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Tensiomyography™ (TMG) is a non-invasive method to monitor skeletal muscle mechanical characteristics. This systematic review and meta-analysis reports on diagnostic accuracy, validity, and reliability of TMG (maximal radial displacement [Dm], contraction time [Tc], delay time [Td], and velocity of contraction [Vc]) to assess exercise-induced fatigue in healthy volunteers, with the specific aim to determine the current level of supporting evidence. Systematic literature searches within Medline, Embase and Sportdiscus databases were conducted from January 1990 through November 2018. Methodological quality was evaluated by the Assessment of Diagnostic Accuracy Studies (QUADAS) tool or the Validity and Reliability Critical Appraisal Tool (CAT) or the Quality Appraisal of Diagnostic Reliability checklist (QAREL). Meta-analytical methods were utilised to summarize relative reliabilities of Dm, Tc, Td (95%, CI). The methodological quality of the 19 included studies (n = 373; female = 13.0%) ranged from low to high quality. The analysis revealed insufficient diagnostic accuracy and validity, mixed results regarding absolute reliability, and high to excellent relative reliability for the assessed measures. To conclude, robust evidence for diagnostic accuracy/validity of TMG has yet to be determined, whereas there is substantial evidence for its reliability. Higher methodological standards need to be established, including the avoidance of gender bias.

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PURPOSE: As reliability of raster stereography was proved only for sagittal plane parameters with repeated measures on the same day, the present study was aiming at investigating variability and reliability of back shape reconstruction for all dimensions (sagittal, frontal, transversal) and for different intervals. METHODS: For a sample of 20 healthy volunteers, intra-individual variability (SEM and CV%) and reliability (ICC ± 95% CI) were proved for sagittal (thoracic kyphosis, lumbar lordosis, pelvis tilt angle, and trunk inclination), frontal (pelvis torsion, pelvis and trunk imbalance, vertebral side deviation, and scoliosis angle), transversal (vertebral rotation), and functional (hyperextension) spine shape reconstruction parameters for different test-retest intervals (on the same day, between-day, between-week) by means of video raster stereography. RESULTS: Reliability was high for the sagittal plane (pelvis tilt, kyphosis and lordosis angle, and trunk inclination: ICC > 0.90), and good to high for lumbar mobility (0.86 < ICC < 0.97). Apart from sagittal plane spinal alignment, there was a lack of certainty for a high reproducibility indicated by wider ICC confidence intervals. So, reliability was fair to high for vertebral side deviation and the scoliosis angle (0.71 < ICC < 0.95), and poor to good for vertebral rotation values as well as for frontal plane upper body and pelvis position parameters (0.65 < ICC < 0.92). Coefficients for the between-day and between-week interval were a little lower than for repeated measures on the same day. Variability (SEM) was less than 1.5° or 1.5 mm, except for trunk inclination. Relative variability (CV) was greater in global trunk position and pelvis parameters (35-98%) than in scoliosis (14-20%) or sagittal sway parameters (4-8 %). CONCLUSIONS: Although we found a lower reproducibility for the frontal plane, raster stereography is considered to be a reliable method for the non-invasive, three-dimensional assessment of spinal alignment in normal non-scoliotic individuals in the sagittal plane and partly for scoliosis parameters, which fulfils scientific as well as practical recommendations for spine shape screening and monitoring, but cross-sectional or follow-up effect analyses should take into account the degree of reliability differing in various spine shape parameters. Further investigations should be conducted to analyse reliability in scoliosis patients with differing spinal deformities.

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BACKGROUND: Functional diagnostic approaches are helpful in the treatment of low back pain (LBP) patients. Reference data of asymptomatic individuals might be helpful to understand individual case profiles of LBP patients, to derive movement therapy goals and issues and to improve quality management in therapy monitoring. METHODS: Spinal form and mobility in the dorsal flexion (static and dynamic rasterstereography), as well as isometric peak forces (back extension/trunk flexion) were analyzed in a cross-sectional study of 103 pain-free volunteers (52 females, 51 males) aged 18-40 years. RESULTS: Reference data could be demonstrated based on percentiles (5-95 %). There were significant differences between males and females for strength values and spinal form parameters describing the lumbosacral transition (p < 0.001), but not for the strength extension/flexion ratio (Ex/Flex), lumbar mobility (dorsiflexion) or any other spine shape parameter. CONCLUSION: Despite the problem of a normal spinal alignment it is proposed to use reference data percentiles of asymptomatic persons to construct a musculoskeletal functional profile for individual LBP patients, which might emphasize the character of different LBP disorders and could be useful in screening, therapy planning and monitoring.

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Verbal descriptors of dyspnea have been suggested as being useful in providing information on the underlying pathophysiology. However, little is known about the reliability of these descriptors. The present study examined the reliability of a German language list of respiratory symptom descriptors and studied the association of these descriptors with the intensity and unpleasantness of perceived dyspnea. Fourteen healthy volunteers performed cycle-ergometer exercise and voluntary breath-holding during which they rated the perceived intensity (VAS-I) and unpleasantness (VAS-U) of dyspnea on visual analog scales. Following this, they judged their sensations of dyspnea using the list of symptom descriptors. Both conditions were repeated in reverse order on a subsequent occasion 10 days apart. Ventilatory measures, heart rate, blood lactate, VAS-I and VAS-U during cycle-exercise as well as breath-holding time, VAS-I and VAS-U during breath-holding showed no differences between both occasions. Separate hierarchical cluster analyses identified four clusters of verbal descriptors of dyspnea which were widely comparable between both occasions: effort, speed, obstruction and suffocation. Separate multidimensional scaling analyses (MDS) confirmed these four clusters for each occasion. On both days, perceived unpleasantness of dyspnea was correlated with all four clusters during cycle-exercise, while perceived intensity showed only correlations with effort or speed, respectively. No such correlations were obtained for breath-holding. The results suggest that separable clusters of German language descriptors of dyspnea are reliably used by healthy volunteers. The obtained clusters are widely comparable to previously described clusters in other languages and are differently related to the intensity and unpleasantness of perceived dyspnea.

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Lack of exercise is a primary cause for today's level of morbidity and mortality in the Western world. Thus, exercise as a therapeutic modality has an important role. Beneficial effects of exercise have been extensively documented, specifically in primary and secondary prevention of coronary heart disease (CHD), diabetes mellitus, hypertension, disorders of fat metabolism, heart insufficiency, cancer, etc. A regular (at least 3 x per week) endurance training program of 30-40 min duration at an intensity of 65-70% of VO(2)max involving large muscle groups is recommended. The specific exercise activity can also positively affect individuals with orthopedic disease patterns, i.e., osteoporosis, back pain, postoperative rehabilitation, etc. Endurance strength training in the form of sequential training involving approx. 8-10 different exercises for the most important muscle groups 2 x per week is a suitable exercise therapy. One to three sets with 8-12 repetitions per exercise should be performed until volitional exhaustion of the trained muscle groups among healthy adults and 15-20 repetitions among older and cardiac patients. Apart from a positive effect on the locomotor system, this type of strength training has positive effects on CHD, diabetes mellitus, and cancer.

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Lack of exercise and poor eating habits are considered to be major causes of most diseases of civilization. In consequence, endurance sports, but also an integration of physical activity in everyday life, are gaining in importance. Positive effects of regular physical exercise have been described for CAD, arterial hypertension, lipid metabolic disorders, type 2 diabetes mellitus and the metabolic syndrome. In order to achieve an optimal training effect, exercise intensity should be oriented to the individual anaerobic threshold. As a rule of thumb, 30 minutes of endurance training--ideallyevery day--is considered necessary. Prior testing of a person's ability to undertake such activities should include ECG and blood pressure measurements, spirometry and lactate determination, and contraindications must be taken into account.

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The aim of the study was, to assess the influence of a knee brace on the development of anterior instability after anterior cruciate ligament rupture and to test aptitude for physical strain. 46 subjects with arthroscopically proven anterior cruciate ligament rupture were divided equally in a randomised order into two groups. Both groups carried out a standardized physical therapy program, while one group (0) received additional stabilization by means of a functional knee brace (SofTec, Bauerfeind). In addition, important features of the brace (stabilization capacity, safety perception and physical performance) were tested and compared to the non-braced contralateral leg among 23 healthy physical education students by means of a standardized scaled questionnaire (observational study). 0 showed lower (p < 0.05) development of the anterior instability by 46 % and lower (p < 0.05) reduction in circumference of the femur muscles by 25 %. Increasing the time interval between accident and beginning of the brace treatment, increased the difference of the therapeutical effect of the brace. In the observational study, the brace received a better evaluation regarding all test parameters. The reduction of developing anterior instability by means of a brace should facilitate - apart from an individual operation-time-arrangement - especially a conservative approach within the framework of anterior instability and physical activity. Aside from the improvement of the mechanical stabilization, indications for suitability in strain situations could be detected for the tested brace.

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In 20 volunteers the relationship between rear-foot pronation and increasing physical exertion during treadmill ergometry was examined. In order to assess the influence of regularly performed running training a group of 10 endurance trained middle- and long-distance runners (age: 27.4 +/- 4.9 years; weight: 71.0 +/- 8.8 kg; height: 184.2 +/- 8.3 cm) was compared to another group of 10 untrained subjects (age: 24.7 +/- 2.1 years; weight: 73.3 +/- 9.8 kg; height: 179.1 +/- 8.3 cm). The examinations were carried out on a treadmill using a high-frequency motion analyzing system. Heart rate, blood lactate as well as rear-foot pronation were measured. Regarding heart rate and lactate concentration there were significant differences between trained and untrained volunteers. The pronation angle increased with higher speed up to a maximum of 6.54 +/- 4.22 degree for the trained group and 6.84 +/- 4.59 degree for the untrained group. With reference to maximal as well as submaximal stages the pronation angles showed no significant differences between both groups. Following the maximal exercise level the runners performed an additional 3 min run with a velocity reduced by 8 km/h compared to the maximal speed. At this level the total group as well as the untrained group showed significantly greater pronation angles compared to those of the corresponding velocity at the beginning of the test. The extent of the differences, however, was not significantly correlated with the lactate levels. Our results demonstrate that the increase of the pronation angle is a function of the running speed. But there is also an influence of fatigue, which depends neither on the running velocity nor on the lactate levels during exercise. Therefore, further investigations should emphasize the question which factors are responsible for this effect.

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UNLABELLED: In an experimental study we investigated the EMG response in 10 human subjects after intraarticular stimulation of the shoulder joint capsule following arthroscopic insertion of the stimulating electrode in the anterior glenohumeral ligaments. The muscle response was documented by mono- or bipolar electrodes. Reproducible EMG response patterns were present in superficial as well as in deep muscle layers. The response time ranged from 100 to 516 msec. The earliest muscle response was found in the anterior part of the deltoid muscle and the latest one in the supraspinatus muscle and the lateral part of the deltoid muscle. CLINICAL RELEVANCE: The results of this study suggest a significant influence of the tension in the joint capsule on the activity of the stabilizing musculature.

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INTRODUCTION: In spite of educational work for many years by the orthopaedic surgeons wrong lifting techniques are still used in everyday life as well as during exercise. The reason for this could be the fact that there is an advantage regarding these techniques from the energetic point of view. MATERIAL AND METHODS: To clarify this issue we examined 30 healthy males within the age range of 17 and 30 years (weight: 74.0 +/- 9.2 kg, height: 182.5 +/- 6.7 cm). In a randomised sequence the volunteers carried out two different lifting techniques: 1. Lifting with stretched legs and bent back, 2. Lifting with bent legs and stretched back (Brügger technique). The test scheme consisted of four different 3-minute exercise levels with increasing weights (0 kg, 5.2 kg, 12.1 kg, 19.2 kg), the repetition rate was 30 times per level. RESULTS: Using the Brügger technique the results for heart rate, VO2, VCO2 and VE were highly significant (p < 0.001) above the results of the other technique at all exercise levels. On the RPE (rate of perceived exertion) scale the differences were statistically significant regarding the 0.01-level. CONCLUSION: The results give rise to the supposition that the energy consumption for the lifting technique with the bent back is lower and is therefore preferred in everyday life and during exercise. These findings should be taken into consideration when informing people about possible damages.

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In a nation-wide survey 350 knee surgeons were asked for their current diagnostic and treatment modalities in patients with osteochondritis dissecans (OD) of the knee joint: 255 questionnaires were analyzed. With respect to the different imaging techniques, standard xray studies were performed by all surgeons. Other techniques were used in the following decreasing order of preference: xray tomography, MRI, CT-scan, ultrasound, bone scan, and arthrography. The indication for surgery was primarily influenced by the standard xray, and secondarily by xray tomography, then by MRI, and CT-scan. Regarding cartilage-inducing treatment methods, Pridie drilling (antegrade) was by far predominant over abrasion arthroplasties and Beck drilling (retrograde). Cartilage or perichondrium transplantation was performed rarely. For fixation of a loose fragment most of the surgeons preferred "Ethipins" followed by screws and K wires. Only one-third of the surgeons used MRI as one of the first diagnostic tools, but a higher percentage of surgeons recommended MRI in special cases. Especially in young patients MRI was used as often as plain xray, whereas the use of MRI in older patients was remarkably reduced. Concerning treatment modalities, the majority of surgeons treated young patients with protection from weight bearing. For cartilage stabilization, "Ethipins" were preferred, whereas screws were rarely recommended. Approximately 25% of the physicians would not treat asymptomatic patients at all. Even patients with typical symptoms were not treated by less than 15% of the surgeons. In general, adults with OD still embedded in the cartilage bed are treated more aggressively. In cases with a loose body the cartilage-inducing procedures are preferred. Perichondrium or cartilage transplantations are only rarely performed.

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In 26 patients we performed an arthroscopically assisted arthrodesis of the ankle. The patients' ages ranged from 31 to 69 years. The male:female ratio. Sixteen patients had posttraumatic degenerative joint disease, three patients suffered from a previous infection, four patients had rheumatoid arthritis, and three patients had an osteochondritis dissecans in their past history. The time taken for surgery ranged from 65 to 135 min. Compared with open procedures we documented less postoperative swelling and minor use of analgesics. Time of follow-up was a minimum of 6 months and a maximum of 75 months. In 22 patients we found solid fusion at the time of followup. Fusion was accomplished by 2 months postoperatively in four patients, by 3 months in nine patients, by 4 months in another six patients, and by 6 months in 3 patients. Three patients did not evidence any bony fusion, but they were free of pain. In one patient an open revision was necessary. According to our experience, we recommend arthroscopically assisted arthrodesis of the ankle in patients with degenerative joint disease without rotational or varus/valgus malalignment, severe bone defects or neuropathic disease.

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In 27 healthy volunteers (9 females, 18 males) we evaluated the proprioceptive function of the glenohumeral joint. The volunteers were asked to place the arm in different positions with and without visual control. The test was performed for the dominant and for the nondominant extremity. The following joint positions were measured: 50 degrees, 100 degrees, 150 degrees abduction; 50 degrees, 100 degrees, 150 degrees flexion; +45 degrees, 0 degrees, -45 degrees rotation in 90 degrees abduction. Joint position was documented with a motion-analyzing system with passive reflecting markers. The results showed significant differences between the measurements with and without visual control. Proprioception was worse below the shoulder level (50 degrees abduction, flexion). Two volunteers with generally good coordinative capabilities showed better results than the rest of the group. We observed no differences between dominant and nondominant extremities nor between males and females. Our results demonstrated low variance of the proprioceptive function of the glenohumeral joint in healthy volunteers. Our findings serve as a base for further evaluations in different patients' populations.

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UNLABELLED: In 31 healthy volunteers aged 18 to 33 years we investigated the intracompartmental pressure in the anterior tibial compartment while running on a treadmill with, and without, a functional knee brace. All volunteers performed two test series with a constant running speed of 8 km/h. Prior to running, the pressure was documented in the supine, sitting and standing position as well as during running. The intracompartmental pressure in the supine position was significantly less without a brace compared to the pressure with a brace. This was also true for the sitting position and the standing position. While running on the treadmill the average pressure was also significantly higher with, than without, a brace. CLINICAL RELEVANCE: Running with a functional knee brace leads to increased intracompartmental pressure in the anterior tibial compartment and, as a consequence, may lead to a chronic compartment syndrome. Wearing a functional knee brace may cause secondary muscle ischemia and may be one reason for the increased incidence of injuries in athletes.

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UNLABELLED: In 82 asymptomatic subjects aged 8-62 years we evaluated the menisci by magnetic resonance imaging [MRI; 1.0 tesla; spin-echo (SE 700/20), PS (partial saturation; 500/10), STIR (short time inversion recovery sequence; 1600/130/30)]. For grading the degeneration of the meniscus we used a standard classification (grades 0-4). MR findings were correlated with the patients' age, weight, profession, and athletic activity. Statistic analysis revealed a correlation between athletic activity and meniscal degeneration of both anterior horns and the posterior horn of the lateral meniscus. Especially the anterior horn of the lateral meniscus seems to be loaded during athletic activities. Correlation of meniscus degeneration with subjects' age showed an increase in grade 3 and grade 4 lesions with advancing age. Among subjects older than 50 years, grade 3 and 4 lesions were present in the SE sequence in 28.5% of cases, in PS sequences in 40.7% of case, and in STIR sequences in 25% of cases. CLINICAL RELEVANCE: Athletic activity seems to load the anterior knee compartments, especially the lateral compartment. MRI shows meniscal lesions in a significant number of asymptomatic subjects, especially those older than 50 years.

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