ECSS Paris 2023: OP-MH19
INTRODUCTION: After anterior cruciate ligament (ACL) reconstruction with doubled gracilis and semitendinosus (DGST) many studies have pointed out how difficult is to restore neuromuscular parameters like maximal voluntary isometric force (MVIF) and rate of force development (RFD) of quadriceps and how it remains altered even 6-9 months post-surgery. Currently, studies regarding the behavior of the knee flexor muscles are still limited. The aim of this pilot study is to investigate the deficits and trends of these parameters also in hamstrings. METHODS: 12 male amateur sport subjects who underwent ACL reconstruction with DGST technique and did not have other concomitant injuries (age: 28aa±3aa; weight: 71Kg±13Kg) have been selected. All participants completed a 6-month rehabilitation program with specific hamstring exercises. The protocol included isometric dynamography tests of the hamstring on prone leg curl (HAM_OCK) with a knee flexion angle of 60° (from the ground). All data were sampled at 1000 Hz. The parameters of MVIF and RFD at 30, 50 and 90% of MVIF (RFD30; RFD50; RFD90) have been assessed. The tests were performed at 3- and 6-months post-surgery (3PS – 6PS). For each variable, the values of the operated limb were compared to the uninvolved limb at 3PS and 6PS. The results were reported as mean and SD as well as side-to-side asymmetries. The data were compared using Students t-test for paired data (p<0.05). RESULTS: The results show a statistically significant difference in all parameters investigated for the HAM_OKC tests performed at 3PS and at 6PS. The Side-to-side asymmetries are as follows: HAM_OKC test at 3PS (MVIF: -40%; RFD30: -33%; RFD50: -37% RFD90: -46%); HAM_OKC at 6PS (MVIF: -29%; RFD30: -17%; RFD50: -22% RFD90: -36%). At the clinical follow up all the test’s results are good or excellent. CONCLUSION: All parameters showed a progressive improvement between the tests performed at 3PS compared to those at 6PS. The most deficient parameters in HAM_OKC at 6PS are the MVIF and the RFD90, unlike the results highlighted on the quadriceps, as reported by previous studies, where the main deficit is about all the RFD parameters. The MFVI and the RFD90 are strongly connected to cross-sectional area of the muscle and it has been also shown that ST muscle atrophy was non accompanied by a compensatory hypertrophy of the other hamstring muscle. The different behavior of RFD30 and RFD50 in the hamstrings compared to what is expressed in the literature for the quadriceps could depend on the lower sensitivity of the hamstrings to the phenomena of arthrogenic and neuromuscular inhibition. The discrepancy with the results obtained in other studies, where the biggest deficit was in the early phase of RFD, could be attributed to the different test setting, the time after surgery, the way to calculate the RFD parameters and rehabilitation program. Further studies are certainly needed to understand the residual deficit affecting the hamstrings and thus improve recovery paths.
Read CV Davide VespaECSS Paris 2023: OP-MH19
INTRODUCTION: Return-to-sport (RTS) criteria are widely used in sports to assist specialists in decision-making. In addition to biomechanical recovery, psychological readiness plays a critical role in successful RTS and reducing re-injury risk. The importance of psychosocial factors in RTS decisions has been highlighted in the international Consensus statement for hamstring injury management. Researchers emphasize psychosocial aspects, with 98.3% of experts supporting the inclusion of emotional and psychological well-being in RTS screening (Paton et al., 2023). Despite this, research on psychosocial factors in RTS after hamstring injuries remains unclear. This scoping review examines psychological, social, and contextual factors influencing RTS after hamstring injuries. METHODS: This review followed Scoping review guidelines from the JBI Manual for Evidence Synthesis. The research protocol was registered in Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/8RK7E). Between March and December 2024, systematic searches were conducted in Medline, Embase, PsycINFO, CINAHL, SPORTDiscus, Scopus, and ProQuest. Eligible studies included English, French, German, Spanish, and Italian articles across study designs, provided they addressed psychosocial or contextual management in RTS after hamstring injuries. Grey literature (theses and dissertations) was also considered. Data extraction included participant demographics, methodologies, psychological and social measures, and psychological readiness definitions. The Mixed Methods Appraisal Tool (MMAT) assessed methodological quality, while the Oxford Centre of Evidence-Based Medicine (OCEBM) evaluated the included studies. RESULTS: Out of 1882 retrieved records, 12 studies met the inclusion criteria, representing four study designs. A total of 799 athletes and 546 professionals were included, with only 124 females, highlighting gender imbalance. About 50% of studies focused on football (soccer), mostly within Europe (58%), with others in Asia, Oceania, and South America. Psychological readiness was central to the RTS process but lacked a clear definition. Self-reported measures such as recovery timelines, comfort during sprinting, and subjective feelings were common, but no standardized assessment tool was used. Contextual stressors, including motivation and team-related factors, influenced psychological readiness. Athlete pressure was also key, as they often set unrealistic expectations due to fear of losing their team position. Team dynamics and poor communication impacted RTS decisions, shaped by institutional resources and cultural differences. Social factors, though underexplored, played a role. External pressures from media, sponsors, and agents sometimes conflicted with recovery decisions. Five of the 12 studies attempted to define psychological readiness, including confidence, resilience, and emotional regulation, but a unified conceptual definition was lacking. CONCLUSION: Athlete perceptions, external pressures, and resource availability shape recovery, yet frameworks remain inconsistent. The results highlight heterogeneity, methodological limitations, and the lack of standardized tools. A better understanding of these factors could optimize the RTS decision-making process and promote long-term athlete health-related quality of life.
Read CV Salvatore Di LibertoECSS Paris 2023: OP-MH19
INTRODUCTION: Blood flow restriction training (BFRT) has gained popularity for enhancing muscle strength and hypertrophy by restricting venous return while maintaining partial arterial inflow. While BFRT has been investigated in various training modalities, its effects when combined with Nordic hamstring exercise (NHE) remain unclear. This study aimed to explore the impact of BFRT during NHE on neuromuscular activation of the hamstring muscles and endothelial function. METHODS: A randomized, single-blind study was conducted with fourteen physically active, healthy male participants (mean age: 27.5 ± 1.24 years). Each participants lower limbs were randomly assigned to either the BFR group or the control group. In the BFR condition, blood flow was restricted at 60% of arterial occlusion pressure using an inflatable cuff. Participants performed three sets of five repetitions of NHE. Neuromuscular activation of the semitendinosus (ST) and biceps femoris (BF) muscles was recorded using surface electromyography (sEMG) during each repetition. Endothelial function was assessed using flow-mediated dilation (FMD) via Doppler ultrasound before and after exercise. Additionally, the ankle-brachial index (ABI) and popliteal artery diameter were measured to evaluate vascular responses. RESULTS: No statistically significant differences in FMD values were observed between the BFR and non-BFR groups before and after exercise (F(1,13) = 0.156, p = 0.7, partial η² = 0.012). Popliteal artery diameter increased significantly in both groups post-exercise (BFR: p = 0.004; Non-BFR: p = 0.000), but there was no difference between groups (p = 0.942). Neuromuscular activation of both ST and BF muscles decreased across sets in both groups, with no significant differences between groups (ST: F(2,26) = 1.172, p = 0.448, partial η² = 0.09; BF: F(2,26) = 1.442, p = 0.527, partial η² = 0.1). The ABI values remained stable across conditions, with no significant differences noted. CONCLUSION: The findings of this study suggest that the incorporation of BFRT during NHE does not provide additional benefits in terms of neuromuscular activation and endothelial function when compared to traditional NHE. Despite prior evidence suggesting that BFRT may enhance muscle activation, our results indicate that its application in high-intensity eccentric exercises such as NHE does not yield significant improvements. From a vascular perspective, short-term application of BFRT did not negatively impact endothelial function, as indicated by stable FMD and ABI values. These findings suggest that BFRT, when applied within controlled parameters, is a safe intervention for vascular health in trained individuals. Future research should investigate the chronic adaptations of BFRT combined with eccentric training to determine whether prolonged exposure elicits beneficial neuromuscular and vascular adaptations.
Read CV Fuat YükselECSS Paris 2023: OP-MH19