Dietmar Schmidtbleicher’s research while affiliated with Goethe University Frankfurt and other places

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Publications (114)


Reactive Strength As A Metric For Informing Return- to-Sport Decisions
  • Conference Paper
  • Full-text available

September 2021

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249 Reads

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Objective: Current return-to-sport decisions are primarily based on elapsed time since surgery or injury and strength measures. Given data that show rates of successful return to competitive sport at around 55%, there is strong rationale for adopting tools that will better inform return to sport decisions. The authors’ objective was to assess reactive strength as a metric for informing return-to-sport decisions. Design: Case-control design. Methods: Fifteen elite athletes from national sports teams (23 [6.0] y) in the final phase of their return-to-sport protocol following a unilateral knee injury and 16 age-matched control athletes (22 [4.6] y) performed a unilateral isometric strength test and 24-cm drop jump test. Pairwise comparisons were used to determine differences between legs within groups and differences in interleg asymmetry between groups. Results: Strength measures did not distinguish the control from the rehabilitation group; however, clear differences in the degree of asymmetry were apparent between the control and rehabilitation groups for contact time (Cohen d = 0.56; −0.14 to 1.27; 8.2%; P = .113), flight time (d = 1.10; 0.44 to 1.76; 16.0%; P = .002), and reactive strength index (d = 1.27; 0.50 to 2.04; 22.4%; P = .002). Conclusion: Reactive strength data provide insight into functional deficits that persist into the final phase of a return-to-sport protocol. The authors’ findings support the use of dynamic assessment tools to inform return-to-sport decisions to limit potential for reinjury.

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Reactive Strength as a Metric for Informing Return-to-Sport Decisions: A Case-Control Study

September 2021

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227 Reads

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5 Citations

Journal of Sport Rehabilitation

Objective: Current return-to-sport decisions are primarily based on elapsed time since surgery or injury and strength measures. Given data that show rates of successful return to competitive sport at around 55%, there is strong rationale for adopting tools that will better inform return to sport decisions. The authors' objective was to assess reactive strength as a metric for informing return-to-sport decisions. Design: Case-control design. Methods: Fifteen elite athletes from national sports teams (23 [6.0] y) in the final phase of their return-to-sport protocol following a unilateral knee injury and 16 age-matched control athletes (22 [4.6] y) performed a unilateral isometric strength test and 24-cm drop jump test. Pairwise comparisons were used to determine differences between legs within groups and differences in interleg asymmetry between groups. Results: Strength measures did not distinguish the control from the rehabilitation group; however, clear differences in the degree of asymmetry were apparent between the control and rehabilitation groups for contact time (Cohen d = 0.56; -0.14 to 1.27; 8.2%; P = .113), flight time (d = 1.10; 0.44 to 1.76; 16.0%; P = .002), and reactive strength index (d = 1.27; 0.50 to 2.04; 22.4%; P = .002). Conclusion: Reactive strength data provide insight into functional deficits that persist into the final phase of a return-to-sport protocol. The authors' findings support the use of dynamic assessment tools to inform return-to-sport decisions to limit potential for reinjury.


Effectiveness of an Unexpected Disturbance Program in the Early Stage of Rehabilitation in Athletes With Unilateral Knee Ligament Injury

February 2020

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255 Reads

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2 Citations

Journal of Sport Rehabilitation

Context: Sensorimotor, proprioceptive, and neuromuscular programs are critical for the successful rehabilitation of injured athletes, and these decrease reinjury rates. Objective: To investigate the effects of an unexpected disturbance program (UDP) on balance and unilateral strength metrics in athletes with unilateral knee ligament injury. Design: A 3-week parallel-group experimental design consisting of 9 rehabilitation sessions. Setting: National Sports Institute. Participants: Twenty-one national-level athletes (age 21.4 [4.4] y, body mass 63.9 [10.8] kg, height 169.0 [10.2] cm) who had sustained a unilateral knee ligament injury. Intervention: An UDP program designed to evoke rapid sensorimotor responses was compared with traditional training and a nonexercise control group. Main outcome measures: Unilateral total, anteroposterior, and mediolateral sway with eyes open and closed and unilateral isometric strength. Results: Traditional exercises tended to outperform the UDP when unilateral balance testing was performed with eyes open; however, balance improvement following UDP tended to be greater in the eyes-closed condition. Significant strength gains in both the injured and uninjured legs were only observed following the UDP. This increase in unilateral isometric strength was 23.4 and 35.1 kg greater than the strength improvements seen in the traditional rehabilitation and control groups (P < .05). Conclusions: UDP could improve neural aspects of rehabilitation to improve rehabilitation outcomes by improving strength, sensorimotor function, and proprioception. Given the complementary adaptations, an UDP could provide an effective adjunct to traditional rehabilitation protocols and improve return-to-play outcomes.


Table 1 . Relaxation-stabilisation exercises and stochastic resonance therapy
Table 2 . General overview of tailor-made strength training programme
Exercises performed during the rehabilitation program
Using stochastic resonance and strength training as part of a rehabilitation programme for recurrent low back pain treatment: A case study

February 2019

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512 Reads

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5 Citations

Journal of Exercise Rehabilitation

Low back pain (LBP) is a common disabling health problem that can cause decreased spine proprioception. Stochastic resonance (SR) can influence detection performance, besides improving patients with significant sensory deficits, but have not been thoroughly tested for LBP. This study aimed to examine the application of SR therapy (SRT) and strength training for LBP treatment. The subject was a resistance-trained male in his early thirties. His back pain was unbearable after a strength training session. Standard pain relief alleviated the pain but the LBP developed at a similar intensity after 4 weeks. SRT (4–5 sets × 90 sec, 30-sec rest interval, supine position) was prescribed along with other exercises for 3 weeks (phase 1), and followed by tailor-made strength training for 16 weeks (phase 2). The Oswestry Disability Index was 66.7% (interpreted as “crippled”) prior to first SRT, and reduced to minimal levels of 15.6% and 6.7% after four and seven SRT sessions, respectively. Similarly, pain intensity was ranging from 5 to 9 (distracting-severe) of the Numeric Rating Scale (NRS-11) prior to the first session but this was reduced considerably after four sessions (NRS-11: 0–1). During phase 2, the patient performed without complaining of LBP, two repetitions of bench press exercise at a load intensity of 1.2 his body weight and attained 4 min of plank stabilisation. This LBP management strategy has a clinically meaningful effect on pain intensity, disability, and functional mobility, by receding the recurrent distracting to severe LBP.



A Three Week Unexpected Disturbance Program Improves Physical Performance of Elite Female Athletes

December 2016

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417 Reads

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8 Citations

Journal of Sport Rehabilitation

Context: Sensorimotor training is commonly used in a rehabilitative setting; however, the effectiveness of an unexpected disturbance program (UDP) to enhance performance measures in uninjured elite athletes is unknown. Objective: To assess the impact of a three-week UDP program on strength, power, and proprioceptive measures. Design: Matched-group, pre- post design. Setting: National Sports Institute. Participants: Twenty-one international-level female field hockey athletes. Interventions: Two 45 min UDP sessions were incorporated into each week of a three week training program (total 6 sessions). Main outcome measures: One-repetition maximum strength, lower limb power, 20 m running speed, and proprioception tests were performed before and after the experimental period. Results: Substantial improvements in running sprint speed at 5- (4.4 ±2.6%; Effect Size [ES]: 0.88), 10- (2.1 ±1.9%; ES: 0.51), and 20-m (1.0 ±1.6%; ES: 0.23) were observed in the UDP group. Squat jump performance was also clearly enhanced when compared to the control group (3.1 ±6.1%; ES: 0.23). Small but clear improvements in maximal strength were observed in both groups. Conclusion: A three week UDP can elicit clear enhancements in running sprint speed and concentric-only jump performance. These improvements are suggestive of enhanced explosive strength and are particularly notable given the elite training status of the cohort and relatively short duration of the intervention. Thus, we would reiterate the statement by Gruber and colleagues (2004) that sensorimotor training is a "highly efficient" modality for improving explosive strength.


A Three Week Unexpected Disturbance Program Improves Physical Performance Of Elite Female Athletes

December 2016

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197 Reads

THREE WEEK UNEXPECTED DISTURBANCE PROGRAM IMPROVES PHYSICAL PERFORMANCE OF ELITE FEMALE ATHLETES Sensorimotor training is commonly used in a rehabilitative setting; however, the effectiveness of a UDP to enhance performance measures in uninjured elite athletes is unknown. Objective: To assess the impact of a three-week UDP program on strength, power, and proprioceptive measures. Design: Matched-group, pre- post design. Setting: National Sports Institute of Malaysia. Participants: Twenty-one international-level female field hockey athletes. Interventions: Two 45 min UDP sessions were incorporated into each week of a three week training program (total 6 sessions). Main Outcome Measures: 1-RM strength, lower limb power, 20 m running speed, and proprioception tests were performed before and after the experimental period. Results: Substantial improvements in running sprint speed at 5- (4.4 ±2.6%; ES: 0.88), 10- (2.1 ±1.9%; ES: 0.51), and 20-m (1.0 ±1.6%; ES: 0.23) were observed in the UDP group. Squat jump performance was also clearly enhanced when compared to the control group (3.1 ±6.1%; ES: 0.23). Small but clear improvements in maximal strength were observed in both groups. Conclusion: A three week UDP can elicit clear enhancements in running sprint speed and concentric-only jump performance. Here we suggest that the UDP-mediated improvements in both running sprint time and the concentric-only jump performance are indicative of enhanced RFD. The enhanced explosive strength is particularly notable given the elite training status of the cohort and relatively short duration of the intervention. Thus, we would reiterate the statement by Gruber and colleagues (2004) that sensorimotor training is a “highly efficient” modality for improving explosive strength. Both rehabilitative specialists and strength and conditioning practitioners should be aware that incorporating exercises that specifically target the sensorimotor system through unexpected disturbances can be effective in improving explosive strength and functional training outcomes. Gruber and Gollhofer. Impact of sensorimotor training on the rate of force development and neural activation. Eur J Appl Physiol. 2004;92:98-105.


Fig. 1 CONSORT flow chart of the study  
Table 1 Demographic characteristics at baseline (mean ± SD)
Fig. 2 Set-up for the muscle strength assessment  
Table 2 SPPB ANOVA with repeated measurements (ranks) intergroup-by-time effects and group-by-time interaction
Sensory-motor training targeting motor dysfunction and muscle weakness in long-term care elderly combined with motivational strategies: a single blind randomized controlled study

December 2016

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296 Reads

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22 Citations

European Review of Aging and Physical Activity

Background This study evaluated the effects of a combined innovative training regime consisting of stochastic resonance whole-body vibration (SR-WBV) and a dance video game (DVG) on physical performance and muscle strength in long-term-care dwelling elderly. Methods Thirthy long-term-care elderly were randomly allocated to an intervention group (IG; n = 16) receiving combined SR-WBV training and DVG, or a sham group (SG; n = 14). IG performed five sets one minute of SR-WBV, with one minute rest between sets (base frequency 3 Hz up to 6 Hz, Noise 4) during the first five weeks on three days per week. From week five to eight a DVG was added to SR-WBV for IG on three days per week. SG performed a five-set SR-WBV program (1 Hz, Noise 1) lasting five times one minute, with one minute rest in between, three days a week. From week five to eight stepping exercises on a trampoline were added on three days per week. Primary outcome: Short physical performance battery (SPPB). Secondary outcome: isometric maximal voluntary contraction (IMVC), and sub phases of IMVC (Fsub), isometric rate of force development (IRFD) and sub time phases of IRFD (IRFDsub) were measured at baseline, after four and eight weeks. ANOVA with repeated measures was used for analyses of time and interaction effects and MANOVA determined between group intervention effects. ResultsBetween group effects revealed significant effects on the SPPB primary outcome after four weeks F(1, 27) = 6.17; p = 0.02) and after eight weeks F(1,27) = 11.8; p = 0.002). Secondary muscle function related outcome showed significant between group effects in IG on IRFD, Fsub 30 ms, 100 ms, 200 ms and IRFDsub 0-30 ms, 0-50 ms, 0-100 ms and 100-200 ms compared to SG (all p < 0.05). Conclusions Eight weeks SR-WBV and DVG intervention improved lower extremity physical function and muscle strength compared to a sham intervention in long-term-care elderly. SR-WBV and DVG seems to be effective as a training regime for skilling up in long-term-care elderly.


Figure 1: Difference values from period 1 - period 2. P-values were computed using Wilcoxon signed rank test for group 1 and group 2 at period 1 and period 2 ES effect size, AP anterior-posterior, ML medial-lateral, FRT Functional Reach Test, ETGUG Expanded Timed Get Up-and-Go, ST single task, DT dual task, RTH reaction time hand, RTF reaction time foot, mm millimetre, s seconds, m/s metre/seconds, ms milliseconds, ss sit-to-stand, m: metre
Table 1 Repeated measures analyses of variance for ranked data for cross-over effects Pillaìs trace (r 2 = SS Bet /SS Tot ) L [(N-1) r 2 ] Probability
Preliminary inconclusive results of a randomised double blinded cross-over pilot trial in long-term-care dwelling elderly assessing the feasibility of stochastic resonance whole-body vibration

October 2015

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134 Reads

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8 Citations

European Review of Aging and Physical Activity

Background This randomised double-blinded controlled cross-over pilot study examined feasibility and preliminary effects of stochastic resonance whole-body vibration training applied in long term care elderly. Findings Nine long term care elderly were recruited and randomized to group A (6 Hz, Noise 4 SR-WBV/ Sham) or B (Sham / 1 Hz, Noise 1 SR-WBV). Feasibility outcomes included recruitment rate, attrition, adherence and safety. Physical performance outcomes focused on the Expanded Timed Get Up-and-Go (ETGUG) test, the Short Physical Performance Battery (SPPB), and lower extremity muscle strength. Of 24 subjects initially approached 9 started and 5 completed the study resulting in 37.5 recruitment, 44.4 attrition and 81.7 % adherence rates. No adverse events were reported. There is more evidence of improved performance levels in the SR-WBV treatment group with significant differences in average change for isometric rate of force development (p = 0.016 left leg; p = 0.028 right leg). No statistical significance was reached for other parameters. Conclusions The findings of this study indicate that the used training protocol for long term care elderly is feasible, however, requires more closely monitoring of participants; e.g. needs protocol modifications that target improved compliance with the intervention in this setting. SR-WBV shows beneficial effects on physical performance for those adhering to the intervention.


Figure 1: Flow chart of this cross-over pilot study.
Table 1 Demographic characteristics and baseline values (mean ± SD)
Figure 2: Picture of the Zeptor med® device.
Feasibility and effects of applying stochastic resonance whole-body vibration on untrained elderly: A randomized crossover pilot study

March 2015

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433 Reads

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23 Citations

BMC Geriatrics

Background Aging is associated with loss of balance and activity in daily life. It impacts postural control and increases the risk of falls. The current study was conducted to determine the feasibility and long-term impact of stochastic resonance whole-body vibration (SR-WBV) on static and dynamic balance and reaction time among elderly individuals. Methods A randomized crossover pilot study with blinding of the participants. Twenty elderly were divided into group A (SR-WBV 5 Hz, Noise 4/SR-WBV 1 Hz, Noise 1) or group B (SR-WBV 1 Hz, Noise 1/SR-WBV 5 Hz, Noise 1). Feasibility outcomes included recruitment, compliance and safety. Secondary outcomes were Semi-Tandem Stand (STS), Functional Reach Test (FRT), Expanded Timed Get Up-and-Go (ETGUG), walking under single (ST) & dual task (DT) conditions, hand and foot reaction time (RTH/RTF). Puri and Sen Rank-Order L Statistics were used to analyse carry-over effects. To analyse SR-WBV effects Wilcoxon signed-ranked tests were used. Results With good recruitment rate (55%) and compliance (attrition 15%; adherence 85%) rates the intervention was deemed feasible. Three participants dropped out, two due to knee pain and one for personal reasons. ETGUG 0 to 2 m (p = 0.143; ES: 0.36) and ETGUG total time (p = 0.097; ES: 0.40) showed medium effect sizes. Conclusions Stochastic resonance training is feasible in untrained elderly resulting in good recruitment and compliance. Low volume SR-WBV exercises over 12 training sessions with 5 Hz, Noise 4 seems a sufficient stimulus to improve ETGUG total time. The stimulation did not elicit changes in other outcomes.


Citations (57)


... Return to sport. Both subjects exceeded the RTS threshold [15], and may provide a precise indication of interlimb asymmetries [9] that can persist into the final phase of a return-to-sport protocol [15]. These outcomes indicate favorable intervention effects in enhancing neuromuscular control, and additional exercises targeting reactive capacity may be beneficial [15]. ...

Reference:

Optimizing ACL Recovery through Prehabilitation and Blood Flow Restriction Training during Rehabilitation: A Case Study
Reactive Strength as a Metric for Informing Return-to-Sport Decisions: A Case-Control Study
  • Citing Article
  • September 2021

Journal of Sport Rehabilitation

... reshold. ere are 6 literature reports on the passive motion perception threshold of the knee joint after surgery [15], including 288 cases in the stump-retaining group and 197 cases in the nonretaining stump group. e analysis of heterogeneity shows that the studies have obvious heterogeneity (P < 0.00001, I 2 � 84%), so random-effect model analysis is used. ...

Effectiveness of an Unexpected Disturbance Program in the Early Stage of Rehabilitation in Athletes With Unilateral Knee Ligament Injury
  • Citing Article
  • February 2020

Journal of Sport Rehabilitation

... The treatment consisted of five weeks of training on the vibrating platform, twice a week, being performed in two positions: a) feet apart in a stable and comfortable position with knees extended, with the aim of obtaining greater activation of postural muscles; b) feet apart and semi-flexed knees. In each of the positions, the vibration was performed in five series of 1 minute duration, with an interval of 1 minute between each series, based on protocols previously performed 27,28,29 . An interval of five minutes was given between the first and the second position. ...

The effects of random whole-body-vibration on motor symptoms in Parkinson's disease
  • Citing Article
  • May 2006

Neurorehabilitation

... Some athletes include strength training as an obligatory part into their training regime; others rely more on cycling-specific (strength) training, which means training with higher resistance and lower cadence. 1 This is intended to improve strength endurance due to the combination of longduration movement and increased resistance, which should positively influence the production of higher power inputs in competitive situations. [2][3][4] One of the main criticisms against strength training for cyclists is often cited as the increase in total muscle mass through hypertrophic effects, although this is not necessarily the case. Increases in (maximum-) strength can also be achieved by neural adaptation processes as well as other factors. ...

Krafttraining im Radsport - Ein Diskussionsbeitrag zu Struktur, Anpassung und Trainingsmethoden

... The results will be presented in further reports. Discussion -Studies have shown that regular exercise helps to prevent pain (Sulejanov, 2009, Lizier et al., 2012, Washif et al., 2019 and it has been found that pain is worsened by Covid (Serrano-Ibáñez et al., 2021). Furthermore, as for the beneficial effect of isometric exercise on the body (Rio et al., 2017, Noorkõiv et al., 2015, Schott et al., 1995, this methodology differs in that it can be performed every day and in any place (gyms, medical centers, homes, and even at work). ...

Using stochastic resonance and strength training as part of a rehabilitation programme for recurrent low back pain treatment: A case study

Journal of Exercise Rehabilitation

... Pada tabel 5: Hasil uji regresi sederhana menunjukkan bahwa kekuatan otot lengan berkontribusi terhadap kemampuan ketepatan servis. Untuk melakukan servis yang baik dibutuhkan kekuatan otot lengan yang mempuni agar menghasilkan servis yang keras dan berputar, sebagaimana dinyatakan oleh (Brkic et al., 2004) kekuatan otot lengan digunakan untuk melakukan gerakan yang eksplosif. Kemampuan untuk menggerakkan lengan ini dipengaruhi oleh kontraksi otot-otot yang bekerja untuk menggerakkan lengan. ...

Arm Muscle HSP70 Response to Strenght Training
  • Citing Article
  • May 2004

Medicine and Science in Sports and Exercise

... Generally sensorimotor or balance training programs are prescribed to improve balance ability. According to Teichmann et al. (2018), when sensorimotor or balance training has been incorporated into rehabilitation programs which can improve static and dynamic balance in both athletic and non-athletic populations. However, these rehabilitative exercises often represent relatively slow perturbations to human sensorimotor function (>350 ms), while empirical observations suggest that injuries occur in a time span of between 17 and 50 milliseconds after initial ground contact. ...

A Three Week Unexpected Disturbance Program Improves Physical Performance of Elite Female Athletes

Journal of Sport Rehabilitation

... The primary cause of ineligibility was not targeting participants at risk of or with sarcopenia. Finally, 21 articles [25][26][27][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] were included in this systematic review ( Figure 1). The characteristics of the included studies are shown in Table 1. ...

Sensory-motor training targeting motor dysfunction and muscle weakness in long-term care elderly combined with motivational strategies: a single blind randomized controlled study

European Review of Aging and Physical Activity

... The remaining 27 full texts were read, of which 9 articles were included in this systematic review ( Figure 1). Three articles originated from Germany (4,46,47), and six from Switzerland 1 (16,19,30,36,48,49). Six trials were designed as pilot study (16,19,30,36,48,49) and three as randomized controlled trials (4,46,47). ...

Preliminary inconclusive results of a randomised double blinded cross-over pilot trial in long-term-care dwelling elderly assessing the feasibility of stochastic resonance whole-body vibration

European Review of Aging and Physical Activity

... These vibrations are characterized by direction, frequency, magnitude, duration, and number of bouts [86]. WBV has been shown to be a feasible alternative for exercise in populations unable to perform sufficient physical activity due to physical and/or cognitive impairments, such as (vulnerable) older adults [6,67] and older people with dementia [33]. Adherence rates for WBV in these groups were high, ranging from 85 % to 96 %. ...

Feasibility and effects of applying stochastic resonance whole-body vibration on untrained elderly: A randomized crossover pilot study

BMC Geriatrics