in a critical-size tibialis anterior (TA) defect. The defect was treated with an injectable myoblast-laden nanofibrous scaffold composed of polycaprolactone nanofibers and collagen (PNCOL). The ex vivo mouse hindlimb culturing platform maintained tissue viability and transmitted physiological strain across bone and muscle without disrupting the unity of the bone–muscle structure. PNCOL treatment under mechanical loading enhanced muscle fiber organization, extracellular matrix regeneration, and anti-inflammatory responses (CD206) while upregulating paired box 7 (PAX7), myogenic factor 5 (MYF5), myogenic regulatory factor 4 (MRF4), and transforming growth factor beta1 (TGFβ1) expression. Cytokine profiling revealed an anabolic shift involving wingless/integrated (WNT) and insulin-like growth factor-1 (IGF-1) signaling, indicating a pro-regenerative microenvironment. Overall, the combination of mechanical stimulation and biomaterial-based therapy significantly improved muscle regeneration within a controlled ex vivo model. This multidimensional approach provides a reproducible and ethical platform that advances musculoskeletal regenerative research while reducing animal use. Full article

This case report describes the acceleration of an Olympic decathlete’s return to competition induced via high-frequency Blood Flow Restriction (BFR) training. BFR has gained popularity as an innovative rehabilitation method for promoting muscle repair and adaptation through anabolic and regenerative pathways when high mechanical loading is not possible. A 26-year-old elite decathlete with nine years of international experience sustained a Grade 2b strain of the semimembranosus and semitendinosus (a 9 mm central tendon tear) during a hurdle sprint. The injury was confirmed via MRI two days post-injury. Grade 2b hamstring injuries with intramuscular tendon involvement commonly require up to 4 weeks of rehabilitation before full training can be resumed. With the athlete due to complete in an Olympic Games competition 17 days post-injury, an intensive BFR-assisted rehabilitation program was initiated. Over 12 consecutive days, the athlete completed 3–6 BFR sessions per day (20–30 min each) at 50% limb occlusion pressure, along with physiotherapy and pain-limited functional testing. BFR was applied passively for recovery, during conditioning, and in low-load strength sessions. By day 12, sprint velocity reached 95% maximum, and the athlete successfully completed the decathlon, with no adverse effects or reinjury. This case illustrates how high-frequency BFR-assisted rehabilitation may facilitate accelerated recovery from a hamstring injury, enabling an effective return to elite competition within condensed timelines. Full article

Objectives: This study investigated the prevalence and severity of musculoskeletal injuries within South Africa’s most popular karate style, Shotokan, a previously unexamined area. As an exploratory study, it aimed to generate hypotheses by determining the prevalence, severity, and nature of these injuries to address this significant gap in the national combat sports literature. Methods: A descriptive, cross-sectional design was employed, utilizing a confidential online questionnaire distributed through various Shotokan organizations. The study gathered 155 responses (26.85% response rate). Results: The findings revealed a high injury prevalence, with 47.3% of participants reporting at least four injuries. These injuries occurred equally in training and competition (56.5%) and developed both acutely and over time (53.4%). Experienced practitioners at the Shodan level were particularly affected. The knee was the most frequently injured body part (11.6%), and muscle strains were the most common injury type (19.3%). Notably, 26.2% of karatekas continued training despite being injured. A significant weak positive correlation was found between years of training experience and injury levels (rs = 0.275, p = 0.007). However, no significant associations were found between injury prevalence and age, BMI, or training frequency. General practitioners were the most consulted healthcare professionals (22.0%). Conclusions: This study establishes a high prevalence of musculoskeletal injuries among South African Shotokan karatekas, particularly associated with experienced practitioners. These findings are hypothesis-generating, and the cross-sectional design precludes causal inferences. The data provides a crucial foundation for future longitudinal research to investigate causality and for developing evidence-based injury prevention protocols, particularly for the knee. Full article