Suburban firefighter perceptions of health and wellness using patient-reported outcome measures.

BACKGROUND: Firefighting is among the most dangerous professions and requires exceptional physical fitness and focus while working. Patient-reported outcomes are a commonly used method to evaluate subjective health information and may be utilized by fire departments to identify the health status of firefighters and provide insight to promote their health and wellness. OBJECTIVE: This study is a novel analysis of firefighters' self-reported health to potentially identify musculoskeletal dysfunction, assist in therapeutic intervention, and improve overall health and wellness. METHODS: Firefighters were evaluated using seven different self-reported health surveys to assess various physical capabilities and quality of life. The questionnaires were delivered via online format and administered once to provide a snapshot of a suburban Oklahoma fire department. RESULTS: Using the Disablement in the Physically Active Scale, 14 of the 35 firefighters answered "slight, moderate, or severe" for the pain and motion variables. Only two of the firefighters indicated no stiffness or soreness after activity on the Nirschl Phase Rating Scale. The firefighters mean rating for "energy/fatigue" via the RAND-36 was 54.14 out of 100. CONCLUSION: Firefighters frequently report pain, impaired motion, and soreness, indicating areas in which health and wellness interventions may be helpful. The incorporation of periodic health surveys into firefighter health and wellness programming can highlight the presence of concerns, as well as intervention effectiveness by subjective health status reporting. By combining the health surveys with aerobic and core strength exercises, fire departments may be able to monitor and improve firefighter health.

ACUTE OUTCOMES OF MYOFASCIAL DECOMPRESSION (CUPPING THERAPY) COMPARED TO SELF-MYOFASCIAL RELEASE ON HAMSTRING PATHOLOGY AFTER A SINGLE TREATMENT.

BACKGROUND: Myofascial decompression (MFD), or cupping, and self-myofascial release (SMR) are common techniques utilized to treat soft tissue injuries and increase flexibility. MFD is a negative pressure soft tissue treatment technique using suction to manipulate the skin and underlying soft tissues. One method of SMR is a foam roller, where a patient rolls his/her bodyweight over a dense foam cylinder in a self-massaging fashion to mobilize soft tissues for the body part treated. HYPOTHESIS/PURPOSE: The purpose of this investigation was to examine the acute effects on hamstring flexibility and patient-rated outcome measures comparing two soft tissue treatments, 1) MFD, and 2) a moist heat pack with SMR using a foam roller in patients with diagnosed hamstring pathology. STUDY DESIGN: Pilot randomized controlled trial study. METHODS: Seventeen collegiate athletes [13 males (20.6+/- years; 184.9+/-cm; 90.8+/-kg) and 4 females (20.5+/-years; 167.1+/-cm; 62.7+/-kg)] with diagnosed hamstring pathology (mild strain and/or symptoms of tightness, pain, decreased strength, and decreased flexibility) were randomly assigned to receive MFD or SMR. The MFD group (n = 9) received three minutes of static treatment using six plastic-valve suction cups along the hamstrings followed by 20 repetitions of active movement with cups in place. SMR (n = 8) received 10 minutes of heat treatment over the hamstrings followed by 60 seconds of general mobilization over the entire hamstring area, and 90 seconds of targeted foam rolling on the area of most perceived tightness. Passive hamstring flexibility (ROM) and a patient-rated outcome measure [Perceived Functional Ability Questionnaire (PFAQ)] were assessed before and immediately after treatment. The Global Rating of Change measure (GROC) was administered post-intervention. RESULTS: Passive ROM and subjective PFAQ measures for overall flexibility and flexibility of the hamstrings were significantly different from pre- to post-intervention measurements regardless of the treatment received. A significant difference was found in favor of the MFD group for the GROC values. CONCLUSION: The findings suggest that both treatments are beneficial in increasing hamstring length. Patients though felt an enhanced treatment effect using MFD over SMR for perceived benefits to hamstring flexibility. LEVELS OF EVIDENCE: Level 2.

Compromised Vitamin D Status Negatively Affects Muscular Strength and Power of Collegiate Athletes.

Increasing evidence indicates that compromised vitamin D status, as indicated by serum 25-hydroxyvitamin D (25-OH D), is associated with decreased muscle function. The purpose of this study was to determine the vitamin D status of collegiate athletes residing in the southern U.S. and its effects on muscular strength and anaerobic power. Collegiate athletes (n = 103) from three separate NCAA athletic programs were recruited for the study. Anthropometrics, vitamin D and calcium intake, and sun exposure data were collected along with serum 25-OH D and physical performance measures (Vertical Jump Test, Shuttle Run Test, Triple Hop for Distance Test and the 1 Repetition Maximum Squat Test) to determine the influence of vitamin D status on muscular strength and anaerobic power. Approximately 68% of the study participants were vitamin D adequate (>75 nmol/L), whereas 23% were insufficient (75-50 nmol/L) and 9%, predominantly non-Caucasian athletes, were deficient (<50 nmol/L). Athletes who had lower vitamin D status had reduced performance scores (p < .01) with odds ratios of 0.85 on the Vertical Jump Test, 0.82 on the Shuttle Run Test, 0.28 on the Triple Hop for Distance Test, and 0.23 on the 1 RM Squat Test. These findings demonstrate that even NCAA athletes living in the southern US are at risk for vitamin D insufficiency and deficiency and that maintaining adequate vitamin D status may be important for these athletes to optimize their muscular strength and power.

Ankle Joint Angle and Lower Leg Musculotendinous Unit Responses to Cryotherapy.

Akehi, K, Long, BC, Warren, AJ, and Goad, CL. Ankle joint angle and lower leg musculotendinous unit responses to cryotherapy. J Strength Cond Res 30(9): 2482-2492, 2016-The use of cold application has been debated for its influence on joint range of motion (ROM) and stiffness. The purpose of this study was to determine whether a 30-minute ice bag application to the plantarflexor muscles or ankle influences passive ankle dorsiflexion ROM and lower leg musculotendinous stiffness (MTS). Thirty-five recreationally active college-aged individuals with no history of lower leg injury 6 months before data collection volunteered. On each testing day, we measured maximum passive ankle dorsiflexion ROM (°) and plantarflexor torque (N·m) on an isokinetic dynamometer to calculate the passive plantarflexor MTS (N·m per degree) at 4 joint angles before, during, and after a treatment. Surface electromyography amplitudes (µV), and skin surface and ambient air temperature (°C) were also measured. Subjects received an ice bag to the posterior lower leg, ankle joint, or nothing for 30 minutes in different days. Ice bag application to the lower leg and ankle did not influence passive ROM (F(12,396) = 0.67, p = 0.78). Passive torque increased after ice bag application to the lower leg (F(12,396) = 2.21, p = 0.011). Passive MTS at the initial joint angle increased after ice bag application to the lower leg (F(12,396) = 2.14, p = 0.014) but not at the other joint angles (p > 0.05). Surface electromyography amplitudes for gastrocnemius and soleus muscles increased after ice application to the lower leg (F(2,66) = 5.61, p = 0.006; F(12,396) = 3.60, p < 0.001). Ice bag application to the lower leg and ankle joint does not alter passive dorsiflexion ROM but increases passive ankle plantarflexor torque in addition to passive ankle plantarflexor MTS at the initial joint angle.

Dorsiflexion, plantar-flexion, and neutral ankle positions during passive resistance assessments of the posterior hip and thigh muscles.

CONTEXT: Passive straight-legged-raise (SLR) assessments have been performed with the ankle fixed in dorsiflexion (DF), plantar-flexion (PF), or neutral (NTRL) position. However, it is unclear whether ankle position contributes to differences in the passive resistance measured during an SLR assessment. OBJECTIVE: To examine the influence of ankle position during an SLR on the passive torque, range of motion (ROM), and hamstrings electromyographic (EMG) responses to passive stretch of the posterior hip and thigh muscles. DESIGN: Crossover study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 13 healthy volunteers (5 men: age = 24 ± 3 years, height = 178 ± 6 cm, mass = 85 ± 10 kg; 8 women: age = 21 ± 1 years, height = 163 ± 8 cm, mass = 60 ± 6 kg). INTERVENTION(S): Participants performed 6 randomly ordered passive SLR assessments involving 2 assessments at each condition, which included the ankle positioned in DF, PF, and NTRL. All SLRs were performed using an isokinetic dynamometer programmed in passive mode to move the limb toward the head at 5°/s. MAIN OUTCOME MEASURE(S): During each SLR, maximal ROM was determined as the point of discomfort but not pain, as indicated by the participant. Passive torque and EMG amplitude were determined at 4 common joint angles (θ) separated by 5° during the final common 15° of ROM for each participant. RESULTS: Passive torque was greater for the DF condition than the NTRL (P = .008) and PF (P = .03) conditions at θ3 and greater for the DF than NTRL condition (P = .02) at θ4. Maximal ROM was lower for the DF condition than the NTRL (P = .003) and PF (P < .001) conditions. However, we found no differences among conditions for EMG amplitude (P = .86). CONCLUSIONS: These findings suggest that performing SLRs with the ankle positioned in DF may elicit greater passive torque and lower ROM than SLRs with the ankle positioned in PF or NTRL. The greater passive torque and lower ROM induced by the DF condition possibly were due to increased tension in the neural structures of the proximal thigh.

Effect of armor and carrying load on body balance and leg muscle function.

This study investigated the impact of weight and weight distribution of body armor and load carriage on static body balance and leg muscle function. A series of human performance tests were conducted with seven male, healthy, right-handed military students in seven garment conditions with varying weight and weight distributions. Static body balance was assessed by analyzing the trajectory of center of plantar pressure and symmetry of weight bearing in the feet. Leg muscle functions were assessed by analyzing the peak electromyography amplitude of four selected leg muscles during walking. Results of this study showed that uneven weight distribution of garment and load beyond an additional 9 kg impaired static body balance as evidenced by increased sway of center of plantar pressure and asymmetry of weight bearing in the feet. Added weight on non-dominant side of the body created greater impediment to static balance. Increased garment weight also elevated peak EMG amplitude in the rectus femoris to maintain body balance and in the medial gastrocnemius to increase propulsive force. Negative impacts on balance and leg muscle function with increased carrying loads, particularly with an uneven weight distribution, should be stressed to soldiers, designers, and sports enthusiasts.

Impact of ballistic body armour and load carriage on walking patterns and perceived comfort.

This study investigated the impact of weight magnitude and distribution of body armour and carrying loads on military personnel's walking patterns and comfort perceptions. Spatio-temporal parameters of walking, plantar pressure and contact area were measured while seven healthy male right-handed military students wore seven different garments of varying weight (0.06, 9, 18 and 27 kg) and load distribution (balanced and unbalanced, on the front and back torso). Higher weight increased the foot contact time with the floor. In particular, weight placement on the non-dominant side of the front torso resulted in the greatest stance phase and double support. Increased plantar pressure and contact area observed during heavier loads entail increased impact forces, which can cause overuse injuries and foot blisters. Participants reported increasingly disagreeable pressure and strain in the shoulder, neck and lower back during heavier weight conditions and unnatural walking while wearing unbalanced weight distributed loads. This study shows the potentially synergistic impact of wearing body armour vest with differential loads on body movement and comfort perception. PRACTITIONER SUMMARY: This study found that soldiers should balance loads, avoiding load placement on the non-dominant side front torso, thus minimising mobility restriction and potential injury risk. Implications for armour vest design modifications can also be found in the results.

Microbiota found in protective athletic mouthguards.

BACKGROUND: Protective athletic mouthguards (PAM) produce oral mucosal injuries and may be associated with other systemic conditions. HYPOTHESIS: With wear, PAM become contaminated by a range of microorganisms. The number of microorganisms in PAM can be reduced by daily use of an antimicrobial solution. STUDY TYPE: Case series. STUDY DESIGN AND METHODS: Sixty-two division I football player volunteers were divided into 4 groups, using PAM for varying lengths of time before surrendering them for microbial analysis. One group had their PAM soaked in an antimicrobial solution between uses. The PAM were analyzed qualitatively and quantitatively for bacteria, yeasts, and fungi, using previously accepted methods. RESULTS: The 62 football players surrendered a total of 81 PAM for microbial analysis. The PAM yielded 154 gram-positive cocci, 150 gram-positive bacilli, 21 gram-negative cocci, 31 gram-negative bacilli, 22 yeasts, and 107 molds. The most common species of gram-positive cocci were Staphylococcus spp. and Micrococcus spp. Only 3 PAM (4%) were positive for Staphylococcus aureus. The most common species of gram-positive bacilli were Brevibacterium spp. and Cellulomonas spp. The most common species of yeasts were Candida parapsilosis and Rhodotorula mucilaginosa, while the most common species of mold were Cochliobolus spp. and Penicillium chrysogenum. Soaking the PAM in an antimicrobial solution between uses substantially reduced the numbers of microorganisms. CONCLUSIONS: Substantial microbial contamination of PAM occurs with use. The microbial load can be reduced by soaking in an antimicrobial solution between uses. CLINICAL RELEVANCE: PAM are contaminated by microorganisms that have the potential to produce oral and systemic diseases. They should be sanitized daily and changed when they become sharp and/or jagged.

The Effect of Energy Patches on Substrate Utilization in Collegiate Cross-Country Runners.

It is well established that an increased capacity of skeletal muscle to oxidize fatty acids can spare glycogen and delay the onset of fatigue in mild- to moderate-intensity exercise. The purpose of the following study was to examine the effect of LifeWave® energy patches on non-protein substrate utilization in Division-1 cross-country runners. To determine the effect of the patches subjects were pretested to establish baselines and randomly assigned to an experimental (EX) or placebo (PL) group. Twenty-two trained male (n = 11; mean ± SD, age = 21.1 ± 2.6years, height = 179.6 ± 4.2cm, body mass = 71.4 ± 7.4kg, VO2max = 72.6 ± 7.1mL·kg-1·min-1) and female (n = 11; mean ± SD, age = 21.5 ± 2.4years, height = 166.7 ± 5.7cm, body mass = 53.7 ± 3.2kg, VO2max = 63.6 ± 6.9mL·kg-1·min-1) cross-country runners volunteered to participate in the study. Dependent variables included maximal oxygen consumption (VO2max), rating of perceived exertion (RPE), respiratory exchange ratio (RER), maximum heart rate (HRmax), and time to exhaustion (TTE). Results indicated there were no significant differences between the EX and PL groups at posttesting for RPE, TTE, HRmax, or VO2max. RER was found to be significantly higher for the EX group compared to the PL group during stage 1 of the Bruce-protocol graded exercise test (p = 0.02). Based on the limited available research regarding LifeWave® energy patches effect on non-protein substrate utilization during aerobic exercise there appears to be no performance enhancing benefits.

The influence of ratio and allometric scaling procedures for normalizing upper body power output in division I collegiate football players.

The purpose of the present study was to examine the differences in upper body power output among lineman and nonlineman division I collegiate football players and to examine the influence of 2 normalization procedures: (a) simple ratio scaling and (b) standardized allometric scaling. Ten lineman (mean +/- SD: age = 19.3 +/- 1.6 years; height = 187.7 +/- 4.7 cm; mass = 127.7 +/- 13.3 kg) and 14 nonlineman (19.6 +/- 1.4 years; 181.8 +/- 5.2 cm; 92.3 +/- 10.6 kg) performed a multiple repetition bench press power test at 50% of their 1 repetition maximum. Peak power (PP) was determined from a Tendo weightlifting analyzer that was attached to the barbell. The PP values were then analyzed under 3 conditions that included: (a) no scaling (absolute values), (b) ratio scaling (PP body mass), and (c) allometric scaling (PP body mass). The results indicated that the larger lineman demonstrated greater absolute PP values (p = 0.02); however, ratio scaling favored the smaller nonlineman group (p = 0.04). There were no differences in PP values between positions after the standardized allometric scaling procedure (p = 0.60). These findings indicated that the standardized allometric scaling procedure may be a more effective method for normalizing PP values among elite division I collegiate football players.

Assessment of the effectiveness of a sublingual, ergogenic spray on muscle strength and power.

Nutrients, chemicals, and drugs may be applied sublingually to provide faster absorption. Sublingual absorption occurs when a substance comes in contact with the buccal mucosa, where it diffuses through a membrane of the dense capillaries. The purpose of this study was to assess the effectiveness of a sublingual, ergogenic product containing vitamins, minerals, amino acids, and a coenzyme on muscle performance. National Collegiate Athletic Association Division I linemen (n = 23) voluntarily participated in the study. All participants (20.11 +/- 1.45 years, 132.1 +/- 9.85 kg, 191.19 +/- 3.85 cm) were tested on 102.1 kg (225 lb) bench press repetitions, vertical jump, and grip strength. One week later, participants were either a placebo or the experimental treatment before they were tested again. Repeated-measures analyses of variance (ANOVAs) yielded a significant (p = 0.046) gain for the bench press. A Newman-Keuls post hoc test revealed a significant change in the treatment group but not in the placebo group. While the treatment group demonstrated greater improvement over the placebo group for each of the remaining variables, none were significant: vertical jump (p = 0.65) and grip strength (p = 0.74). The inconsistency of the results may be due to several factors. First, the spray may not be an ergogenic agent; second, the standardized dose may be too small for those weighing >or=290 lb and should be administered based on weight. Furthermore, the coenzyme and amino acids may not possess the molecular size, solubility, chemical stability, or hydrophilic character to be easily absorbed. Lastly, the data were generated by field tests and may not be sensitive enough to elicit subtle responses.

Protective athletic mouthguards: do they cause harm?

BACKGROUND: Protective athletic mouthguards (PAMs) have been worn in competitive sports for more than 100 years. Today, participants in contact and noncontact sports wear PAMs. HYPOTHESIS: Wearing a PAM produces oral injury. STUDY TYPE: Case series. STUDY DESIGN AND METHODS: Sixty-two Division I football players voluntarily participated in the study. Before the beginning of the season, each player underwent a thorough oral examination, and all abnormal oral findings were photographed (hyperkeratosis, erythema, ulceration, and combinations thereof). At midseason, 14 players were given complete oral examinations, with all abnormal oral findings documented. At season end, all remaining players (n = 53) had complete oral examinations and photographs taken of abnormal oral findings. RESULTS: The preseason examination of 62 players found a total of 85 lesions (1.4 lesions per player) on the gingiva (n = 17), buccal mucosa (n = 60), and palate (n = 8). The 14 midseason players had 28 lesions (2.0 lesions per player) on gingiva (n = 8), buccal mucosa (n = 16), and tongue (n = 4). At season end, the 53 remaining players had 198 lesions (3.7 per player) on the gingiva (n = 96), buccal mucosa (n = 79), tongue (n = 18), and palate (n = 5). In addition, the lesion intensity scores progressively increased over the season. Because the palate did not come into direct contact with the PAM, it was used as an internal control. CONCLUSION: The wearing of a PAM may increase the number and intensity of oral mucosal injuries, which may cause localized soft tissue reactions such as hyperkeratosis, erythema, and ulceration. CLINICAL RELEVANCE: Because the PAM reduces tooth injury but may cause oral lesions, it should be sanitized daily and changed regularly and replaced whenever it becomes sharp and jagged or when the athlete develops an irritation in the mouth.

Assessment of the effectiveness of nontransdermal energy patches on muscle endurance and power.

Claims of recently developed energy patches suggest that organic nanoscale biomolecular "antennas" produced by L and D-stereoisomers resonate at frequencies in unison with molecules in the cells inducing electron flow to assists in recruiting calcium ions, allowing greater muscle fiber recruitment during muscle contraction. The purpose of the study was to assess the efficacy of energy patches in the performance of selected muscle power and endurance measures. After a 5-minute warm-up and stretch, 41 college varsity football players (age, 20.37 +/- 1.24 years; height, 169.91 +/- 7.44 cm; weight, 109.45 +/- 19.85 kg) were pre-tested on 102-kg maximal bench press repetitions, standing vertical jump, grip strength, peak torque, torque to body weight, total work, average power, and average torque as measured by 50 repetitions of leg extensions at 180 degrees .s. The following week, the players were randomly assigned the experimental or placebo patches. After placement of the patches, the participants again completed a 5-minute warm-up, followed by the identical pre-test protocol. Repeated-measures ANOVAs were used to compare resultant data. No significant group interaction effects were found between experimental and placebo patches for maximal bench press repetitions (p = 0.48), vertical jump distance (p = 0.39), grip strength (p = 0.29), total work (p = 0.26), torque to body weight (p = 0.05), average peak torque (p = 0.08), and average power (p = 0.05). A significant increase occurred in the experimental group for peak torque (p = 0.04). It was concluded that the energy patches significantly improved performance over placebo patches in one of the eight variables tested and registered near significance in two additional variables. However, inconsistency in overall results demands further studies to determine the reliability in improvement of performance in the presence of energy patches.

Seasonal changes of body mass, body composition, and muscular performance in collegiate wrestlers.

PURPOSE: The purpose of the present investigation was to examine the physiological response of collegiate wrestlers to their competitive season. METHODS: Eleven Division I collegiate wrestlers (mean +/- SD; 19.45 +/- 1.13 y) volunteered and completed 4 testing sessions throughout the course of the collegiate wrestling season. Testing sessions were conducted pre-, mid-, and postseason, as well as before the national tournament. Testing consisted of weigh-in, skinfold body composition testing, and a 50-rep concentric, isokinetic leg extension muscle endurance test (180 degrees /s). Muscular performance variables measured included peak torque, peak torque at fatigue, percent decline, and peak torque/body mass ratio. RESULTS: A significant increase (P < .05) of 2.9% was observed for body mass between midseason and postseason (2.38 kg). From pre- to postseason, a mean increase of 3.8% (3.1 kg) was observed for body mass. An increase (P < .05) in BF% of 2.9% was observed between prenationals and postseason. No significant differences (P > .05) were observed between consecutive time points for quadriceps peak torque; however, there was a significant increase (P < .05) between preseason and prenationals (23.39 N.m). Peak torque at fatigue was greater (P < .05) at midseason than preseason, representing an increase of 9.82 N.m. Between midseason and prenationals testing, we observed an 11% increase (P < .05) in %DCLN. Finally, we noted an increase (P < .05) from 0.6 to 0.69 in peak torque/body mass ratio between preseason and prenationals. CONCLUSIONS: Our results indicate that while force values seem to suffer at midseason, the wrestlers compensated and were strongest just before their national competition.

A comparison of periodization models during nine weeks with equated volume and intensity for strength.

The purpose of the present investigation was to determine if significant differences exist among 3 different periodization programs in eliciting changes in strength. Twenty-eight recreationally trained college-aged volunteers (mean +/- SD; 22.29 +/- 3.98) of both genders were tested for bench press, leg press, body fat percentage, chest circumference, and thigh circumference during initial testing. After initial testing, subjects were randomly assigned to 1 of 3 training groups: (a) linear periodization (n = 9), (b) daily undulating periodization (n = 10), or (c) weekly undulating periodization (n = 9). The training regimen for each group consisted of a 9-week, 3-day-per-week program. Training loads were assigned as heavy (90%, 4 repetition maximum [4RM]), medium (85%, 6RM), or light (80%, 8RM) for bench press and leg press exercises. Subjects were familiarized with the CR-10 rated perceived exertion scale and instructed to achieve an 8 or 9 on the final repetition of each set for all other exercises. Subjects were then retested after 4 weeks of training. Training loads were then adjusted according to the new 1RM. Subjects were then retested after 5 more weeks of exercise. For all subjects, significant (p < 0.05) increases in bench press and leg press strength were demonstrated at all time points (T1-T3). No significant differences (p > 0.05) were observed between groups for bench press, leg press, body fat percentage, chest circumference, or thigh circumference at all time points. These results indicate that no separation based on periodization model is seen in early-phase training.