Mechanisms Underlying Lumbopelvic Pain During Pregnancy: A Proposed Model

Up to 86% of pregnant women will have lumbopelvic pain during the 3rd trimester of pregnancy and women with lumbopelvic pain experience lower health-related quality of life during pregnancy than women without lumbopelvic pain. Several risk factors for pregnancy-related lumbopelvic pain have been identified and include history of low back pain, previous trauma to the back or pelvis and previous pregnancy-related pelvic girdle pain. During pregnancy, women go through several hormonal and biomechanical changes as well as neuromuscular adaptations which could explain the development of lumbopelvic pain, but this remains unclear. The aim of this article is to review the potential pregnancy-related changes and adaptations (hormonal, biomechanical and neuromuscular) that may play a role in the development of lumbopelvic pain during pregnancy. This narrative review presents different mechanisms that may explain the development of lumbopelvic pain in pregnant women. A hypotheses-driven model on how these various physiological changes potentially interact in the development of lumbopelvic pain in pregnant women is also presented. Pregnancy-related hormonal changes, characterized by an increase in relaxin, estrogen and progesterone levels, are potentially linked to ligament hyperlaxity and joint instability, thus contributing to lumbopelvic pain. In addition, biomechanical changes induced by the growing fetus, can modify posture, load sharing and mechanical stress in the lumbar and pelvic structures. Finally, neuromuscular adaptations during pregnancy include an increase in the activation of lumbopelvic muscles and a decrease in endurance of the pelvic floor muscles. Whether or not a causal link between these changes and lumbopelvic pain exists remains to be determined. This model provides a better understanding of the mechanisms behind the development of lumbopelvic pain during pregnancy to guide future research. It should allow clinicians and researchers to consider the multifactorial nature of lumbopelvic pain while taking into account the various changes and adaptations during pregnancy.

The effect of passive mobilization associated with blood flow restriction and combined with electrical stimulation on cardiorespiratory safety, neuromuscular adaptations, physical function, and quality of life in comatose patients in an ICU: a randomized controlled clinical trial

Background Intensive care unit-acquired atrophy and weakness are associated with high mortality, a reduction in physical function, and quality of life. Passive mobilization (PM) and neuromuscular electrical stimulation were applied in comatose patients; however, evidence is inconclusive regarding atrophy and weakness prevention. Blood flow restriction (BFR) associated with PM (BFRp) or with electrical stimulation (BFRpE) was able to reduce atrophy and increase muscle mass in spinal cord-injured patients, respectively. Bulky venous return occurs after releasing BFR, which can cause unknown repercussions on the cardiovascular system. Hence, the aim of this study was to investigate the effect of BFRp and BFRpE on cardiovascular safety and applicability, neuromuscular adaptations, physical function, and quality of life in comatose patients in intensive care units (ICUs). Methods Thirty-nine patients will be assessed at baseline (T0–18 h of coma) and randomly assigned to the PM (control group), BFRp, or BFRpE groups. The training protocol will be applied in both legs alternately, twice a day with a 4-h interval until coma awake, death, or ICU discharge. Cardiovascular safety and applicability will be evaluated at the first training session (T1). At T0 and 12 h after the last session (T2), muscle thickness and quality will be assessed. Global muscle strength and physical function will be assessed 12 h after T2 and ICU and hospital discharge for those who wake up from coma. Six and 12 months after hospital discharge, physical function and quality of life will be re-assessed. Discussion In view of applicability, the data will be used to inform the design and sample size of a prospective trial to clarify the effect of BFRpE on preventing muscle atrophy and weakness and to exert the greatest beneficial effects on physical function and quality of life compared to BFRp in comatose patients in the ICU. Trial registration Universal Trial Number (UTN) Registry UTN U1111-1241-4344. Retrospectively registered on 2 October 2019. Brazilian Clinical Trials Registry (ReBec) RBR-2qpyxf. Retrospectively registered on 21 January 2020, http://ensaiosclinicos.gov.br/rg/RBR-2qpyxf/

AGING & MUSCULAR FUNCTION: A SELECTED REVIEW OF LITERATURE WITH EMPHASIS ON CARDIORESPIRATORY ENDURANCE AND FUNCTIONAL PERFORMANCE RESPONSE TO RESISTANCE EXERCISE

This narrative review evaluates strength or resistance training on cardiorespiratory endurance, blood pressure, contractile function, contractile protein synthesis rate, bone turnover, gait and balance, and neuromuscular adaptations in elderly populations. Seventy-eight studies spanning from 1999 through 2020 were reviewed. Database sources including PubMed, Science Direct, Web of Knowledge and Google Scholar were searched in accordance with the purpose of the study. A majority of the studies reported that resistance training reduces blood pressure and increases contractile functions, contractile protein synthesis rate, bone turnover, gait and balance, cardiorespiratory endurance, and neuromuscular adaptations in the elderly. Furthermore, combined training (CT), also known as concurrent training (strength plus endurance training) may also be as effective as traditional endurance training or traditional strength/resistance training alone for improving cardiorespiratory endurance and functional performance. According to the evaluation of studies included in this review, we concluded that training modalities that involve low-load, high velocity strength training combined with endurance training might be the best training strategy in improving cardiovascular fitness, functional capacity and musculoskeletal health in the elderly populations. Elderly people should be encouraged to participate in a concurrent training or a combination of strength and endurance training to delay, or even reverse the negative effects of aging. <p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0875/a.php" alt="Hit counter" /></p>

Neuromuscular Adaptations after an Altitude Training Camp in Elite Judo Athletes

The aim of this study was to investigate neuromuscular adaptations in elite judo athletes after three weeks of power-oriented strength training at terrestrial altitude (2320 m). Nineteen men were assigned to altitude training (AL) (22.1 ± 2.3 years) and sea level training (SL) (22.6 ± 4.1 years). Neuromuscular assessment consisted of: (1) maximal isometric knee extensor (KE) torque, (2) KE rate of torque development (RTD), (3) quadriceps activity and voluntary activation, (4) soleus H-reflex, (5) quadriceps single (TTW) and double twitch torque (TDB100) and contraction time (CTTW). There were no significant differences between groups at baseline for any of the observed parameters. Significant differences were found between groups in terms of change in RTD (p = 0.04). Cohen’s d showed a positive significant effect (0.43) in the SL group and a negative significant effect (−0.58) in the AL group. The difference between groups in changes in CTTW as a function of altitude was on the edge of significance (p = 0.077). CTTW increased by 8.1 ± 9.0% in the AL group (p = 0.036) and remained statistically unchanged in the SL group. Only the AL group showed a relationship between changes in TTW and TDB100 and changes in RTD at posttest (p = 0.022 and p = 0.016, respectively). Altitude induced differences in muscular adaptations likely due to greater peripheral fatigue.

Effects of Velocity-Based Training on Strength and Power in Elite Athletes—A Systematic Review

Due to drawbacks of the percentage-based approach, velocity-based training was proposed as a method to better and more accurately prescribe training loads to increase general and specific performance. The purpose of this study was to perform a systematic review of the studies that show effects of velocity-based resistance training on strength and power performance in elite athletes. Electronic searches of computerized databases were performed according to a protocol that was agreed by all co-authors. Four databases—SportDiscus with Full Text and MEDLINE via EBSCO, SCOPUS, and Web of Science—were searched. Seven studies were found which researched the effects of velocity-based resistance training on athletes after a given training period. The analyzed studies suggest that applying velocity losses of 10–20% can help induce neuromuscular adaptations and reduce neuromuscular fatigue. Using velocity zones as part of a separate or combined (e.g., plyometric) training program can elicit adaptations in body composition and performance parameters. Moreover, velocity zones can be programmed using a periodized or non-periodized fixed velocity zones protocol. Lastly, obtaining instantaneous feedback during training is a more effective tool for increasing performance in sport-specific parameters, and should be used by sport practitioners to help keep athletes accountable for their performance.

Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review

A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.