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      Effects of muscle fatigue on exercise-induced hamstring muscle damage: a three-armed randomized controlled trial

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          Abstract

          Purpose

          Hamstring injuries in soccer reportedly increase towards the end of the matches’ halves as well as with increased match frequency in combination with short rest periods, possibly due to acute or residual fatigue. Therefore, this study aimed to investigate the effects of acute and residual muscle fatigue on exercise-induced hamstring muscle damage.

          Methods

          A three-armed randomized-controlled trial, including 24 resistance-trained males, was performed allocating subjects to either a training group with acute muscle fatigue + eccentric exercise (AF/ECC); residual muscle fatigue + eccentric exercise (RF/ECC) or a control group with only eccentric exercise (ECC). Muscle stiffness, thickness, contractility, peak torque, range of motion, pain perception, and creatine kinase were assessed as muscle damage markers pre, post, 1 h post, and on the consecutive three days.

          Results

          Significant group × time interactions were revealed for muscle thickness ( p = 0.02) and muscle contractility parameters radial displacement (D m) and contraction velocity (V c) (both p = 0.01), with larger changes in the ECC group (partial η 2 = 0.4). Peak torque dropped by an average of 22% in all groups; stiffness only changed in the RF/ECC group ( p = 0.04). Muscle work during the damage protocol was lower for AF/ECC than for ECC and RF/ECC ( p = 0.005).

          Conclusion

          Hamstring muscle damage was comparable between the three groups. However, the AF/ECC group resulted in the same amount of muscle damage while accumulating significantly less muscle work during the protocol of the damage exercise.

          Trial registration

          This study was preregistered in the international trial registration platform (WHO; registration number: DRKS00025243).

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00421-023-05234-z.

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          Most cited references52

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          Exercise-Induced Muscle Damage in Humans

          Exercise-induced muscle injury in humans frequently occurs after unaccustomed exercise, particularly if the exercise involves a large amount of eccentric (muscle lengthening) contractions. Direct measures of exercise-induced muscle damage include cellular and subcellular disturbances, particularly Z-line streaming. Several indirectly assessed markers of muscle damage after exercise include increases in T2 signal intensity via magnetic resonance imaging techniques, prolonged decreases in force production measured during both voluntary and electrically stimulated contractions (particularly at low stimulation frequencies), increases in inflammatory markers both within the injured muscle and in the blood, increased appearance of muscle proteins in the blood, and muscular soreness. Although the exact mechanisms to explain these changes have not been delineated, the initial injury is ascribed to mechanical disruption of the fiber, and subsequent damage is linked to inflammatory processes and to changes in excitation-contraction coupling within the muscle. Performance of one bout of eccentric exercise induces an adaptation such that the muscle is less vulnerable to a subsequent bout of eccentric exercise. Although several theories have been proposed to explain this "repeated bout effect," including altered motor unit recruitment, an increase in sarcomeres in series, a blunted inflammatory response, and a reduction in stress-susceptible fibers, there is no general agreement as to its cause. In addition, there is controversy concerning the presence of sex differences in the response of muscle to damage-inducing exercise. In contrast to the animal literature, which clearly shows that females experience less damage than males, research using human studies suggests that there is either no difference between men and women or that women are more prone to exercise-induced muscle damage than are men.
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            Skeletal muscle fatigue: cellular mechanisms.

            Repeated, intense use of muscles leads to a decline in performance known as muscle fatigue. Many muscle properties change during fatigue including the action potential, extracellular and intracellular ions, and many intracellular metabolites. A range of mechanisms have been identified that contribute to the decline of performance. The traditional explanation, accumulation of intracellular lactate and hydrogen ions causing impaired function of the contractile proteins, is probably of limited importance in mammals. Alternative explanations that will be considered are the effects of ionic changes on the action potential, failure of SR Ca2+ release by various mechanisms, and the effects of reactive oxygen species. Many different activities lead to fatigue, and an important challenge is to identify the various mechanisms that contribute under different circumstances. Most of the mechanistic studies of fatigue are on isolated animal tissues, and another major challenge is to use the knowledge generated in these studies to identify the mechanisms of fatigue in intact animals and particularly in human diseases.
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              Epidemiology of muscle injuries in professional football (soccer).

              Muscle injuries constitute a large percentage of all injuries in football. To investigate the incidence and nature of muscle injuries in male professional footballers. Cohort study; Level of evidence, 2. Fifty-one football teams, comprising 2299 players, were followed prospectively during the years 2001 to 2009. Team medical staff recorded individual player exposure and time-loss injuries. The first-team squads of 24 clubs selected by the Union of European Football Associations as belonging to the best European teams, 15 teams of the Swedish First League, and another 15 European teams playing their home matches on artificial turf pitches were included. A muscle injury was defined as "a traumatic distraction or overuse injury to the muscle leading to a player being unable to fully participate in training or match play." In total, 2908 muscle injuries were registered. On average, a player sustained 0.6 muscle injuries per season. A squad of 25 players can thus expect about 15 muscle injuries per season. Muscle injuries constituted 31% of all injuries and caused 27% of the total injury absence. Ninety-two percent of all muscle injuries affected the 4 major muscle groups of the lower limbs: hamstrings (37%), adductors (23%), quadriceps (19%), and calf muscles (13%). Sixteen percent of the muscle injuries were reinjuries. These reinjuries caused significantly longer absences than did index injuries. The incidence of muscle injury increased with age. When separated into different muscle groups, however, an increased incidence with age was found only for calf muscle injuries and not for hamstring, quadriceps, or hip/groin strains. Muscle injuries are a substantial problem for players and their clubs. They constitute almost one third of all time-loss injuries in men's professional football, and 92% of all injuries affect the 4 big muscle groups in the lower limbs.
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                Author and article information

                Contributors
                schwiete@sport.uni-frankfurt.de
                Journal
                Eur J Appl Physiol
                Eur J Appl Physiol
                European Journal of Applied Physiology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1439-6319
                1439-6327
                18 June 2023
                18 June 2023
                2023
                : 123
                : 11
                : 2545-2561
                Affiliations
                [1 ]Department of Sports Sciences, Goethe University Frankfurt, ( https://ror.org/04cvxnb49) Frankfurt am Main, Germany
                [2 ]Department of Exercise Science, Olympic Training and Testing Center of Hessen, Frankfurt am Main, Germany
                [3 ]Department of Science, Performance and Fitness, FC Bayern München AG, Munich, Germany
                [4 ]Department of Performance, Neuroscience, Therapy, and Health, Medical School Hamburg, ( https://ror.org/006thab72) Hamburg, Germany
                Author notes

                Communicated by William J. Kraemer.

                Author information
                http://orcid.org/0000-0002-9373-2571
                Article
                5234
                10.1007/s00421-023-05234-z
                10616225
                37330434
                d7f47289-07b2-4f7e-8241-511ab141e2b8
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 4 November 2022
                : 21 May 2023
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2023

                Anatomy & Physiology
                muscle damage,muscle fatigue,hamstring injuries,damage markers
                Anatomy & Physiology
                muscle damage, muscle fatigue, hamstring injuries, damage markers

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