The Reliability of Transcranial Magnetic Stimulation-Derived Corticomotor Inhibition as a Brain Health Evaluation Tool in Soccer Players

Background The suitability of corticomotor inhibition and corticospinal excitability to measure brain health outcomes and recovery of sport-related head impact (concussion and subconcussion) depends on good inter-day reliability, which is evaluated in this study. Transcranial magnetic stimulation (TMS) reliability in soccer players is assessed by comparing soccer players, for whom reliability on this measure may be reduced due to exposure to head impacts, to generally active individuals not engaged in contact sport. Methods TMS-derived corticomotor inhibition and corticospinal excitability were recorded from the rectus femoris muscle during two testing sessions, spaced 1–2 weeks apart in 19 soccer players (SOC—age 22 ± 3 years) and 20 generally active (CON—age 24 ± 4 years) healthy volunteers. Inter-day reliability between the two time points was quantified by using intra-class correlation coefficients (ICC). Intra-group reliability and group differences on actual measurement values were also explored. Results Good inter-day reliability was evident for corticomotor inhibition (ICCSOC = 0.61; ICCCON = 0.70) and corticospinal excitability (ICCSOC = 0.59; ICCCON = 0.70) in both generally active individuals and soccer players routinely exposed to sport-related head impacts. Corticomotor inhibition showed lower coefficients of variation than excitability for both groups (InhibSOC = 15.2%; InhibCON = 9.7%; ExcitabSOC = 41.6%; ExcitabCON = 39.5%). No group differences between soccer players and generally active individuals were found on the corticomotor inhibition value (p > 0.05), but levels of corticospinal excitability were significantly lower in soccer players (45.1 ± 20.8 vs 85.4 ± 6.2%Mmax, p < 0.0001). Corticomotor inhibition also showed excellent inter-rater reliability (ICC = 0.87). Conclusions Corticomotor inhibition and corticospinal excitability are stable and maintain good degrees of reliability when assessed over different days in soccer players, despite their routine exposure to head impacts. However, based on intra-group reliability and group differences of the levels of excitability, we conclude that corticomotor inhibition is best suited for the evaluation of neuromuscular alterations associated with head impacts in contact sports.

Effects of Running on Sand vs. Stable Ground on Kinetics and Muscle Activities in Individuals With Over-Pronated Feet

Background: In terms of physiological and biomechanical characteristics, over-pronation of the feet has been associated with distinct muscle recruitment patterns and ground reaction forces during running.Objective: The aim of this study was to evaluate the effects of running on sand vs. stable ground on ground-reaction-forces (GRFs) and electromyographic (EMG) activity of lower limb muscles in individuals with over-pronated feet (OPF) compared with healthy controls.Methods: Thirty-three OPF individuals and 33 controls ran at preferred speed and in randomized-order over level-ground and sand. A force-plate was embedded in an 18-m runway to collect GRFs. Muscle activities were recorded using an EMG-system. Data were adjusted for surface-related differences in running speed.Results: Running on sand resulted in lower speed compared with stable ground running (p &lt; 0.001; d = 0.83). Results demonstrated that running on sand produced higher tibialis anterior activity (p = 0.024; d = 0.28). Also, findings indicated larger loading rates (p = 0.004; d = 0.72) and greater vastus medialis (p &lt; 0.001; d = 0.89) and rectus femoris (p = 0.001; d = 0.61) activities in OPF individuals. Controls but not OPF showed significantly lower gluteus-medius activity (p = 0.022; d = 0.63) when running on sand.Conclusion: Running on sand resulted in lower running speed and higher tibialis anterior activity during the loading phase. This may indicate alterations in neuromuscular demands in the distal part of the lower limbs when running on sand. In OPF individuals, higher loading rates together with greater quadriceps activity may constitute a proximal compensatory mechanism for distal surface instability.

Less common synaptic input between muscles from the same group allows for more flexible coordination strategies during a fatiguing task

This study aimed to determine whether neural drive is redistributed between muscles during a fatiguing isometric contraction, and if so, whether the initial level of common synaptic input between these muscles constrains this redistribution. We studied two muscle groups: triceps surae (14 participants) and quadriceps (15 participants). Participants performed a series of submaximal isometric contractions and a torque-matched contraction maintained until task failure. We used high-density surface electromyography to identify the behavior of 1874 motor units from the soleus, gastrocnemius medialis (GM), gastrocnemius lateralis(GL), rectus femoris, vastus lateralis (VL), and vastus medialis(VM). We assessed the level of common drive between muscles in absence of fatigue using a coherence analysis. We also assessed the redistribution of neural drive between muscles during the fatiguing contraction through the correlation between their cumulative spike trains (index of neural drive). The level of common drive between VL and VM was significantly higher than that observed for the other muscle pairs, including GL-GM. The level of common drive increased during the fatiguing contraction, but the differences between muscle pairs persisted. We also observed a strong positive correlation of neural drive between VL and VM during the fatiguing contraction (r=0.82). This was not observed for the other muscle pairs, including GL-GM, which exhibited differential changes in neural drive. These results suggest that less common synaptic input between muscles allows for more flexible coordination strategies during a fatiguing task, i.e., differential changes in neural drive across muscles. The role of this flexibility on performance remains to be elucidated.

Bioelectrical Impedance Vector and Creatine Phosphokinase Changes Induced by a High-Intensity Training Session in Rink Hockey Players

This study aimed to analyze anthropometric and whole-body/muscle-localized bioelectrical impedance vector analysis (BIVA) adaptations and their relation to creatine kinase (CK) as a biomarker of muscle damage in a group of seven male players in the maximum category of professional rink hockey. There were three checkpoint assessments in relation to a high-intensity training session: pre-session (PRE), post-session (POST), and 24 h-post-session (POST24H). The resistance, reactance, and impedance module were adjusted by height (R/h, Xc/h, and Z/h, respectively). The Wilcoxon signed-rank test was used to compare the data at baseline and follow-up, while Spearman correlation was used to explore the relationship between CK and the rest of the parameters. The results registered a decrease in body mass at POST (p = 0.03) and a reestablishment at POST24H (p = 0.02). Whole-body BIVA registered a significant increase in R/h between PRE–to–POST (p = 0.02) and returned to baseline values at POST24H (p = 0.02), which was expected since this parameter is related to hydration processes. Muscle-localized BIVA in the rectus femoris muscle showed an increase in both Xc/h and phase angle in POST (p = 0.04 and p = 0.03, respectively) and a decrease in Xc/h at POST24H (p = 0.02). CK correlated with R/h in the rectus femoris at all the checkpoints (PRE–to–POST: r = 0.75, p = 0.05; PRE–to–POST24H: r = 0.81, p = 0.03; POST–to–POST24H: r = 0.82, p = 0.02). Our results indicate that BIVA is a sensitive methodology to assess general and muscle-localized hydration induced by a high-intensity training session in rink hockey players. A correlation between BIVA and CK was also reported.

Skeletal Muscle Depletion and Major Postoperative Complications in Locally-Advanced Head and Neck Cancer: A Comparison between Ultrasound of Rectus Femoris Muscle and Neck Cross-Sectional Imaging

Skeletal muscle mass (SMM) depletion has been validated in many surgical fields as independent predictor of complications through cross-sectional imaging. We evaluated SMM depletion in a stage III-IV head and neck cancer cohort, comparing the accuracy of CT/MRI at C3 level with ultrasound (US) of rectus femoris muscle (RF) in terms of prediction of major complications. Patients submitted to surgery were recruited from 2016 to 2021. SMM was estimated on CT/MRI by calculating the sum of the cross-sectional area (CSA) of the sternocleidomastoid and paravertebral muscles at C3 level and its height-indexed value (cervical skeletal muscle index, CSMI) and on US by computing the CSA of RF. Specific thresholds were defined for both US and CT/MRI according to ROC curve in terms of best prediction of 30-day major complications to detect sarcopenic subjects (40–53%). Sixty-five patients completed the study. At univariate analysis, major complications were associated to lower RF CSA, lower CSA at C3 level and lower CSMI, together with previous radiotherapy, higher ASA score and higher modified frailty index (mFI). At multivariate analysis RF CSA (OR 7.07, p = 0.004), CSA at C3 level (OR 6.74, p = 0.005) and CSMI (OR 4.02, p = 0.025) were confirmed as independent predictors in three different models including radiotherapy, ASA score and mFI. This analysis proved the value of SMM depletion as predictor of major complications in a head and neck cancer cohort, either defined on cross-sectional imaging at C3 or on US of RF.

Muscle-Skeletal Abnormalities and Muscle Oxygenation during Isokinetic Strength Exercise in Heart Failure with Preserved Ejection Fraction Phenotype: A Cross-Sectional Study

Exercise intolerance, a hallmark of patients with heart failure (HF), is associated with muscle weakness. However, its causative microcirculatory and muscle characteristics among those with preserved or reduced ejection fraction (HFpEF or HFrEF) phenotype is unclear. The musculoskeletal abnormalities that could result in impaired peripheral microcirculation are sarcopenia and muscle strength reduction in HF, implying lowered oxidative capacity and perfusion affect transport and oxygen utilization during exercise, an essential task from the microvascular muscle function. Besides that, skeletal muscle microcirculatory abnormalities have also been associated with exercise intolerance in HF patients who also present skeletal muscle myopathy. This cross-sectional study aimed to compare the muscle microcirculation dynamics via near-infrared spectroscopy (NIRS) response during an isokinetic muscle strength test and ultrasound-derived parameters (echo intensity was rectus femoris muscle, while the muscle thickness parameter was measured on rectus femoris and quadriceps femoris) in heart failure patients with HFpEF and HFrEF phenotypes and different functional severities (Weber Class A, B, and C). Twenty-eight aged-matched patients with HFpEF (n = 16) and HFrEF (n = 12) were assessed. We found phenotype differences among those with Weber C severity, with HFrEF patients reaching lower oxyhemoglobin (O2Hb, μM) (−10.9 ± 3.8 vs. −23.7 ± 5.7, p = 0.029) during exercise, while HFpEF reached lower O2Hb during the recovery period (−3.0 ± 3.4 vs. 5.9 ± 2.8, p = 0.007). HFpEF with Weber Class C also presented a higher echo intensity than HFrEF patients (29.7 ± 8.4 vs. 15.1 ± 6.8, p = 0.017) among the ultrasound-derived variables. Our preliminary study revealed more pronounced impairments in local microcirculatory dynamics in HFpEF vs. HFrEF patients during a muscle strength exercise, combined with muscle-skeletal abnormalities detected via ultrasound imaging, which may help explain the commonly observed exercise intolerance in HFpEF patients.

Neuromuscular Impairment of Knee Stabilizer Muscles in a COVID-19 Cluster of Female Volleyball Players: Which Role for Rehabilitation in the Post-COVID-19 Return-to-Play?

COVID-19 athletes reported persistent and residual symptoms many weeks after initial infection, including cough, fatigue, and neuromuscular disorders. Poor neuromuscular control may cause inefficient movement strategies increasing anterior cruciate ligament load. This is particularly relevant in female athletes, who show a 3-time higher risk than male counterparts. Aim is to evaluate the impairment in thigh muscles activation, body composition, and physical performance after COVID-19 in volleyball athletes. We recruited a cohort of female professional players from the same team. We assessed the pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Lateral Hamstring (LH) before (T0) and after (T1) COVID-19 infection, bioelectrical impedance analysis (BIA), and jump tests. We included 12 athletes with COVID-19 infection diagnosis in January 2021. At T1 we found a significant (p < 0.05) delay (ms) of the activation time of RF (426 ± 188 vs. 152 ± 106); VM (363 ± 192 vs. 140 ± 96); BF (229 ± 60 vs. 150 ± 63); MH (231 ± 88 vs. 203 ± 89), and a significant reduction of body composition at BIA. The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 infection determines a deficit of knee stabilization. Physicians should consider neuromuscular and metabolic sequelae to identify athletes at higher risk of injury and set up specific neuromuscular rehabilitation protocols.

Electrical Stimulation Attenuates Disuse Muscular Atrophy by Modulating Endoplasmic Reticulum Stress-induced Parkin-dependent Mitophagy

Background: The aim of this study was to investigate the therapeutic effect of electrical stimulation on disuse muscular atrophy in a rabbit model of knee joint contracture and explore the role of endoplasmic reticulum stress-induced Parkin-dependent mitophagy in this process.Methods: Two sub-experiments were carried out successively in our study. In the first sub-experiment, 24 rabbits were divided into four groups on average based on the immobilization time: Ctrl 1, I-2, I-4, and I-6 groups. In the second sub-experiment, 24 rabbits were also divided into four groups on average in accordance with the process mode: Ctrl2, ES, NR, and EST groups. To test the time-dependent changes of the rectus femoris muscles after immobilization in rabbits, and to evaluate the effect of electrical stimulation on the atrophic rectus femoris muscles, the wet weights of rectus femoris muscles were assessed in this study, along with the protein levels of atrogin-1, p-PERK, Parkin and COXIV.Results: The wet weights of rectus femoris muscles, the protein levels of atrogin-1, p-PERK and Parkin increased after immobilization. It was also revealed that the protein levels of COXIV decreased after immobilization. Electrical stimulation was effective against muscle atrophy, the elevated expression of atrogin-1, p-PERK, Parkin, and the decreased expression of COXIV.Conclusions: Immobilization of unilateral lower limb could induce rectus femoris muscle atrophy, endoplasmic reticulum stress and Parkin mediated mitophagy. Endoplasmic reticulum stress-induced Parkin-dependent mitophagy may be one of the mechanisms by which electrical stimulation can play a significant role.