Nicola Maffiuletti

Schulthess Clinic, Zürich · Human Performance Lab

Background Hip and groin problems are common among team-sport athletes. However, few studies have been conducted in female athletes that have used the Doha Agreement classification system to categorize these problems. Purpose The purpose of this study was to examine the preseason point prevalence of hip and groin problems in elite female team-spor...

Wide-pulse high-frequency neuromuscular electrical stimulation (WPHF NMES) can generate a progressive increase in tetanic force through reflexive recruitment of motor units, called extra force. This phenomenon has previously been observed on different muscle groups, but little is known on potential inter-muscle differences. We compared extra force...

Context : The evaluation of quadriceps muscle inhibition with the interpolated twitch technique is usually performed by stimulating the femoral nerve (FN). However, there are some problems related to the use of this stimulation site, which may be partially overcome by delivering the stimulation over the motor point (MP). This study sought to compar...

The purpose of this study was to investigate the impact of actual soccer match-play on muscle strength, physical performance, and perceptual responses in elite female players. Twelve Swiss elite players were tested before (pre), after (post) and 48 hours after a 90-minute soccer match for knee and hip muscle strength, vertical jump height, and spri...

Acoustical knee health assessment has long promised an alternative to clinically available medical imaging tools, but this modality has yet to be adopted in medical practice. The field is currently led by machine learning models processing acoustical features, which have presented promising diagnostic performances. However, these methods overlook t...

Background Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever...

Background Hip and groin (HAG) problems are common among team-sport athletes. However, very few studies have focused in female athletes and used the clinical entity approach to describe the origin of these problems. Objective (1) To examine the preseason prevalence of HAG problems in elite female team-sport athletes. (2) To classify the subjects w...

Background Hip and groin problems are common in soccer. However, most studies have focused on male players and primarily used a time-loss injury definition. Despite the increasing popularity of women’s soccer, data on female players remain limited. Objective To investigate the prevalence, incidence, and potential risk factors of hip and groin prob...

Background This study aimed to determine the effect of different carbohydrate (CHO) doses on exercise capacity in patients with McArdle disease—the paradigm of “exercise intolerance”, characterized by complete muscle glycogen unavailability—and to determine whether higher exogenous glucose levels affect metabolic responses at the McArdle muscle cel...

Independent physiotherapy at home is a crucial element of rehabilitative care for a wide range of conditions as it constitutes a large portion of the overall therapy dose. However, up to 80% of individuals who are prescribed at-home physiotherapy do not consistently adhere to their treatment schedule, resulting in poor treatment outcomes. This is l...

Purpose The effectiveness of a neuromuscular electrical stimulation (NMES) program is proportional to the level of evoked torque, which can be achieved with either conventional or wide‐pulse stimulations. The aim of this study was to compare evoked torque, objective fatigability, and related peripheral and central alterations, as well as changes in...

Objectives: To examine hip muscle strength deficits in patients with femoroacetabular impingent syndrome (FAIS), with special emphasis on potential sex- and comparison-related (between-subject vs within-subject) differences. Design: Cross-sectional comparative study. Participants: Forty FAIS patients (20 women), 40 healthy controls (20 women)...

This historical review summarizes the major advances - particularly from the last 50 years - in transcutaneous motor-level electrical stimulation, which can be used either as a tool to investigate neuromuscular function and its determinants (electrical stimulation for testing; EST) or as a therapeutic/training modality to improve neuromuscular and...

Introduction Neuromuscular electrical stimulation (NMES) is used in athletes to enhance muscle strength (Filipovic et al., 2012) or in patients to restore muscle strength (Nussbaum et al., 2017). The increased maximal voluntary contraction (MVC) torque of one limb (e.g. right leg) while transcutaneous NMES is concomitantly applied to the contralat...

Purpose The effectiveness of a neuromuscular electrical stimulation (NMES) program has been shown to be proportional to the maximal evocable torque (MET), which is potentially influenced by pulse characteristics such as duration and frequency. The aim of this study was to compare MET between conventional and wide-pulse NMES at two different frequen...

Fatty infiltration, the ectopic deposition of adipose tissue within skeletal muscle, is mediated via the adipogenic differentiation of fibro-adipogenic progenitors (FAPs). We used single-nuclei and single-cell RNA sequencing to characterize FAP heterogeneity in patients with fatty infiltration. We identified an MME⁺ FAP subpopulation which, based o...

Background Patients with femoroacetabular impingement syndrome (FAIS) show sex-specific differences in hip muscle function, hip morphology, and symptoms. Possible differences in hip muscle characteristics between men and women with FAIS are unknown. Purpose To compare hip muscle cross-sectional area (CSA) and fatty infiltration between men and wom...

Contralateral facilitation, i.e., the increase in contralateral maximal voluntary strength that is observed when neuromuscular electrical stimulation (NMES) is applied to the ipsilateral homonymous muscle, has previously been reported for the knee extensors but the neurophysiological mechanisms remain to be investigated. The aim of this study was t...

Purposes To evaluate peripheral muscle function of the knee extensors during repeated changes of direction in professional soccer players by examining differences between competitive levels, periods of the season and playing positions, and to investigate the relationships between peripheral muscle function and physical activities during matches. M...

Background Older adults often fail to reach the recommended amount of physical activity to prevent the age-related decline in metabolic, cardiorespiratory, and muscular function. Effective home-based physical training programs could neutralize barriers preventing older adults from being active, and administration/supervision through videoconference...

Submaximal levels of effort are required for the performance of the most common daily tasks. Inaccuracy in modulating motor outputs during submaximal tasks has been reported as indicator of safety during daily activities in subjects with lower limb musculoskeletal disorders. The study is aimed at investigating performance modulation ability during...

Purpose The effectiveness of a neuromuscular electrical stimulation (NMES) program has been shown to be proportional to the maximal evocable torque (MET), which is potentially influenced by pulse characteristics such as duration and frequency. The aim of this study was to compare MET between conventional and wide-pulse NMES at two different frequen...

The main aims of this study were to compare the magnitude of inter-limb asymmetry (ILA) and the relation with self-reported knee function between maximal and explosive knee extensor strength outcomes in professional soccer players. Forty-six male soccer players completed different maximal isokinetic and isometric contractions of the knee extensors...

Fatty infiltration, the ectopic deposition of adipose tissue within skeletal muscle, is mediated via the adipogenic differentiation of fibro-adipogenic progenitors (FAPs). We used single-nuclei and single- cell RNA sequencing to characterize FAP heterogeneity in patients with fatty infiltration. We identified an MME ⁺ FAP subpopulation which, based...

Objectives To investigate the mid-term outcomes of exercise therapy in patients with femoroacetabular impingement syndrome (FAIS). Design Follow-up study. Setting Clinical setting. Participants Twenty-six patients with FAIS who completed a 12-week semi-standardized, progressive exercise therapy program. Main outcome measures At a mid-term follo...

Background: older adults often fail to reach the recommended amount of physical activity to prevent the age-related decline in metabolic, cardiorespiratory and muscular function. Effective home-based physical training programs could neutralise barriers preventing older adults from being active, and administration/supervision through videoconferenc...

We compared the effectiveness of a home-based neuromuscular electrical stimulation (NMES) program applied to the quadriceps of the nonoperative side against sham-NMES as a complement to standard rehabilitation on knee extensor neuromuscular function in patients following anterior cruciate ligament (ACL) reconstruction. Twenty-four patients complete...

Background Lower extremity injury prevention programs are effective in team sport athletes. Objective This study identifies barriers to and facilitators for an injury prevention program in professional male ice hockey teams among players and staff members. Design Cross-sectional survey. Setting Professional male ice hockey teams. Participants E...

Purpose: Neuromuscular electrical stimulation (NMES) is a widely-used technique for diagnostic and therapeutic purposes. Here we developed and tested the reliability of a new NMES-dynamometer system for bedside evaluation of knee extensor muscle function. Materials and methods: Thirty-two healthy participants (16 men, 16 women; 27±5 years) compl...

Deficits in maximal and explosive knee extensor strength, which are usually assessed with unilateral tasks, are substantial in patients with knee osteoarthritis (KOA). The aim of this study was to investigate the clinical relevance of unilateral vs. bilateral tasks for assessing knee extensor strength in patients with KOA. This was achieved primari...

INTRODUCTION: Sex differences in triathlon performance range around 10-20% of the overall time likely due to physiological, morphological, and hormonal factors (1). To date, studies investigating sex differences showed that women (W) present a higher percentage of type I fibers, a better substrate efficiency, lower VO2max values, and a lower O2-c...

Because rate of force development (RFD) is an emerging outcome measure for the assessment of neuromuscular function in unfatigued conditions, and it represents a valid alternative/complement to the classical evaluation of pure maximal strength, this scoping review aimed to map the available evidence regarding RFD as an indicator of neuromuscular fa...

Objective To appraise the highest available evidence provided by randomized controlled trials (RCTs) on the effectiveness of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement syndrome (FAIS). Methods Four databases (Medline, Embase, Web of Science, and Scopus) were systematically searched until October 1, 2019....

Purpose Spaceflight impairs physical capacity. Here we assessed the protective effect of artificial gravity (AG) on aerobic exercise capacity and muscle function during bed rest, a spaceflight analogue. Methods 24 participants (33 ± 9 years, 175 ± 9 cm, 74 ± 10 kg, 8 women) were randomly allocated to one of three groups: continuous AG (cAG), inter...

Neuromuscular electrical stimulation (NMES) applied to skeletal muscles is an effective rehabilitation and exercise training modality. However, the relatively low muscle force and rapid muscle fatigue induced by NMES limits the stimulus provided to the neuromuscular system, and subsequent adaptations. We hypothesise that adaptations to NMES will be...

Low-frequency and high-frequency wide-pulse neuromuscular electrical stimulation (NMES) can generate extra-torque (ET) via afferent pathways. Superimposing tendon vibration (TV) to NMES can increase the activation of these afferent pathways and favour ET generation. Knowledge of the characteristics of ET is essential to implement these stimulation...

Objective To appraise the highest evidence on hip morphology as a risk factor for developing hip osteoarthritis (OA). Design We searched for studies evaluating the association between radiological hip morphology parameters and the prevalence, incidence or progression of hip OA (based on different radiographic and clinical criteria) in the MEDLINE,...

Context: Injury prevention programs for the lower extremities are effective in team-sport athletes. Objective: To identify barriers and facilitators among professional ice hockey players and staff members for adhering to an injury prevention program. Design: Cross-sectional survey. Setting and participants: A questionnaire about barriers and...

Background The aim of this cross-sectional comparative study was to investigate potential differences in soleus H-reflex to M-wave ratio between obese and non-obese individuals under different postural constraints. Methods A total of 23 obese individuals and 23 matched non-obese controls took part in the study. The maximal soleus H-reflex to M-wav...

In March 2020, the COVID-19 pandemic forced most activities in Italy, including soccer, to cease. During lockdown, players could only train at home, with limited evidence regarding the effect of this period. Therefore, this study aimed to investigate the effect of COVID-19 lockdown on professional soccer players’ physical performance. Aerobic fitne...

Purpose Neuromuscular electrical stimulation (NMES) has been considered as a promising approach for the early rehabilitation of patients during and/or after intensive care unit (ICU) stay. The overall objective of this study is to evaluate the NMES effectiveness to counteract the post-ICU impairment in physical function of COVID-19 patients. The sp...

Purpose: To compare the effects of different modalities of morning priming exercise on afternoon physical performance with the associated hormonal and psychophysiological responses in young soccer players. Methods: In a randomized counterbalanced crossover design, 12 young soccer players completed 3 different morning conditions on 3 different da...

Objective To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. Design We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting origi...

We re-examined the relationship between rate of torque development (RTD) and maximal voluntary contractions (MVC) torque, and investigated some possible neuromuscular determinants of early (≤100 ms) and late (≥200 ms) RTD. Seventeen healthy men performed maximal explosive isometric knee extensions at five joint angles, from which MVC torque, RTD at...

INTRODUCTION: NMES-induced isometric contractions may arise from the direct activation of motor axons [i.e. efferent pathway; conventional (CONV) NMES] and/or from the recruitment of motoneurons in the spinal cord through the depolarization of sensory axons (i.e. afferent pathway) [1]. This “extra” contraction, the so-called “extra force (EF)” is f...

Background Isometric strength measures and timed up and go (TUG) tests are both recognized as valuable tools for fall prediction in older adults. However, results from direct comparison of these two tests are lacking. We aimed to assess the potential of isometric strength measures and the different modalities of the TUG test to detect individuals a...

Background Ice hockey injury patterns in Europe were last evaluated in the 1990s. Purpose The aim of this study was to assess the frequency, type, location, and incidence of traumatic injuries, as well as the prevalence and relative effect of overuse injuries in professional male ice hockey players. Study Design Descriptive epidemiology study. M...

Despite growing research in the field of inter-limb asymmetries (ILAs), little is known about the variation of ILAs in different populations of athletes. The purpose of this study was to compare ILAs among young basketball, soccer and tennis players. ILAs were assessed in three different types of tests (strength, jumping and change of direction (Co...

Historical, educational, and technical barriers have been reported to limit the use of surface electromyography (sEMG) in clinical neurorehabilitation settings. In an attempt to identify, review, rank, and interpret potential factors that may play a role in this scenario, we gathered information on (1) current use of sEMG and its clinical potential...

Electrical stimulation is widely used in rehabilitation to prevent muscle weakness and to assist the functional recovery of neural deficits. Its application is however limited by the rapid development of muscle fatigue due to the non-physiological motor unit (MU) recruitment. This issue can be mitigated by interleaving muscle belly (mStim) and nerv...

Coaches and athletes in elite sports are constantly seeking to use innovative and advanced training strategies to efficiently improve strength/power performance in already highly-trained individuals. In this regard, high-intensity conditioning contractions have become a popular means to induce acute improvements primarily in muscle contractile prop...

Objective: To determine the influence of neuromuscular electrical stimulation (NMES) pulse waveform and frequency on evoked torque, stimulation efficiency and discomfort at two NMES levels. Design: Repeated measures study. The quadriceps muscle of 24 healthy men was stimulated at submaximal (NMESsub) and maximal (NMESmax) levels using two pulse...

Purpose The purpose of the present study was to investigate the influence of strength outcome (maximal voluntary contraction (MVC) torque vs. rate of torque development (RTD)), motor task (unilateral vs. bilateral) and muscle group (knee extensors vs. flexors) on the magnitude of bilateral deficits and inter-limb asymmetries in a large heterogeneou...

Background Instrumented treadmills are potentially useful tools for the assessment of gait parameters in orthopaedic clinical settings, but their measurement properties remain uncertain. Research question What is the discriminant validity and reproducibility of spatiotemporal and kinetic gait parameters measured by a pressure-instrumented treadmil...

During COVID-19 home confinement, athletes are likely exposed to some level of detraining (i.e. the partial or complete loss of training-induced morphological and physiological adaptations), as a consequence of insufficient and/or inappropriate training stimuli. Such changes may result in impaired performance and increased injury risk if, upon rest...

Background: Muscle quality (i.e., the expression of muscle function per unit of muscle mass) has been proposed as a clinically-relevant measure to detect individuals at risk of functional incapacity. Individuals with obesity might be at an increased risk of having poor muscle quality. Thus, we aimed to analyze the prevalence of poor muscle quality...

Objectives To provide reference values and examine the influence of hip/groin pain on hip adductor and abductor strength in professional male ice hockey players, by using a straightforward 5-min procedure. Design Cross-sectional study. Setting On-field assessment of hip/groin muscle strength with dynamometry, together with the concomitant level o...

Although reverse shoulder arthroplasty (RSA) has shown successful postoperative outcomes, little is known about compensatory activation patterns of remaining shoulder muscles following RSA. The purpose of this experimental case control series was to investigate shoulder muscle strength and neuromuscular activation of deltoid and teres minor muscles...

Objectives: To investigate sex-specific differences in hip muscle strength asymmetries, and associations between hip abductor and flexor strength asymmetries, hip morphology and symptoms in patients with femoroacetabular impingement syndrome (FAIS). Design: Cross-sectional study. Setting: Clinical setting. Participants: Thirty-four patients...

Maximum oxygen consumption (VO2max) is not only an indicator of endurance performance, but also a strong predictor of cardiovascular disease and mortality. This physiological parameter is known to decrease with aging. In turn, physical exercise might attenuate the rate of aging-related decline in VO2max, which in light of the global population agin...

Quadriceps neuromuscular function remains impaired in the short- and long-term following knee arthroscopy for meniscal surgery and/or anterior cruciate ligament (ACL) reconstruction. The aim of this study was to compare quadriceps neuromuscular impairments in patients following meniscal surgery with and without ACL reconstruction. Thirty patients w...

Life expectancy is increasing globally, and the oldest old (≥85 years) are the fastest-growing population segment. Preservation of physical fitness at advanced ages is, therefore , a major medical problem that no drug is likely to target in the foreseeable future. However, some sports achievements by centenarians suggest that, with proper exercise...

Background: Falls are a major concern for older adults and their care givers. The Timed Up and Go (TUG) test is extensively used to identify individuals at risk of falling, but less is known about the validity of simple isometric strength measures for this purpose. We aimed to assess the potential of isometric strength measures and the different mo...

We thoroughly appreciate the interest shown by many authors (1) in replying to our previous Viewpoint on eccentric exercise (2). Various important points were raised, and, briefly, we would like to summarize our line of thought. Even if the operational definition/classification can differ from the one we recently suggested (2)-for example based on...