Article

A novel approach for rehabilitation of a triceps tendon rupture: A case report

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Abstract

Objective: Generate hypotheses and add new perspectives to the literature in the nonsurgical management of large ruptures in the distal part of the triceps tendon. Methods: The patient was physically active, right handed, with a history of 20 years of resistance training practice and involvement in many activities, mostly combat sports (boxing, karate and mixed martial arts). The exercise program was designed with high repetitions and low rest intervals between sets in order to increase the metabolic stress. The resistance training with focus on tendon rehabilitation was performed in 28 weeks, with a follow-up of 52 weeks. The outcomes were changes in muscle strength and in the morphology of muscle and tendon. Results: The results obtained in the isokinetic tests showed that the functional deficit was more evident during isometric than dynamic actions, and was also higher is slow than fast actions. Dynamic performance was fully recovered at the end of the follow up, while isometric strength did not. Conclusions: The present case reports a successful rehabilitation program after a near maximum triceps tendon rupture. The novelty was in the use of a simple resistance training program, that demanded low time commitment and was performed in a regular fitness facility.

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... Although not based on scientific data, a rupture size of > 50% of the tendon is often given as an indication for surgical treatment [1]. In contrast, multiple successful reports of non-operative treatment of partial ruptures have been described in the literature [7][8][9][10][11]. Subsequently, this raises the question of whether non-operative treatment for partial distal triceps tendon ruptures might be more favorable in these cases than previously presumed. ...
... The patient returned to weightlifting four weeks after his injury and recovered to near-normal function at 41 weeks. Similar reports confirm these promising results in patients with high functional demands [7][8][9][10][11]. However, there are also less successful reports. ...
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Objective Partial ruptures of the distal triceps tendon are usually treated surgically from a size of > 50% tendon involvement. The aim of this study was to compare the ultimate load to failure of intact triceps tendons with partially ruptured tendons and describe the rupture mechanism. Methods Eighteen human fresh-frozen cadaveric elbow specimens were randomly assigned to two groups with either an intact distal triceps tendon or with a simulated partial rupture of 50% of the tendon. A continuous traction on the distal triceps tendon was applied to provoke a complete tendon rupture. The maximum required ultimate load to failure of the tendon in N was measured. In addition, video recordings of the ruptures of the intact tendons were performed and analysed by two independent investigators. Results A median ultimate load to failure of 1,390 N (range Q0.25—Q0.75, 954 – 2,360) was measured in intact distal triceps tendons. The median ultimate load to failure of the partially ruptured tendons was 1,330 N (range Q0.25—Q0.75, 1,130 – 1.470 N). The differences were not significant. All recorded ruptures began in the superficial tendon portion, and seven out of nine tendons in the lateral tendon portion. Discussion Partial ruptures of the distal triceps tendon demonstrate a not statistically significant lower ultimate load to failure than intact tendons and typically occur in the superficial, lateral portion of the tendon. This finding can be helpful when deciding between surgical and conservative therapy for partial ruptures of the distal triceps tendon.
... Even though the surgery has an established role as a successful treatment of substantial distal triceps tendon injury, a successful conservative treatment trial has been reported with a near-to-total distal triceps rupture [9]. This puts even more pressure on the scientific community to develop evidence-based treatment guidelines for distal triceps ruptures. ...
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... However, it is important to remember that overuse injuries and tendinopathies are frequent in young athletes (Le Gall et al., 2006;Johnson et al., 2020), which might be due to an imbalance between muscle and tendon adaptation (Mersmann et al., 2014(Mersmann et al., , 2016(Mersmann et al., , 2017. Considering that resistance training might increase tendon strength (Kongsgaard et al., 2007;Martins et al., 2018), it is recommended to design programs with an adequate balance between plyometric (particularly high-impact jumps) and resistance training volumes, specially adolescents. The combination of resistance and plyometric training might also be beneficial for increasing performance (Zghal et al., 2019;Thapa et al., 2021). ...
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Strength training with isometric contractions produces large but highly angle-specific adaptations. To contrast the contractile mode of isometric versus dynamic training, but diminish the strong angle specificity effect, we compared the strength gains produced by isometric training at four joint angles with conventional dynamic training. Thirty-three recreationally active healthy males aged 18 - 30 years completed 9 weeks of strength training of the quadriceps muscle group three times per week. An intra-individual design was adopted: one leg performed purely isometric training at each of four joint angles (isometrically trained leg); the other leg performed conventional dynamic training, lifting and lowering (dynamically trained leg). Both legs trained at similar relative loads for the same duration. The quadriceps strength of each leg was measured isometrically (at four angles) and isokinetically (at three velocities) pre and post training. After 9 weeks of training, the increase in isokinetic strength was similar in both legs (pooled data from three velocities: dynamically trained leg, 10.7%; isometrically trained leg, 10.5%). Isometric strength increases were significantly greater for the isometrically trained leg (pooled data from four angles: dynamically trained leg, 13.1%; isometrically trained leg, 18.0%). This may have been due to the greater absolute torque involved with isometric training or a residual angle specificity effect despite the isometric training being divided over four angles.
Article
We reported, using a unilateral resistance training (RT) model, that training with high or low loads (mass per repetition) resulted in similar muscle hypertrophy and strength improvements in RT-naïve subjects. Here we aimed to determine whether the same was true in men with previous RT experience using a whole-body RT program and whether post-exercise systemic hormone concentrations were related to changes in hypertrophy and strength. Forty-nine resistance-trained men (mean ± SEM, 23 ± 1 y) performed 12 wk of whole-body RT. Subjects were randomly allocated into a higher-repetition (HR) group who lifted loads of ~30-50% of their maximal strength (1RM) for 20-25 repetitions/set (n=24) or a lower-repetition (LR) group (~75-90% 1RM, 8-12 repetitions/set, n=25), with all sets being performed to volitional failure. Skeletal muscle biopsies, strength testing, DXA scans, and acute changes in systemic hormone concentrations were examined pre- and post-training. In response to RT, 1RM strength increased for all exercises in both groups (p < 0.01), with only the change in bench press being significantly different between groups (HR: 9 ± 1 vs. LR: 14 ±1 kg, p = 0.012). Fat- and bone-free (lean) body mass, type I and type II muscle fibre cross sectional area increased following training (p < 0.01) with no significant differences between groups. No significant correlations between the acute post-exercise rise in any purported anabolic hormone and the change in strength or hypertrophy were found. In congruence with our previous work, acute post-exercise systemic hormonal rises are not related to or in any way indicative of RT-mediated gains in muscle mass or strength. Our data show that in resistance-trained individuals load, when exercises are performed to volitional failure, does not dictate hypertrophy or, for the most part, strength gains.
Article
Acute triceps ruptures are an uncommon entity, occurring mainly in athletes, weight lifters (especially those taking anabolic steroids), and following elbow trauma. Accurate diagnosis is made clinically, although MRI may aid in confirmation and surgical planning. Acute ruptures are classified on an anatomic basis based on tear location and the degree of tendon involvement. Most complete tears are treated surgically in medically fit patients. Partial-thickness tears are managed according to the tear severity, functional demands, and response to conservative treatment. We favor an anatomic footprint repair of the triceps to provide optimal tendon to bone healing and, ultimately, functional outcome.
Article
Complete triceps tendon rupture is relatively rare, but more commonly seen in the athletic population. Loss of extension strength is the functional deficit for the elbow after rupture of the triceps tendon. Although partial tears may be treated conservatively, complete tears of the triceps tendon must be repaired to provide active extension at the elbow. Our preferred surgical technique for repair of the acute triceps tendon rupture is presented, as well as strategies for reconstruction of the triceps tendon with an Achilles tendon allograft. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Article
Background Distal rupture of the triceps tendon is a rare injury, and treatment guidelines are not well established. Hypothesis Football players with triceps tendon ruptures will be able to return to their sport with minimal functional deficits. Study Design Uncontrolled retrospective review. Methods Twenty-one partial and complete ruptures of the triceps tendon were identified in 19 National Football League players over a period of 6 years. Team physicians retrospectively reviewed training room, clinical, and operative notes for each of these players. Results Most of the injured players were linemen. The most common mechanism of injury was an eccentric load to a contracting triceps. Seven players had prodromal symptoms prior to injury, and 5 had received a cortisone injection. Eleven elbows with complete tears underwent surgical repair. Of 10 players with partial tears, 6 healed without surgery. One player suffered a subsequent complete tear requiring surgery, and 3 with residual pain and weakness underwent surgical repair following the season. Two surgical complications occurred, both requiring a second operation. All of the players but 1 returned to play at least one season of professional football after their injury. Conclusions Partial triceps tendon ruptures can heal without functional deficit. Surgical repair for complete ruptures generally produces good functional results and allows return to play.
Article
Triceps injuries are relatively uncommon in most traumatic events, and the distal triceps tendon ruptures are rare. Recently, the knowledge of this tendon lesion has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle, while several other risk factors have been studied as chronic renal failure, endocrine disorders, metabolic bone diseases as well as steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The commonest site of rupture is at the tendon's insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. The surgical intervention is recommended in acute complete ruptures, and non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demanding patients. Various techniques and approaches as the direct repair to bone, the tendon augmentation, the anconeus rotation flap and the Achilles tendon allograft have been proposed for the management of these challenging injuries. The goal of surgical management should be an anatomical repair of the injured tendon by selection of a procedure with a low complication rate and one that allows early mobilization. This manuscript focuses the triceps tendon ruptures starting from the anatomy to the diagnosis and entity of the triceps tendon injuries, as well as the indications and guidelines for the management.
Article
Biceps and triceps ruptures are rare, but can cause significant disability. They typically result from a forceful eccentric contraction, resulting in weakness and pain. Biceps and triceps tendon injuries represent the most and least common tendinous injuries about the elbow, respectively. Nonoperative management of these injuries is generally reserved for partial ruptures or patients unfit for surgery. Surgical repair has become the preferred method of treatment for acute, complete ruptures. Anatomy, epidemiology, clinical evaluation, and treatment of these injuries are described in this review.
Article
The premise of eliciting the greatest acute fatigue is accepted and used for designing programs that include excessive, potentially dangerous volumes of high-intensity resistance exercise. There is no evidence examining acute fatigue and neuromuscular responses throughout multiple sets of moderate-to-high intensity resistance exercise. Fifteen resistance trained males performed a single exercise session using eight-sets of Bulgarian Split Squats performed at 75% maximal force output. Maximal force output (N) was measured after every set of repetitions. Electromyographic (EMG) activity of vastus lateralis (VL) was monitored during all force trials and exercise repetitions. Repetitions per set decreased from the first to the third set (p<0.001). Maximal force output decreased from pre-exercise to set four (p<0.001). EMG amplitudes during exercise did not change. Secondary sub-group analysis was performed based on the presence, or not, of a fatigue plateau (<5% reductions in maximal force output in subsequent sets). 9 participants exhibited a fatigue plateau, and 6 did not. Participants who plateaued performed less first-set repetitions, accrued less total volume, and did not exhibit increases in EMG amplitudes during exercise. Initial strength levels and neuromuscular demand of the exercise was the same between sub-groups. This data suggests that there are individual differences in the training session responses when prescribing based off a percentage of maximal strength. When plateaus in fatigue and repetitions per set are reached, subsequent sets are not likely to induce greater fatigue and muscle activation. High-volume resistance exercise should be carefully prescribed on an individual basis, with intra-session technique and training responsiveness continually monitored. Copyright (C) 2015 by the National Strength & Conditioning Association.
Article
To elucidate mechanism of injury, nonoperative protocols, surgical techniques, rehabilitation schedules, and return to sports guidelines for partial and complete triceps tendon injuries. The PubMed and OVID databases were searched in 2010 and peer-reviewed English language articles in 2011. After a fall on an outstretched hand, direct trauma on the elbow or lifting against resistance, patients often present with pain and weakness of extension. Examination may reveal a palpable tendon gap, and radiographs may reveal a Flake sign. Acute partial injuries have positive outcomes with immobilization in 30-degree flexion for 4 to 6 weeks. Primary repair for complete rupture can restore normal extensor function after 3 to 4 months. Reconstruction returns normal extensor function up to 4 years. Most authors support postoperative immobilization for 2 to 3 weeks at 30- to 40-degree flexion, flexion block bracing for an additional 3 weeks, and unrestricted activity at 6 months. Athletes may be able to return to sports after 4 to 5 weeks of recovery from a partial injury, but return may be delayed if operative tendon repair is performed. Acute partial triceps tendon injuries may be managed conservatively at first and should be repaired primarily if this fails or if presentation is delayed. Reconstruction should first use the anconeus rotation technique. If the anconeus is devitalized, the Achilles tendon may be the allograft of choice.
Article
We have reported that the acute postexercise increases in muscle protein synthesis rates, with differing nutritional support, are predictive of longer-term training-induced muscle hypertrophy. Here, we aimed to test whether the same was true with acute exercise-mediated changes in muscle protein synthesis. Eighteen men (21 ± 1 yr, 22.6 ± 2.1 kg/m(2); means ± SE) had their legs randomly assigned to two of three training conditions that differed in contraction intensity [% of maximal strength (1 repetition maximum)] or contraction volume (1 or 3 sets of repetitions): 30%-3, 80%-1, and 80%-3. Subjects trained each leg with their assigned regime for a period of 10 wk, 3 times/wk. We made pre- and posttraining measures of strength, muscle volume by magnetic resonance (MR) scans, as well as pre- and posttraining biopsies of the vastus lateralis, and a single postexercise (1 h) biopsy following the first bout of exercise, to measure signaling proteins. Training-induced increases in MR-measured muscle volume were significant (P < 0.01), with no difference between groups: 30%-3 = 6.8 ± 1.8%, 80%-1 = 3.2 ± 0.8%, and 80%-3= 7.2 ± 1.9%, P = 0.18. Isotonic maximal strength gains were not different between 80%-1 and 80%-3, but were greater than 30%-3 (P = 0.04), whereas training-induced isometric strength gains were significant but not different between conditions (P = 0.92). Biopsies taken 1 h following the initial resistance exercise bout showed increased phosphorylation (P < 0.05) of p70S6K only in the 80%-1 and 80%-3 conditions. There was no correlation between phosphorylation of any signaling protein and hypertrophy. In accordance with our previous acute measurements of muscle protein synthetic rates a lower load lifted to failure resulted in similar hypertrophy as a heavy load lifted to failure.
Article
Biceps or triceps ruptures are rare but can cause a significant disability. Surgical repair has become the preferred method of treatment for the complete rupture, but the decision when to treat partial tears is less clear. Reconstruction of the tendon is the preferred method when patients have a delayed presentation.
Article
This study investigated whether isokinetic strength training might induce changes in static and dynamic power already achieved as a result of isometric strength training. The subjects were twelve males. The isometric strength and dynamic power of elbow flexors were tested by means of an electric dynamometer and fly-wheel every two weeks. During the first 8 weeks all subjects trained the elbow flexors isometrically at four different positions of elbow joints. This training produced 27-36% gains in isometric strength and 34-46% in power. Thereafter the subjects were divided into two groups: the FG group who trained isokinetically at a fast velocity of 157 degrees . s-1, and the SG group at slow velocity of 73 degrees . s-1. After 6 weeks of training, the FG group produced a significant gain in power with light equivalent masses and the SG group did so with heavy equivalent masses. Neither group showed change in isometric strength.
Article
To study the relationship between isokinetic and isometric torque, maximum voluntary contractions were elicited from 352 male volunteers. Knee extensors, knee flexors, elbow extensors, and elbow flexors were tested isometrically and at isokinetic velocities of 30 degrees/sec, 90 degrees/sec, and 180 degrees/sec on a modified Cybex II apparatus. Isokinetic torque declined with increasing velocity of contraction. Intercorrelations of the isometric and isokinetic torque showed a moderate to high relationship between these 2 modes of testing. A higher relationship was noted between the isometric tests and the low-velocity isokinetic tests and between isokinetic velocities that were closest together. The correlations decreased as the isokinetic velocities became more widely separated. These data suggest that the torque elicited at low-velocity isokinetic contractions can be predictive of the torque elicited during isometric contractions. Faster velocities are less related to isometric strength.
Article
Flexor tendon repair in zone II is complicated by adhesions to the surrounding fibro-osseous sheath. Lactate is an early mediator of wound healing known to play an important role in stimulation of collagen production after cellular injury. Little attention has been paid to the role of lactate in flexor tendon wound healing. In this study tendon and tendon sheath were excised from rabbit forepaws. We examined proliferation of tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes; collagen production by each of these 3 cell types; and effects of lactate on cell proliferation and collagen production. Three cell lines, tendon sheath, epitenon, and endotenon, were isolated and cultured. Tendon sheath fibroblasts showed the greatest proliferation. All 3 cell lines produced collagen I, II, and III. Lactate significantly increased collagen production by all 3 cell lines. We show that cells of the tendon sheath, epitenon, and endotenon produce collagen in vitro. Modulation of lactate levels may provide a means to modulate collagen production.
Article
The identification of a quantifiable dose-response relationship for strength training is important to the prescription of proper training programs. Although much research has been performed examining strength increases with training, taken individually, they provide little insight into the magnitude of strength gains along the continuum of training intensities, frequencies, and volumes. A meta-analysis of 140 studies with a total of 1433 effect sizes (ES) was carried out to identify the dose-response relationship. Studies employing a strength-training intervention and containing data necessary to calculate ES were included in the analysis. ES demonstrated different responses based on the training status of the participants. Training with a mean intensity of 60% of one repetition maximum elicits maximal gains in untrained individuals, whereas 80% is most effective in those who are trained. Untrained participants experience maximal gains by training each muscle group 3 d.wk and trained individuals 2 d.wk. Four sets per muscle group elicited maximal gains in both trained and untrained individuals. The dose-response trends identified in this analysis support the theory of progression in resistance program design and can be useful in the development of training programs designed to optimize the effort to benefit ratio.
Article
Flexor tendon wound healing in zone II is complicated by adhesions to the surrounding fibro-osseous sheath. These adhesions can significantly alter tendon gliding and ultimately hand function. Lactate and transforming growth factor-beta (TGF-beta) are two important mediators of wound healing that have been demonstrated to independently increase collagen production by cells of the tendon sheath, epitenon, and endotenon. This study examined the effects of lactate on TGF-beta peptide and receptor production by flexor tendon cells. Tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes were isolated from rabbit flexor tendons and cultured separately. Cell cultures were supplemented with 50 mM lactate, and the expression of three TGF-beta peptide isoforms (beta1, beta2, and beta3) and three receptor isoforms (R1, R2, and R3) was quantified with enzyme-linked immunosorbent assays. TGF-beta functional activity was also assessed with the addition of tendon cell conditioned media to mink lung epithelial cells transfected with a luciferase reporter gene expression construct responsive to TGF-beta. Supplementation of the cell culture medium with lactate significantly (p < 0.05) increased the expression of all TGF-beta peptide and receptor isoforms in all three cell lines. Tendon sheath fibroblasts exhibited the greatest increases in beta1 and beta2 peptide isoform expression (30 and 23 percent, respectively), whereas endotenon tenocytes demonstrated the greatest increase in beta3 peptide expression (32 percent). Epitenon tenocytes exhibited the greatest increases in receptor isoform R1 and R2 expression (17 and 19 percent, respectively). All three tendon cell types demonstrated significant (p < 0.05) increases in TGF-beta functional activity when exposed to lactate. Epitenon tenocytes demonstrated the greatest increase in activity (>4 times control values), whereas tendon sheath fibroblasts demonstrated the highest overall levels of total TGF-beta functional activity. Lactate significantly increased TGF-beta peptide (beta1, beta2, and beta3) expression, receptor (R1, R2, and R3) expression, and functional activity, suggesting a common pathway regulating tendon cell collagen production. Modulation of lactate and TGF-beta levels may provide a means of modulating the effects of TGF-beta on adhesion formation in flexor tendon wound healing.
Article
Injuries to the biceps and triceps tendons about the elbow are relatively infrequent. Typically, they are traumatic events that occur as a result of a forceful eccentric contraction. Early recognition of these injuries and prompt intervention are the cornerstones to a successful outcome. Acute anatomic repair of complete injuries offers predictably good results. Conservative management, on the other hand, is typically reserved for partial injuries with little functional compromise, and for patients unfit for surgery. The challenges posed by chronic injuries can be addressed with a variety of surgical options. This article focuses on the timely identification and diagnosis of these injuries and specific indications and guidelines for their treatment.
Article
The purpose of this study was to investigate the importance of training leading to repetition failure in the performance of 2 different tests: 6 repetition maximum (6RM) bench press strength and 40-kg bench throw power in elite junior athletes. Subjects were 26 elite junior male basketball players (n = 12; age = 18.6 +/- 0.3 years; height = 202.0 +/- 11.6 cm; mass = 97.0 +/- 12.9 kg; mean +/- SD) and soccer players (n = 14; age = 17.4 +/- 0.5 years; height = 179.0 +/- 7.0 cm; mass = 75.0 +/- 7.1 kg) with a history of greater than 6 months' strength training. Subjects were initially tested twice for 6RM bench press mass and 40-kg Smith machine bench throw power output (in watts) to establish retest reliability. Subjects then undertook bench press training with 3 sessions per week for 6 weeks, using equal volume programs (24 repetitions x 80-105% 6RM in 13 minutes 20 seconds). Subjects were assigned to one of two experimental groups designed either to elicit repetition failure with 4 sets of 6 repetitions every 260 seconds (RF(4 x 6)) or allow all repetitions to be completed with 8 sets of 3 repetitions every 113 seconds (NF(8 x 3)). The RF(4 x 6) treatment elicited substantial increases in strength (7.3 +/- 2.4 kg, +9.5%, p < 0.001) and power (40.8 +/- 24.1 W, +10.6%, p < 0.001), while the NF(8 x 3) group elicited 3.6 +/- 3.0 kg (+5.0%, p < 0.005) and 25 +/- 19.0 W increases (+6.8%, p < 0.001). The improvements in the RF(4 x 6) group were greater than those in the repetition rest group for both strength (p < 0.005) and power (p < 0.05). Bench press training that leads to repetition failure induces greater strength gains than nonfailure training in the bench press exercise for elite junior team sport athletes.
Article
We hypothesized that an acute bout of strenuous, non-damaging exercise would increase rates of protein synthesis of collagen in tendon and skeletal muscle but these would be less than those of muscle myofibrillar and sarcoplasmic proteins. Two groups (n = 8 and 6) of healthy young men were studied over 72 h after 1 h of one-legged kicking exercise at 67% of maximum workload (W(max)). To label tissue proteins in muscle and tendon primed, constant infusions of [1-(13)C]leucine or [1-(13)C]valine and flooding doses of [(15)N] or [(13)C]proline were given intravenously, with estimation of labelling in target proteins by gas chromatography-mass spectrometry. Patellar tendon and quadriceps biopsies were taken in exercised and rested legs at 6, 24, 42 or 48 and 72 h after exercise. The fractional synthetic rates of all proteins were elevated at 6 h and rose rapidly to peak at 24 h post exercise (tendon collagen (0.077% h(-1)), muscle collagen (0.054% h(-1)), myofibrillar protein (0.121% h(-1)), and sarcoplasmic protein (0.134% h(-1))). The rates decreased toward basal values by 72 h although rates of tendon collagen and myofibrillar protein synthesis remained elevated. There was no tissue damage of muscle visible on histological evaluation. Neither tissue microdialysate nor serum concentrations of IGF-I and IGF binding proteins (IGFBP-3 and IGFBP-4) or procollagen type I N-terminal propeptide changed from resting values. Thus, there is a rapid increase in collagen synthesis after strenuous exercise in human tendon and muscle. The similar time course of changes of protein synthetic rates in different cell types supports the idea of coordinated musculotendinous adaptation.
Article
This study investigated the acute hormonal response to three different rest periods between sets of a traditional lower body resistance training session in young women. Twelve healthy trained females (26.83+/-3.93 years) participated in the study. On three separate sessions of a lower body resistance exercise protocol, subjects were assigned in a random order a rest interval of 30s (P30), 60s (P60) or 120s (P120) between sets. The resistance exercise session consisted of four lower body exercises with three sets performed until contractile failure using 10-repetition maximum (RM) load. Blood samples were drawn for determination of serum growth hormone (GH) and cortisol concentrations before exercise (T0), immediately after each training session (T1), and after 5min (T5), 15min (T15), and 30min (T30) of recovery. Statistical evaluation of the area under the time-concentration relationship for GH (GHauc) and for cortisol (Cauc) were analyzed using a one-way ANOVA There were no differences among protocols (P30, P60 and P120) in the serum GH and cortisol concentrations at baseline (T0). However, as compared to T0, all protocols led to acute increases (p<0.05) in serum GH concentrations after each training session. The GHauc was greater for P30 than for both P60 and P120, however, there were no differences between P60 and P120. The Cauc were not different among protocols. Thus, the magnitude of acute GH responses in previously strength-trained women appears greater with a 30-s rest interval between sets compared to longer rest periods of 60- or 120-s.
The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model
  • R Bernard
  • R F Warren
  • T L Wickiewicz
  • J E Bialosky
  • M D Bishop
  • D D Price
  • M E Robinson
  • S Z George
Bernard, R., Warren, R. F., & Wickiewicz, T. L. (n.d.). Triceps Rupture, 285e289. Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2010). The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy, 14(5), 531e538. https://doi.org/10.1016/ j.math.2008.09.001.The.
Single-leg power output and between-limb imbalances in team-sports Players: Unilateral vs. Bilateral combined resistance training
  • J Giessing
  • O Gonzalo-Skok
  • J Tous Fajardo
  • L Suarez Arrones
  • J L Serrano
  • J A Casajus
  • A Villanueva
Giessing, J. (2012). The Effects of low volume resistance training with and without advanced techniques in trained participants. Uma Etica Para Quantos?, (2), 81e87. XXXIII https://doi.org/10.1007/s13398-014-0173-7.2. Gonzalo-Skok, O., Tous Fajardo, J., Suarez Arrones, L., Arjol Serrano, J. L., Casajus, J. A., & Mendez Villanueva, A. (2016). Single-leg power output and between-limb imbalances in team-sports Players: Unilateral vs. Bilateral combined resistance training. International Journal of Sport Physiology and Performance, 32, 1e44. https://doi.org/10.1123/ijspp.2015-0012.