Dr Ashley Jones

It is widely accepted that participating in physical activity (PA) is beneficial for individuals with an amputation (Donachy et al. 2004 Disability & Rehabilitation 2004, 26(8), 495-499), with reported benefits to include improved cardiovascular function, balance, self-esteem and quality of life (Bragaru et al. 2011, Sports Medicine, 41(9), 721-740). Despite these benefits, studies have shown low levels of participation in PA by lower limb amputees (LLA), with limited research existing exploring the reasons for this (Couture et al. 2010, Disability & Rehabilitation, 32(1), 57-64). The aim of this study was to explore the perceived facilitators and barriers to participating in PA for individuals with LLA, with the thought of understating what influences the type and amount of activities LLA’s enjoy today. Following university ethical approval, 8 participants who responded to an advertisement were interviewed using semi-structured telephone interviews. All interviews were transcribed and analysed by thematic analysis and fifteen themes emerged: body health and fitness, goal achievement, intrinsic motivation, change, wellbeing, enjoyment, mind and body, social support, social influences, vocation, facilities and cost, extrinsic motivators, prosthetic and participation costs, lack of physical activity encouragement and basic rehabilitation period. Cycling was 88% of participants preferred form of activity, and the perceived amount of PA compared to pre-amputation was largely the ‘Same’ or ‘less’. In summary, the facilitators and barriers to PA for LLA are multifactorial, consisting of physical, psychological, social and environmental factors. Findings suggest a potential review of the LLA physiotherapy rehabilitation experience with an emphasis to be put upon increasing PA participation for all stages, taking an individualised approach to encourage involvement.

It is widely accepted that participating in physical activity (PA) is beneficial for individuals with an amputation (Donachy et al. 2004 Disability & Rehabilitation 2004, 26(8), 495-499), with reported benefits to include improved cardiovascular function, balance, self-esteem and quality of life (Bragaru et al. 2011, Sports Medicine, 41(9), 721-740). Despite these benefits, studies have shown low levels of participation in PA by lower limb amputees (LLA), with limited research existing exploring the reasons for this (Couture et al. 2010, Disability & Rehabilitation, 32(1), 57-64). The aim of this study was to explore the perceived facilitators and barriers to participating in PA for individuals with LLA, with the thought of understating what influences the type and amount of activities LLA’s enjoy today. Following university ethical approval, 8 participants who responded to an advertisement were interviewed using semi-structured telephone interviews. All interviews were transcribed and analysed by thematic analysis and fifteen themes emerged: body health and fitness, goal achievement, intrinsic motivation, change, wellbeing, enjoyment, mind and body, social support, social influences, vocation, facilities and cost, extrinsic motivators, prosthetic and participation costs, lack of physical activity encouragement and basic rehabilitation period. Cycling was 88% of participants preferred form of activity, and the perceived amount of PA compared to pre-amputation was largely the ‘Same’ or ‘less’. In summary, the facilitators and barriers to PA for LLA are multifactorial, consisting of physical, psychological, social and environmental factors. Findings suggest a potential review of the LLA physiotherapy rehabilitation experience with an emphasis to be put upon increasing PA participation for all stages, taking an individualised approach to encourage involvement.

This case study presents the insights gained from the presentation and treatment of a longitudinal sprain of the medial collateral ligament (MCL) of the knee in a professional footballer. MCL sprains are usually transverse and longitudinal sprains present with subtle differences. This article describes the differences in the common signs and symptoms and clinical testing to allow readers to make a differential diagnosis in their own practice.

Background Fixed-frame dynamometry systems are used worldwide to assess isometric strength in both general and athletic populations. There is currently a paucity of published work where reliability estimates for fixed-frame dynamometry systems have been estimated. The aim of this study was to determine the inter-and intra-rater reliability of the KangaTech (KT360) fixed frame dynamometry system when measuring maximal isometric strength of the knee flexor muscles. Study Design Inter and intra-rater reliability single cohort study. Methods Twenty healthy university-level athletes (age= 21.65 ± 3 years, weight= 74.465 ± 30kg, height= 170.1 ± 7.0cm) took part in two testing sessions where two raters collected data during a 90° hip and knee flexion protocol. Participants performed each test twice, building to a maximal isometric contraction holding over a 5 second period with 30 second rest between sets. Data were checked for normality using a Shapiro-Wilk test. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Finally, a Bland-Altman analysis was used to determine the levels of agreement for intra-and inter-rater measurements. Results High levels of agreement were demonstrated between left and right knee flexion as 95% of the differences were less than two standard deviations away from the mean. ‘Almost perfect’ intraclass correlation coefficient (ICC) values were demonstrated (Knee flexion: Inter-rater: Left, 0.99; Right, 0.99; Intra-rater: Left, 0.99; Right:0.99). Standard error of measurement (SEM) for inter-and intra-rater strength ranged from 0.26-0.69 kg, SEM% ranged from 1.34-2.71% and minimal detectable change (MDC) ranged from 1.14-2.31kg. Conclusion Overall, high level of inter-and intra-rater reliability were demonstrated when testing maximal isometric knee flexion. Therefore, the KT360 fixed frame dynamometry system may be considered a viable tool for measuring maximal isometric contraction of the knee flexors when repeat measures are required in clinical settings. Level of Evidence 3b

Purpose Underwater Hockey (UWH) is an upcoming sport involving limited contact between players. To date there are no published estimates of injuries in UWH. The aim of this study was to provide estimate on overall injury incidence and injury period prevalence in a sample of UWH players. Methods A cross-sectional study design with a convenience sample of UWH players recorded injuries sustained over the previous 12-month period. A total of 441 UWH players completed the study online questionnaire. Descriptive statistics with confidence intervals, alongside a one variable Chi squared test (χ2) or independent sample t-test. Results The overall injury incidence was 2.33/1000 h. Wrist, hand, and finger injuries combined (31.8%) were the most frequently injured regions followed by isolated shoulder injuries (16.8%). Contact with another player was the most frequent injury mechanism (43.5%) attributed, whilst the most common injury duration was between 8 and 28 days (35.9%). Conclusion This is the first study to report injury data in a sample of UWH players. Incidence rates were similar to other water-based sports such as endurance swimming. The high prevalence of wrist, hand and finger and shoulder injuries suggest that future injury prevention programmes should look to include upper limb-focussed risk reduction strategies.

Sport and football encourage a commitment to the athletic role and masculine socialization. When athletes get injured the ability to fulfil an athletic and masculine identity is threatened and they may experience injury-related fear-avoidance behaviours as part of a negative injury appraisal. The aim of the study was to explore whether higher athletic identity was associated with higher gender role conflict and injury fear-avoidance. Seventy-two professional English footballers completed an Athletic Identity Measurement Scale (AIMS), Gender Role Conflict Scale (GRCS), and Athlete Fear Avoidance Questionnaire (AFAQ) based on historical injuries. Correlational analyses were conducted for all variables and a one-way ANOVA was used to compare high, moderate, and low athletic identity. Results showed that AIMS was positive correlated with two GRCS subscales (success, power, and competition, and restricted affectionate behaviour between men). Additionally, the current study showed that high and moderate levels of athletic identity had significantly higher levels of total GRCS than those with low athletic identity. No significant results were found for AIMS and AFAQ. Results suggest that academy footballers with higher athletic identities may be more susceptible to masculine role conflicts, specifically, success, power, and competition, and restrictive affectionate behaviour between men. The current study informs sport and health professionals of the need to monitor athletic identity and masculine conformity in their academy level footballers to minimise gender-role conflict and potential maladaptive rehabilitation responses when their identities are threatened.

Background and Purpose Tensiomyography (TMG) is reported to measure muscle contractile properties of superficial skeletal muscle. Between day reliability has not been reported for all of the major lower limb muscles in a mixed gender sample of healthy adults. Therefore, the aim of this study was to examine the between-day reliability of muscle contractile properties associated with involuntary contractions of the rectus femoris (RF) and bicep femoris (BF), as measured by TMG. Study Design Within-subject repeated measures study (3 consecutive days) Methods Twenty-four healthy participants (twelve male; twelve females) were recruited to take part in the study over 3 consecutive days. Measurements of muscle contractile properties were obtained on the bicep femoris (BF) and rectus femoris (RF) muscles in the dominant limb. All data were checked for normality using the Shapiro-Wilk test. Pooled intra-class correlation coefficient (ICC), coefficient of variance (CV) and standard error of measurement (SEM) values were generated for the BF and RF for delay time (Td), sustain time (Ts), relaxation time (Tr), contraction time (Tc) maximal displacement (Dm). Additionally, a Bland-Altman analysis was performed for paired data points (day 1 vs 2, 2 vs 3 and 3 vs 1). Identical analyses were then performed on gender sub-groups. Results Good to excellent ICC values (0.68-0.93) were reported for delay time (Td), contraction time (Tc), and maximal displacement (Dm) in BF and RF muscles. Conversely, relaxation time (Tr) and sustain time (Ts) reported low ICC values (-0.10-0.56). Levels of agreement were not significantly different in most pairs of data points across the whole sample and also across males and females (p=>0.05). However, significant differences were detected in the whole sample: day 3 vs day 1 in the Td (p=0.03) and Dm RF (p=0.009); males: BF Td day 1 vs 2 (p=0.04); females: BF day 2 vs 2 (p=0.01), RF Td day 1 vs 2 (p=0.03), RF Ts day 3 vs 1 (p=0.04). Conclusion The Td, Tc, and Dm variables obtained during TMG measurements demonstrate acceptable reliability across 3 consecutive days. The Tr and Ts variables cannot be measured reliably between days using TMG.

Background: Sport, and specifically football, can foster increased masculine and athletic identities, which could potentially influence athletes’ injury and rehabilitation-related attitudes. Objective: To examine the relationships between masculinity, athletic identity, and athlete fear avoidance attitudes. Design: An observational, cross-sectional, study design was used. Correlational analyses examined the relationships between identity and fear avoidance variables. Setting: Male English professional football. Patients (or Participants): 72 academy players from northern professional football clubs within ~1hour of the University completed a battery of identity and fear avoidance questionnaires. Interventions (or Assessment of Risk Factors): All players completed a gender role conflict scale (GCRS), athletic identity measurement scale (AIMS), and an athlete fear avoidance questionnaire (AFAQ) during either a lab visit or as part of their training sessions. Main Outcome Measurements: Masculine role-related attitudes and conflicts were measured by the GRCS. Athletic identity was measured via the AIMS and the athlete’s injury-related fear avoidance was record via the AFAQ. Results: Age was negatively correlated with total GRCS (r = .24, p=.04), expressing emotion and affection with other men (r=-.28, p=.02), and work, life, & family interferences (r=-.24, p=.04). Athletic identity was associated with an increased fear of others’ perceptions about an athlete’s ability post-injury (r=.31, p=0.007) and higher male affection concerns (r=.28, p=.03) and drives for male success, power, and competition (r=.25, p=.03). Conclusions: Younger footballers and those with higher athletic identities may be more susceptible to masculine role conflicts. Strongly identifying as an athlete and perceiving more work, life, and family conflicts can influence a fear of others' perceptions about the athlete’s sporting abilities post-injury. Therapists may consider monitoring younger athletes’ masculine and athletic identities. Identifying the potential gender-related conflicts or high levels of athletic identity could inform practitioners' approaches to rehabilitation to minimise a potential lack of disclosure or engagement regarding injury and rehabilitation respectively.

Background and aim: American Football is a developing sport in the United Kingdom. Establishing injury rates is the first part of any injury prevention strategy. To date, medically reported injury rates amongst British American Football (AF) university athletes are limited. Therefore, this study aimed to estimate the prevalence, severity, mechanism and period of game related injury in a British university AF team over one season. Methods: Twenty-four male university AF players were observed. The consensus statement on injury definitions in rugby union (2007) and the Community Rugby Injury Surveillance and Prevention (CRISP) programme were followed. Several injury factors were measured (e.g., injury site, type, severity, mechanism etc.). One variable chi squared tests (x2) calculated if expected values were significantly different from observed values. Results: Thirty-two injuries were sustained across the 9-game season, a clinical incidence of 0.75. Contact injures accounted for 68.8% of all injuries. Common sites of injury were the knee (21.9%) and shoulder (15.6%), whilst ligament (25%), muscle (21.9%) and haematoma (21.9%) injuries were most frequent types. Forty percent (12/32) of injuries had moderate severity. Conclusion: This is the first prospective medically reported cohort study to estimate the prevalence, severity, mechanism and period of injury in a single British university AF team. Findings are comparable to studies from the United States, with injures due to contact being the most frequent. However further research is needed to determine whether these findings are representative of wider British university leagues. Practical Implications: The data generated from this study allows the multidisciplinary sports science team to focus injury risk reduction strategies by region and injury type.

Purpose The aim of the study was to investigate the incidence, nature and burden of injury in a cohort of male ice hockey players competing in the National Ice Hockey League (NIHL) over two seasons. Methods A prospective single‐site cohort study was conducted on 50 players (age: 22.3 ± 3.7) competing over the 2022–2023 and 2023–2024 seasons. All injuries (medical attention and time loss) and illnesses were recorded. Match and training exposure were also recorded. Injury incidence was expressed as injuries per 1000 h of exposure while burden was the number of time loss days per 1000 h of exposure. Prevalence was reported as percentages for: body area, injury type, diagnosis, mechanism, mode of onset and injury episode. One‐variable chi‐squared tests were used to determine if observed values were as expected for each prevalence subcategory. Results One hundred and eighty‐two injuries were recorded, of which 26 injuries (26/182) led to time‐loss. Seven illnesses were reported. The injury incidence rate for all injuries was 54.18 (95% confidence interval [CI]: 7.87–62.0)/1000 h, while the time‐loss was 7.74 (95% CI: 2.97–10.71)/1000 h. More injuries were recorded during matches than in training (35.63 [95% CI: 13.81–48.34]/1000 h vs. 0.75 [95% CI: –1.04 to 1.79]/1000 h). Injuries to the head occurred most often (17.6%), although the shoulder was the most burdensome (16.3 severity score). Bone contusions were the most frequent diagnosis (19.8%), although the most days were lost per injury were following muscle contusion injuries (18.3 severity score). Most injuries occurred from (direct and indirect) contact (70.8%) mechanisms, were acute in nature (77.5%) and were classed as first occurrences (86.8%). Conclusion The overall incidence of injury was 54.18/1000 h, yet time‐loss injury incidence was much lower at 7.74/1000 h. The most injured body area was the head, and the most injured tissue type was muscle and tendon. Bone contusions were the most common pathology recorded. Level of Evidence Level II.

BACKGROUND: The systematic effect of inter-electrode distance on electrically elicited radial muscle displacement (Dm) and contraction time (T c) of the biceps femoris, gastrocnemius medialis and biceps brachii using tensiomyography (TMG) is currently unavailable. OBJECTIVE: To investigate the effects of inter-electrode distance (4 cm, 5 cm, 6 cm and 7 cm) on Dm and T c of the biceps femoris, gastrocnemius medialis and biceps brachii, when the current amplitude is standardised. APPROACH: A within subject, repeated measures cross-over study. PARTICIPANTS: 24 participants. MAIN RESULTS: Biceps femoris and gastrocnemius medialis Dm increased with increased inter-electrode distance (biceps femoris: p   =  0.015; gastrocnemius medialis: p   =  0.000), yet T c were not affected (p   >  0.05). Biceps brachii Dm was not affected by inter-electrode distance (p   >  0.05), yet T c became shorter with increased inter-electrode distance (p   =  0.032). SIGNIFICANCE: Inter-electrode distance affects Dm but not T c in two pennate muscles (biceps femoris and gastrocnemius medialis), and T c but not Dm in one parallel muscle (biceps brachii). Based on Dm measurements, optimal muscle specific inter-electrode distances were judged within the limits of this study. The following optimal inter-electrode distances are suggested: biceps femoris  =  6 cm, gastrocnemius medialis  =  7 cm and biceps brachii  =  4 cm. Our findings emphasise the importance of accurate implementation and reporting of inter-electrode distance, for the reproducibility and comparability of studies using TMG.

Objectives Football has the highest sports participation (10.6%) in Ireland ahead of its Gaelic counterpart (3.9%). Research into injury incidence and patterns in Irish football is non-existent. The aim of this study was to conduct a prospective injury audit of league of Ireland (semi-professional) footballers during the 2014 season (8 months; 28 games). Methods A total of 140 semi-professional league of Ireland footballers were prospectively followed between March and November 2014. Data was collected in accordance with the international consensus on football injury epidemiology. Results The injury rate was 9.2/1000 h exposure to football (95% CI 6.2 to 12.9, P<0.05). Players were at a higher risk of injury during a match compared with training (23.1 (95% CI 15.2 to 31.3) vs. 4.8 (95% CI 2.2 to 7.7)/1000 h, P<0.05). Injuries were most common during non-contact activity (54.6%), mainly running (30.9%) and occurred almost 3 times more often in the second half (56% vs. 21%, P<05). Strains (50.1%) and sprains (20.3%) were the most common injury type and the thigh region was injured most often (28.3%). Conclusions The prevalence of injury in league of Ireland football is similar to that of European professional football although the incidence of injury is higher. The incidence of injury is in line with that of Dutch amateur football.

The authors regret to inform that during recent additional analysis of the data included in this manuscript, a slight error in the reported exposure hours was detected. Whilst this does not change the overall conclusions and clinical implications of the study, the error does change the overall, match and training injury incidence figures reported in the study. The amended figures for exposure, overall injury incidence, match injury incidence and training injury incidence can be found below. In total, 52180 hours of exposure (42498 of training and 9682 of match play) were recorded across the season. The total incidence of injury was 9.06 injuries/1000h of exposure (95% CI [4.69 to 17.24]). Participants sustained a higher incidence of injury in match play (25.30 injuries/1000h, 95% CI [17.22 to 37.17]) than during training related activities (5.36 injuries/1000h, 95% CI [2.30 to 12.46]) with a mean difference of 19.44 injuries/1000h (95% CI [12.51 to 30.19]). The authors would like to apologise for any inconvenience caused.

Intra-articular and degenerative hip pathologies have become common place with the number of total hip replacements rising year on year in the United Kingdom (UK). Pathology is identified by clinicians using special tests which are researched maneuvers used by clinicians to rule in or rule out specific musculoskeletal pathologies. Special tests used for hip pathology usually have high specificity to exclude degenerative and intraarticular pathology but vary in sensitivity. These special tests are usually only conducted when a person is symptomatic and typically require radiological confirmation to diagnose. The aim of this review was to appraise research to determine whether functional changes in the TFL and UGM muscle complex could indicate degenerative and/or intra articular pathology, with a specific focus on the utility of the ratio in strength of TFL and UGM to assist clinical diagnosis. The hypothesis was that the ratio of the strength of Tensor Fascia Latae (TFL) and the upper fibres of Gluteus Maximus (UGM) could suggest early intra-articular hip pathology, and that changes to this ratio could indicate deterioration of the hip joint before symptoms present/progress. Level of Evidence 5

Poster presentation at the WiSEAN conference 2025.

Background and Aim Britain has competed in Freestyle Wrestling since it first featured in the Olympic Games in 1904 and the Commonwealth Games in 1930. Despite Britain’s long history with the sport, there are currently no studies that have aimed to quantify injury incidence and prevalence. Therefore, the aim of this study was to estimate the injury incidence and prevalence in a sample of wrestlers based in Britain. Methods A self-reported, cross-sectional study design was used. All participants were registered British Wrestling Association Club members and had at least 12 months of prior wrestling experience. Data was collected via a questionnaire offered to participants in both online and paper format at the English Wrestling Championships 2022 and via coaches from each British wrestling club. Injury incidence was calculated by estimating injuries /1000 athletic exposures (AE). Injury site, type, mechanism and severity were measured. One variable chi-square tests (X2) were used to calculate if observed values were significantly different from expected values. Results One hundred and forty-six (n=146) wrestlers (30.1 ± 8.6 years, 85.4 ± 15.6 kg, 176.6 ±10.37cm) completed the injury survey. Over 12 months, the participants sustained one hundred and ninety-five (n= 195) injuries, equating to an average of 1.3 ± 1.2 per participant. The overall incidence rate was 3.40/1000 AE (95% CI 3.16 to 3.6). The competition injury incidence of 42.01/1000 AE (95% CI 26.97 to 57.05) and 2.92/1000 AE (95% CI 2.69 to 3.14) for wrestling training activities. The knee was the most common injury site, accounting for 26.1% of all injuries, whilst strains or sprains occurred most often (36.3%). Takedowns were the leading mechanism of injury (36.4%), and most injuries were categorised as slight (28.7%). Conclusions This is the first study to estimate the prevalence, severity, and mechanism of injury in Wrestlers based in Britain. Data is comparable to previous studies in American high school and college wrestlers. Future studies should consider a medically reported method to confirm these results further. Practical Implications The reported data from this study allows for the development of injury risk reduction strategies by region and injury type.

Purpose Primary aims of the study were to (i) assess the current equipment usage amongst American football (AF) players in the UK, (ii) evaluate the knowledge, adherence and practise to correct helmet fit guidelines, and (iii) explore AF player attitudes towards the use of protective safety equipment for injury prevention. Methods Cross-sectional study design. One hundred and sixty-eight British AF athletes participated in the online survey. Data were collected on current equipment usage, including practise related to reconditioning of equipment. Questions to assess knowledge, behaviour and perception of importance were designed using the 13-criteria checklist used for helmet fit assessment. Questions related to safety of helmet use and attitude towards equipment were asked on a 5-point scale. Results Knowledge of safe helmet fit was generally good. The most common knowledge question correctly identified by all participants was ‘The helmet should fit the head snugly on all sides’; however, attitude to use of equipment and long-term health was not reflective of this knowledge. Nineteen percent of athletes reported that wearing equipment allowed them to play, whilst injured and 31% of players felt fearless when wearing full AF equipment. Conclusion Despite good knowledge related to helmet safety, attitude to equipment and long-term health was poor. Research shows that the wearing of and choice of equipment is of upmost importance; however, our findings suggest that players attitude to its use could impact its effectiveness. The authors recommend that the national governing body seeks to educate players on equipment use and conditioning to ensure safe play.

A male runner (30 years old; 10-km time: 33 min, 46 sec) had been running with suspected insertional Achilles tendinopathy (AT) for ~2 years when the pain reached a threshold that prevented running. Diagnostic ultrasound (US), prior to a high-volume stripping injection, confirmed right-sided medial insertional AT. The athlete failed to respond to injection therapy and ceased running for a period of 5 weeks. At the beginning of this period, the runner completed the Victoria institute of sports assessment-Achilles questionnaire (VISA-A), the foot and ankle disability index (FADI), and FADI sport prior to undergoing an assessment of bi-lateral gastrocnemius medialis (GM) muscle architecture (muscle thickness (MT) and pennation angle (PA); US), muscle contractile properties (maximal muscle displacement (Dm) and contraction time (Tc); Tensiomyography (TMG)) and calf endurance (40 raises/min). VISA-A and FADI scores were 59%/100% and 102/136 respectively. Compared to the left leg, the right GM had a lower MT (1.60 cm vs. 1.74 cm), a similar PA (22.0° vs. 21.0°), a lower Dm (1.2 mm vs. 2.0 mm) and Tc (16.5 ms vs. 17.7 ms). Calf endurance was higher in the right leg compared to the left (48 vs. 43 raises). The athlete began a metronome-guided (15 BPM), 12-week progressive eccentric training protocol using a weighted vest (1.5 kg increments per week), while receiving six sessions of shockwave therapy concurrently (within 5 weeks). On returning to running, the athlete kept daily pain (Numeric Rating Scale; NRS) and running scores (miles*rate of perceived exertion (RPE)). Foot and ankle function improved according to scores recorded on the VISA-A (59% vs. 97%) and FADI (102 vs. 127/136). Improvements in MT (1.60 cm vs. 1.76 cm) and PA (22.0° vs. 24.8°) were recorded via US. Improvements in Dm (1.15 mm vs. 1.69 mm) and Tc (16.5 ms vs. 15.4 ms) were recorded via TMG. Calf endurance was lower in both legs and the asymmetry between legs remained (L: 31, R: 34). Pain intensity (mean weekly NRS scores) decreased between week 1 and week 12 (6.6 vs. 2.9), while running scores increased (20 vs. 38) during the same period. The program was maintained up to week 16 at which point mean weekly NRS was 2.2 and running score was 47.

Tensiomyography is used to measure skeletal muscle contractile properties, most notably muscle displacement (Dm) and contraction time (Tc). Professional football medical departments are currently using the equipment to profile the muscle function of their squad and subsequently evaluate change due to injury or intervention. However, at present there are no published standardised operating procedures for identifying probe position for muscle assessment. In this technical report we propose standardised operating procedures for the identification of precise probe position as part of an on-going study in male professional footballers.

The purpose of this dissertation was to explore the relevance of dysfunctional breathing (DB) in musculoskeletal (MSK) practice. As exposure to breathing practices become increasingly more prevalent across healthcare professionals and the public, and progressively more treatment modalities related to breathing mechanics are emerging, it is important to explore whether breathing mechanics are a relevant consideration within MSK practice. Initially, a critical review was conducted to explore the term ‘dysfunctional breathing’, its definition and the current evidence around DB in MSK health. One suggested formal definition of DB was identified, by Barker and Everard (2015), but there remains no consensus on what DB is within the reviewed literature. One model of DB was also identified (Barker and Everard, 2015), but it needs further modification and adaptation to meet the requirements of the most recent research published on DB. In addition, a literature review of the potential effects that DB can have on the MSK system was conducted. Anatomical, biomechanical, physiological and neurological effects of DB on the MSK system were identified, some grounded in research and others more narrative in nature and needing further exploration. Finally, an explorative focus group interview and one individual interview were conducted to acquire the beliefs and opinions of current MSK practitioners on the relevance of DB, their assessment methods, interventions and their beliefs on what effects DB can have on the MSK system. Thematic analysis was used to develop themes and classifications. This study revealed that DB assessment methods can be classified into three categories: observational assessment, manual assessment, and subjective assessment. Three types of breathing intervention were identified: breathing re-education, breathing exercises, and manual therapy. In total, fourteen potential effects of DB on the MSK system were identified by the participants. Unlike previous research exploring DB this dissertation has only focused on the implications within MSK health as opposed to exploring DB within respiratory and cardiovascular medicine. It adds to the debate of the need for a formal definition of DB and has identified areas for further research that are needed around the perceived effects of DB on the MSK system. In the absence of an overarching and accurate definition a new model of DB has been produced as a result of this dissertation to provide a suggested framework of what DB could potentially look like, when divided into three subcategories. These subcategories are biomechanical DB, biochemical DB and psychophysiological DB It is proposed by this author that the work produced in this study enables a future consensus to be reached on the formal definition, model and signs and symptoms of DB.

Musculoskeletal injuries are common in both general and sporting populations and contribute to significant healthcare costs, lost workdays and compromised performance of daily activity and sport. Despite various rehabilitation models being available to health and rehabilitation practitioners, there are some inconsistencies in structure, terminology and specificity across these. The current narrative review critically evaluates existing rehabilitation models, frameworks and phased approaches, identifying limitations related to structure, content and specificity. Additionally, a novel multicomponent exercise rehabilitation model is proposed which adopts a non-linear, concurrent approach to attribute development and integration of progression guidance. Using a multicomponent approach, a structured yet adaptable progression framework is provided that could help optimize rehabilitation outcomes, minimize detraining and enhance individuals’ readiness for return to sport or daily activity.

Background There is a lack of of cross-sectional research that has investigated muscle morphology, function, and functional capability in all age-bands of healthy adults. The primary aim of this study was to evaluate age-related differences in indices of vastus lateralis (VL) muscle morphology, function and functional capability in a sample of healthy males and females aged 18-70yrs. Secondary aims were to evaluate relationships between age and VL muscle morphology and function and functional capability. Methods B mode Ultrasonography and Tensiomyography were used to measure VL muscle thickness, pennation angle, fascicle length, and contractile properties in 274 healthy adults aged 18-70yrs. Measurements of grip strength and functional capability (1-min chair rise test) were also taken. Data analysis included descriptive statistics, correlations, one-way ANOVAs, and multiple regressions. Results Negative correlations were found between age and muscle thickness (rs = -.56), pennation angle (rs = -.50), fascicle length (rs = -.30), maximal displacement (rs = -.24), grip strength (rs = -.27) and the 1-min chair rise test (rs = -.32). Positive correlations were observed between age and the echo intensity of the muscle (rs = .40) and total contraction time (rs = .20). Differences in the indices of muscle health were noticeable between the 18–29 age band and the 50–59 and 60–70 age bands (p < 0.05). The interaction of age and level of physical activity predicted changes in the variables (r2 = .04—.32). Conclusion Age-related differences in muscle health are noticeable at 50 years of age, and age-related differences are larger in females compared to males. It was suggested that the thickness of the VL changed the most with age across the adult lifespan and that physical activity likely acts to abate detrimental change.

Dysfunctional breathing (DB) refers to various abnormalities breathing patterns. Whilst a formal definition exists, subsequent research has inconsistently applied or omitted it. As interest in breathing techniques grows among both healthcare professionals and the public, it is important to reach a consensus on DB's definition to ensure effective assessment and treatment. This critical review explores how DB is currently defined and applied within respiratory and musculoskeletal health. A lack of consistency in the literature identified the need for a more comprehensive framework of DB. To address this, a new model of DB is proposed that includes three subcategories: biomechanical, biochemical and psychophysiological DB. This revised model offers a foundation for future research and clinical application.

This study aimed to characterise selected lower-limb muscle contractile properties in a sample of male professional soccer players, and to investigate if muscle contractile properties differed according to playing position or limb dominance. One hundred and ninety-three male professional soccer players (mean ± SD: age=21.6yrs±4.4; height=181.1cm±10.0; body mass=77.4kg±8.5) had bilateral measurements of muscle contractile properties taken during the pre-season period (June-July) of the 2016-17, 2017-18 and 2018-19 seasons using Tensiomyography. The following muscles were measured: Adductor Magnus (AM), Bicep Femoris (BF), Gastrocnemius Lateralis (GL), Gastrocnemius Medialis (GM), Gluteus Maximus (GT) and Rectus Femoris (RF). Participants were sub-categorised by playing position and limb dominance. Data were analysed using Kruskal Wallis H tests or Mann-Whitney U tests. The left GM muscle produced the shortest delay time (Td) (19.5 ms ± 1.9) and contraction time (Tc) (21.3 ms±14.3) whilst the right BF had the longest sustain time (Ts) (196.9ms±83.9). Relaxation time (Tr) was shortest in the right GL (39.3ms±22.7) and the right GT the largest maximal displacement (Dm) value (10.2mm±3.6). Small differences were present between the left AM Td in Forwards (p=0.005, η2=0.05) and Midfielders and in the left GM Ts between Forwards and Goalkeepers (p=0.04, η2=0.02). The right RF Tc measurement was lower in the right dominant participants (p=0.04, η2=0.35). No other differences were detected between playing positions or limb dominance (p>0.05). The findings from this study provide a profile of lower limb muscle contractile properties in a sample of male professional soccer players. The lack of consistent differences reported between sub-categories suggest that soccer players are homogeneous, regardless of playing position or limb dominance. The data generated from this study may be used to monitor soccer players following periods of inactivity, fixture congestion, long-term injury or acute changes in professional status.

Objective To estimate the current incidence and location of injury in English professional football. Design Prospective cohort study conducted over one competitive season (2015/16). Setting Professional football players competing in the English Football League and National Conference. Participants 243 players from 10 squads (24.3 ± 4.21 per squad). Main outcome measure Injury incidence, training and match exposure were collected in accordance with the international consensus statement on football injury epidemiology. Results 473 injuries were reported. The estimated incidence of injury was, 9.11 injuries/1000 h of football related activity. There was a higher incidence of injury during match play (24.29/1000 h) compared to training (6.84/1000 h). The thigh was the most common site of injury (31.7%), muscle strains accounted for 41.2% of all injuries. The hamstrings were the most frequently strained muscle group, accounting for 39.5% of all muscle strains and 16.3% of all injuries. Moderate severity injuries (8–28 days) were the most common (44.2%). Conclusions Incidence of injury has increased over the last 16 years with muscle strains remaining the most prevalent injury. The hamstrings remain the most commonly injured muscle group.

Abstract

Abstract

Body composition assessments in professional male football often lack sport-specific evidence, risking mismanagement of player health and performance. This study described dual-energy X-ray absorptiometry (DXA)-derived values by playing position, ethnicity, competition level, and seasonal timepoints. A total of 343 players (mean ± SD: age = 22.6 ± 4.6 years; stature = 182.0 ± 6.9 cm; body mass = 79.1 ± 8.6 kg) from the English Premier League (n = 76) and English Football League (n = 267) completed 939 scans over a 10-year period (2014–2024) using DXA (Lunar iDXA, GE Healthcare), with repeat measurements taken across the season. Players were sub-classified as Goalkeepers (n = 32), Central Defenders (n = 55), Wide Defenders (n = 64), Central Midfielders (n = 73), Wide Midfielders (n = 62), and Forwards (n = 57). Body composition ranges specific to position were identified for bone mass (3.5–4.2 kg), lean mass (61.2–69.6 kg), fat mass (9.1–13.5 kg), and percentage body fat (11.6–15.4%). Significant differences in bone, lean, and fat mass were observed between playing positions, ethnicity, and league level ( p  < 0.050). Across a single season, fat-free mass increased significantly, while fat mass decreased (both: p  < 0.001), indicating positive physiological adaptations from moderate body mass increases rather than performance concerns. These findings indicate that body fat values above the commonly cited < 10% threshold are regularly observed in elite male footballers, suggesting the need for more individualised targets over generic team-wide standards. Providing the largest criterion-measured dataset for professional male footballers, this study supports athlete-centred, position-specific decision-making to optimise player health and performance.

Purpose: To (a) quantify the internal and external training load (TL) demands of professional ballet dancers; (b) explore the influence of session type, and sex on TL. Methods: Twenty-nine professional ballet dancers (men = 14; women = 15) were monitored over two weeks. Internal TL data was measured using heart rate-derived TRIMP, and external TL using PlayerLoad (PL). TL data from 303 sessions were categorised and analysed according to session type (rehearsal, class, and conditioning), and sex. Results: Dancers averaged ~4.62 per day (~ 26.1 hours/week) comprised of daily (PL: 539 AU; HR TRIMP: 314 arbitrary units (AU)) and weekly (PL: 2608 AU; HR TRIMP: 1503 AU) TL. Rehearsals had the longest duration (197 ± 66 min) but lowest load per minute. Conditioning produced the highest PL (140.1 AU, 95% CI: 120.2-160.0), while class elicited the greatest HR TRIMP (89.4 AU, 95% CI: 72.1-106.7). Session type significantly influenced TL (P = 0.004, η2 = 0.68) with small to moderate differences between rehearsal and conditioning (PL ES = 0.38; TRIMP ES = 0.49). No significant differences were observed by sex (PL, P = 0.57; TRIMP, P = 0.18). Conclusions: Conditioning sessions produced the greatest TL response and should play a key role in professional ballet dancer’s schedules. Although TL did not significantly differ by sex, the study suggests that a uniform training model may not meet individual dancer needs. These findings support the implementation of personalised monitoring and periodised scheduling strategies to optimise both artistic and physical performance in professional ballet.