Mild traumatic brain injury in New Zealand: factors influencing post-concussion symptom recovery time in a specialised concussion service.

INTRODUCTION By 2020, traumatic brain injuries (TBIs) are predicted to become the third largest cause of disease burden globally; 90% of these being mild traumatic brain injury (mTBI). Some patients will develop post-concussion syndrome. AIM To determine whether the time between sustaining a mTBI and the initial assessment by a specialised concussion service, along with the post-concussion symptoms reported at the assessment, affected recovery time. METHODS A retrospective medical record review of clients who had completed the Rivermead Post-Concussion Questionnaire (RPQ) at their initial assessment and were discharged from a large metropolitan concussion service in New Zealand was undertaken over a 6-month period in 2014 (n = 107). Using correlations, General Linear Mixed-effects Models (GLMM) and linear regressions, we explored associations between factors including ethnicity, gender and accident type, along with individual RPQ symptom scores and cluster scores, with time from injury to initial assessment by the specialised concussion service and initial assessment to discharge. RESULTS Time from injury to initial assessment by a specialist concussion service was correlated with proportionally more psychological symptoms present at initial assessments (r = 0.222, P = 0.024); in particular, feeling depressed or tearful (r = 0.292, P = 0.003). Time to discharge was correlated with individual RPQ symptom proportions present at initial assessment for headaches (r = -0.238, P = 0.015), sensitivity to noise (r = 0.220, P = 0.026), feeling depressed or tearful (r = 0.193, P = 0.051) and feeling frustrated or impatient (r = 0.252, P = 0.003), along with the psychological cluster proportion (r = 0.235, P = 0.017) and the total RPQ score (r = 0.425, P < 0.001). CONCLUSION Prompt diagnosis and treatment of mTBI may minimise the severity of post-concussion symptoms, especially symptoms associated with mental health and wellbeing.

Biomechanical risk factors and mechanisms of knee injury in golfers.

Knee injuries in golf comprise approximately 8% of all injuries, and are considered to result from overuse, technical faults or a combination of those factors. This review examines factors involved in injury, including the structure of the knee joint, kinematics and kinetics of the golf swing, forces sustained by knee joint structures and the potential for joint injury as well as injury prevention strategies. The golf swing generates forces and torques which tend to cause internal or external rotation of the tibia on the femur, and these are resisted by the knee ligaments and menisci. Research has shown that both maximum muscle forces and the forces sustained during a golf swing are less than that required to cause damage to the ligaments. However, the complex motion of the golf swing, involving both substantial forces and ranges of rotational movement, demands good technique if the player is to avoid injuring their knee joint. Most knee injury in golf is likely related to joint laxity, previous injuries or arthritis, and such damage may be exacerbated by problems in technique or overuse. In addition to appropriate coaching, strategies to remedy discomfort include specific exercise programmes, external bracing, orthotics and equipment choices.

Centre of mass kinematics of fast bowling in cricket.

Kinematic studies have shown that fast bowlers have run-up velocities, based on centre of mass velocity calculations, which are comparable to elite javelin throwers. In this study, 34 fast bowlers (22.3 +/- 3.7 years) of premier grade level and above were tested using a three-dimensional (3-D) motion analysis system (240 Hz). Bowlers were divided into four speed groups: slow-medium, medium, medium-fast, and fast. The mean centre of mass velocity at back foot contact (run-up speed) was 5.3 +/- 0.6 m/s. Centre of mass velocity at back foot contact was significantly faster in the fastest two bowling groups compared to the slow-medium bowling group. In addition, stepwise multiple regression analysis showed that the centre of mass deceleration over the delivery stride phase was the strongest predictor of ball speed in the faster bowling groups. In conclusion, centre of mass kinematics are an important determinant of ball speed generation in fast bowlers. In particular, bowlers able to coordinate their bowling action with periods of centre of mass deceleration may be more likely to generate high ball speed.

Relationships between ground reaction force impulse and kinematics of sprint-running acceleration.

The literature contains some hypotheses regarding the most favorable ground reaction force (GRF) for sprint running and how it might be achieved. This study tested the relevance of these hypotheses to the acceleration phase of a sprint, using GRF impulse as the GRF variable of interest. Thirty-six athletes performed maximal-effort sprints from which video and GRF data were collected at the 16-m mark. Associations between GRF impulse (expressed relative to body mass) and various kinematic measures were explored with simple and multiple linear regressions and paired t-tests. The regression results showed that relative propulsive impulse accounted for 57% of variance in sprint velocity. Relative braking impulse accounted for only 7% of variance in sprint velocity. In addition, the faster athletes tended to produce only moderate magnitudes of relative vertical impulse. Paired t-tests revealed that lower magnitudes of relative braking impulse were associated with a smaller touchdown distance (p < 0.01) and a more active touchdown (p < 0.001). Also, greater magnitudes of relative propulsive impulse were associated with a high mean hip extension velocity of the stance limb (p < 0.05). In conclusion, it is likely that high magnitudes of propulsion are required to achieve high acceleration. Although there was a weak trend for faster athletes to produce lower magnitudes of braking, the possibility of braking having some advantages could not be ruled out. Further research is required to see if braking, propulsive, and vertical impulses can be modified with specific training. This will also provide insight into how a change in one GRF component might affect the others.

Segment-interaction analysis of the stance limb in sprint running.

A high angular velocity of the thigh of the stance limb, generated by hip extensor musculature, is commonly thought to be a performance-determining factor in sprint running. However, the thigh segment is a component of a linked system (i.e., the lower limb), therefore, it is unlikely that the kinematics of the thigh will be due exclusively to the resultant joint moment (RJM) at the hip. The purpose of this study was to quantify, by means of segment-interaction analysis, the determinants of sagittal plane kinematics of the lower limb segments during the stance phase of sprint running. Video and ground reaction force data were collected from four male athletes performing maximal-effort sprints. The analysis revealed that during the first-third of the stance phase, a hip extension moment was the major determinant of the increasing angular velocity of the thigh. However, during the mid-third of stance, hip and knee extension moments and segment interaction effects all contributed to the thigh attaining its peak angular velocity. Extension moments at the ankle, and to a lesser extent the knee, were attributed with preventing the 'collapse' of the shank under the effects of the interactive moment due to ground reaction force. The angular acceleration of the foot was determined almost completely by the RJM at the ankle and the interactive moment due to ground reaction force. Further research is required to determine if similar results exit for a wide range of athletes and for other stages of a sprint race (e.g. early acceleration, maximal velocity, and deceleration phases).

Reliability of biomechanical variables of sprint running.

PURPOSE: The purpose of this paper was to report the reliability of variables used in the biomechanical assessment of sprint running and to document how these reliability measures are likely to improve when using the average score of multiple trials. METHODS: Twenty-eight male athletes performed maximal-effort sprints. Video and ground reaction force data were collected at the 16-m mark. The reliability (systematic bias, random error, and retest correlation) for a single score was calculated for 26 kinematic and 7 kinetic variables. In addition, the reliability (random error and retest correlation) for the average score of 2, 3, 4, and 5 trials was predicted from the reliability of a single score. RESULTS: For all variables, there was no evidence of systematic bias. The measures of random error and retest correlation differed widely among the variables. Variables describing horizontal velocity of the body's center of mass were the most reliable, whereas variables based on vertical displacement of the body's center of mass or braking ground reaction force were the least reliable. For all variables, reliability improved notably when the average score of multiple trials was the measurement of interest. CONCLUSION: Although it is up to the researcher to judge whether a measurement is reliable enough for its intended use, some of the lower-reliability variables were possibly too unreliable to monitor small changes in an athlete's performance. Nonetheless, there was a consistent trend for reliability to improve notably when the average score of multiple trials was the measurement of interest. Subsequently, if resources permit, researchers and applied sports-scientists may like to consider using the average score of multiple trials to gain the advantages that improved reliability offers.

Interaction of step length and step rate during sprint running.

UNLABELLED: A "negative interaction" between step length and step rate refers to an increase in one factor resulting in a decrease in the other. PURPOSES: There were three main purposes: a) to investigate the relative influence of the determinants of step length and step rate, b) to determine the sources of negative interaction between step length and step rate, and c) to investigate the effects of manipulation of this interaction. METHODS: Thirty-six athletes performed maximal-effort sprints. Video and ground reaction force data were collected at the 16-m mark. Sprint velocity, step length, step rate, and their underlying determinants were calculated. Analyses included correlations, multiple linear regressions, paired t-tests, and a simple simulation based on alterations in flight determining parameters. RESULTS: A wide range of step length and step rate combinations was evident, even for subgroups of athletes with similar sprint velocities. This was partly due to a negative interaction that existed between step length and step rate; that is, those athletes who used a longer step length tended to have a lower step rate and vice versa. Vertical velocity of takeoff was the most prominent source of the negative interaction. CONCLUSIONS: Leg length, height of takeoff, and vertical velocity of takeoff are all possible sources of a negative interaction between step length and step rate. The very high step lengths and step rates achieved by elite sprinters may be possible only by a technique that involves a high horizontal and low vertical velocity of takeoff. However, a greater vertical velocity of takeoff might be of advantage when an athlete is fatigued and struggling to maintain a high step rate.

Force-velocity analysis of strength-training techniques and load: implications for training strategy and research.

The purpose of this study was to investigate the force-velocity response of the neuromuscular system to a variety of concentric only, stretch-shorten cycle, and ballistic bench press movements. Twenty-seven men of an athletic background (21.9 +/- 3.1 years, 89.0 +/- 12.5 kg, 86.3 +/- 13.6 kg 1 repetition maximum [1RM]) performed 4 types of bench presses, concentric only, concentric throw, rebound, and rebound throw, across loads of 30-80% 1RM. Average force output was unaffected by the technique used across all loads. Greater force output was recorded using higher loading intensities. The use of rebound was found to produce greater average velocities (12.3% higher mean across loads) and peak forces (14.1% higher mean across loads). Throw or ballistic training generated greater velocities across all loads (4.4% higher average velocity and 6.7% higher peak velocity), and acceleration-deceleration profiles provided greater movement pattern specificity. However, the movement velocities (0.69-1.68 m.s(-1)) associated with the loads used in this study did not approach actual movement velocities associated with functional performance. Suggestions were made as to how these findings may be applied to improve strength, power, and functional performance.

Lunge performance and its determinants.

For activities such as squash, badminton and fencing, the ability to quickly complete a lunge and return to the start or move off in another direction is critical for success. Determining which strength qualities are important predictors of lunge performance was the focus of this study. Thirty-one male athletes performed: (1) a unilateral maximal squat (one-repetition maximum, 1-RM) and unilateral jump squat (50% 1-RM) on an instrumented supine squat machine, and (2) a forward lunge while attached to a linear transducer. We performed stepwise multiple regression analysis with lunge performance as the dependent variable and various strength, flexibility and anthropometric measures as the independent variables. From the many strength and power measures calculated, time to peak force was the best single predictor of lunge performance, which accounted for 55% of the explained variance. The best three-variable model for predicting lunge performance accounted for 76-85% of the explained variance. The models differed, however, according to whether lunge performance was expressed relative to body mass (time to peak force, mean power and relative strength = 76%) or taken as an absolute value (time to peak force, leg length and flexibility = 85%). We conclude that one to two trials were reliable for strength diagnosis and that one strength measure cannot accurately explain functional performance because other factors, such as body mass, flexibility and leg length, have diverse effects on the statistical models.

The effects of bungy weight training on muscle function and functional performance.

Eccentric strength training is thought to be important for improving functional performance. A form of training that may enhance the eccentric training stimulus is the attachment of a rubber bungy to the strength-training apparatus in such a way that the return velocity and, therefore, the force required to decelerate the load at the end of the eccentric phase are increased. To determine the effects of elastic bungy training, we performed two studies. In the first, we examined the electromyographic (EMG) and kinematic characteristics of three different squat techniques: traditional squat, non-bungy jump squat and bungy jump squat. In the second study, we examined whether jump squat training with and without the attachment of a rubber bungy to an isoinertial supine squat machine affects muscle function, multidirectional agility, lunge ability and single leg jump performance. The EMG activity of the vastus lateralis and gastrocnemius muscles was recorded. An instrumented isoinertial supine squat machine was used to measure maximal strength and various force, velocity and power measures in both studies. Participants were randomly assigned to one of three groups: a control group and two weight-trained groups, one of which performed bungy squat jumps and one of which performed non-bungy squat jumps. The two experimental groups performed 10 weeks of ballistic weight training. The kinematic and EMG characteristics of the bungy and non-bungy squat techniques differed significantly from those of the traditional squat on all the variables measured. The only difference between the bungy squat and non-bungy squat training was greater EMG activity during the later stages (70-100%) of the eccentric phase of the bungy squat condition. The 10 weeks of bungy squat and non-bungy squat jump weight training were found to be equally effective in producing improvements in a variety of concentric strength and power measures (10.6-19.8%). These improvements did not transfer to improved performance for the single leg jump and multidirectional agility. However, bungy weight training did lead to a significant improvement in lunge performance (21.5%) compared with the other groups.

Power absorption and production during slow, large-amplitude stretch-shorten cycle motions.

The purpose of this study was to determine the important predictors of power absorption and power production during slow, large-amplitude stretch-shorten cycle (SSC) motions. The relationship between power absorption (mean eccentric power output) and production (mean concentric power output) across different inertial loads was also investigated. Fifty-four subjects with a sporting background performed concentric (CBP) and rebound bench-presses (RBP) at 40% and 80% of their one-repetition maximum (1RM). The relationship between kinematic and kinetic variables and mean eccentric power and RBP mean power output was determined using correlation and multiple regression analysis. Maximal strength was found to be the best single predictor of power absorption, explaining between 44.2% and 69.1% of the variability that was associated with mean eccentric power output for 40% and 80% 1RM loads. Stretch velocity in combination with maximal strength was found to be the best two-predictor model of power absorption ( R(2)=83.7-97.3%). The best single predictor of SSC power production was found to be concentric mean power output ( R(2)=49.2-88.0%). The utilisation of the power absorbed during the power production phase differed across loads. It was suggested that as maximal strength is more trainable than speed, training to improve power absorption might emphasise maximal strength development. It was also suggested that SSC power output might benefit from training methods that focus on concentric force development. Further research is needed to evaluate these hypotheses and whether the findings of this study are similar for fast SSC motion.

Effects of power and flexibility training on vertical jump technique.

PURPOSE: The purpose of this study was to assess the effects of power and flexibility training on countermovement and drop jump techniques. METHOD: All jumps were executed with the goal of attaining maximum height and no restrictions were placed on the magnitude of countermovement or ground contact time. Subjects underwent initial testing followed by random allocation to one of four groups: power training to increase vertical jump height (P), stretching to increase flexibility (S), a combination of power and stretch training (PS), and a control group (C). Training lasted for 10 wk, followed by retesting. Jump height was calculated in addition to the following technique variables: eccentric lower-limb stiffness produced during the countermovement phase, magnitude of countermovement, and in the case of the drop jumps, ground contact time. RESULTS: Groups PS, P, and S all increased countermovement jump (CMJ) height, but only groups PS and P increased drop jump height (DJ30, DJ60, and DJ90 for drop jumps performed from 30-, 60-, and 90-cm drop heights). The technique changes associated with power training were increases in magnitude of countermovement (CMJ, DJ30, DJ60, and DJ90) and increases in ground contact time (DJ30 and DJ60). In addition, the eccentric lower-limb stiffness produced during the countermovement phase of the jumps increased for CMJ and decreased for DJ30, DJ60, and DJ90. Stretching appeared to have no significant effect on CMJ or drop jump technique. CONCLUSION: The results of this study show that when the training goal is maximum jump height alone, it is likely that drop jump technique will change in the direction of a lower eccentric leg stiffness, greater depth of countermovement, and a longer ground contact time, whereas for a countermovement jump eccentric leg stiffness and the depth of countermovement will both increase. It is proposed that these technique changes are a result of attempting to optimize a complex combination of factors involved in jumping (e.g., utilization of elastic energy, Golgi tendon organ inhibition, and contractile component contribution).