Este estudo analisou experimentalmente as propriedades de tração no local da neurorrafia em nervos ciáticos seccionados dos porcos. Trata-se de um estudo comparativo entre quatro técnicas de suturas. Foram utilizados 25 nervos ciáticos distribuídos em cinco grupos com cinco nervos cada, de acordo com o tipo de técnica de sutura. Grupo 1: grupo controle composto por nervos, sem lesão; Grupo 2: com nervos lesionados submetidos à sutura epineural; Grupo 3: com nervos lesionados submetidos à sutura epineural e reforço com duas suturas extra lesionais; Grupo 4: composto por nervos lesionados submetidos à sutura epineural e reforço com Ultrapro® (Tela Cirúrgica Sintética não Absorvível) e Grupo 5: com nervos lesionados submetidos à sutura epineural reforçada com duas veias com suturas extra lesionais. A força máxima (N), deformação de ruptura (mm) e energia na força máxima (N.mm) foram medidos em ensaios mecânicos de tração em máquina universal de teste. Os resultados mostraram que não houve diferença estatística entre os Grupos 3 e 4 e Grupos 2 e 5. A sutura do Grupo 3 apresentou maior resistência a tração, maior capacidade de absorver energia. Conclui-se que a técnica de sutura utilizada no Grupo 3 alcançou melhor desempenho. / This study aimed to analyze experimentally, in the laboratory, the tensile properties at the neurorrhaphy site on sectioned sciatic nerves of pigs. A comparative study of four suture techniques. Twenty-five sciatic nerves were used. They were randomly distributed into 5 groups with 5 nerves each, according to the type of suturing technique. Group 1, Control group, consisting of nerves, without injury. Group 2, with injured nerves submitted to epineural suture. Group 3, with injured nerves submitted to epineural suture and reinforcement using 2 extralesional sutures. Group 4, composed of injured nerves submitted to epineural suture and reinforcement with Ultrapro® (Synthetic Non-Absorbable Surgical Patch). And Group 5, with injured nerves submitted to reinforced epineural suture with two veins using extralesional sutures. Maximum force (N), rupture deformation (mm), and energy at maximum force (N.mm) were measured in mechanical trials using a universal test machine. The results showed that there was no statistical difference between Groups 3 and 4 and between Groups 2 and 5. The Group 3 suture presented greater tensile strength, greater capacity to absorb energy. It was concluded that the suture technique used in group 3 achieved better performance.

La lombalgie (LBP) touche 80% de la population mondiale adulte et devient chronique dans 10 à 15% des cas. Pour la grande majorité des cas adultes (85%), aucune cause ne peut être clairement identifiée pour expliquer ces douleurs et l’on parle alors de lombalgie chronique « non-spécifique » (NSCLBP). Chez l’enfant et l’adolescent, la prévalence de la NSCLBP est semblable à celle de l’adulte. Malgré la faible incidence de pathologies graves associées, la lombalgie de l’enfant et de l’adolescent implique, souvent dans sa prise en charge diagnostique, une exposition augmentée aux radiations et un stress parental important. Cependant, la présence d’anomalies radiologiques est aussi fréquente dans la population asymptomatique que dans la population avec NSCLBP. Ceci remet en question l’intérêt clinique de la radiologie pour dépister une cause possible de NSCLBP. Dans ce contexte, il est nécessaire d’identifier de nouveaux outils, si possible non-irradiants et peu coûteux, pour identifier des caractéristiques spécifiques aux enfants et adolescents souffrant de NSCLBP et ainsi améliorer la compréhension de cette pathologie.L’analyse électromyographique (EMG) de l’activité des muscles paravertébraux lombaires s’est avérée cliniquement pertinente dans la population adulte pour discriminer les patients souffrant de NSCLBP des participants asymptomatiques. Plusieurs paramètres EMG enregistrés lors de différentes tâches ont été identifiés chez l’adulte pour caractériser les participants NSCLBP. Les paramètres EMG des muscles lombaires les plus couramment rapportés dans la littérature sont : un temps de maintien réduit ainsi qu’une fatigue musculaire accélérée pendant le test d’endurance des muscles extenseurs du tronc, la réduction ou l’absence du phénomène de flexion-relaxation (FRP) pendant la tâche de flexion maximale du tronc ainsi qu’un pattern atypique supportant l’hypothèse de précaution pendant la marche à différentes vitesses. Si ces caractéristiques EMG spécifiques aux patients souffrant de NSCLBP ont été bien établies chez l’adulte, la question est désormais de savoir ce qu’il en est chez l’enfant et l’adolescent souffrant de NSCLBP.Dans ce contexte clinique, l’objectif de ce travail doctoral était d’évaluer les caractéristiques EMG décrites ci-dessus dans une cohorte d’enfants et d’adolescents souffrant de NSCLBP en comparaison à des participants asymptomatiques (CTRL). Pour y répondre, plusieurs études complémentaires ont été effectuées.Dans leur ensemble, les travaux de cette thèse de doctorat ont montré que les phénomènes EMG reportés dans une population adulte avec NSCLBP ne sont pas retrouvés dans une population pédiatrique avec NSCLBP. Ces résultats remettent en question le diagnostic et la prise en charge actuelle des enfants et adolescents souffrant de NSCLBP, qui est, à ce jour, calquée sur le modèle adulte. Des études supplémentaires sont cependant nécessaires pour confirmer ces résultats sur une cohorte plus importante. Il serait aussi intéressant d’évaluer une même cohorte à partir de l’enfance jusqu’à l’âge adulte afin d’évaluer quels facteurs pourraient prédire l’apparition des phénomènes rapportés dans la littérature adulte. / The majority of the worldwide population (80%) suffers from low back pain (LBP) over life. LBP becomes chronic (CLBP) in 10 to 15% of (all) adult cases yielding important functional and socio-economic adverse repercussions. The majority of LBP (85%) is classified as “non-specific” (NSCLBP), i.e. with an absence of any identified cause. LBP prevalence on children and adolescents is comparable to adults. Despite the low incidence of serious associated diseases, the fear of missing them increased patient’s exposure to radiation. However, an absence of significant correlation between radiology changes in the lower spine and low back pain was reported for school children. In this context, it is necessary to identify new tools, if possible non-irradiating and inexpensive, to identify specific characteristics of children and adolescents suffering from NSCLBP and thus improve the understanding of this pathology.An interesting tool, highlighted in adult population, is to evaluate surface electromyography (EMG) of low back muscles. Existing EMG phenomena were reported to discriminate adults with and without NSCLBP: reduced trunk muscle endurance, absence of flexion-relaxation phenomenon and guarding hypothesis during gait at different velocities. These EMG characteristics have not yet been confirmed for children and adolescents suffering of NSCLBP.This clinical context justifies the present doctoral work. The aim was to evaluate EMG characteristics in children and adolescents with NSCLBP in comparison with control participants. To achieve these objectives, several complementary studies were successively conducted.Taken together, the results of this doctoral work showed that the EMG characteristics frequently reported for NSCLBP in adults were absent or reduced in children and adolescent suffering from NSCLBP. These findings are inconsistent with the existing literature on adults and might affect the future therapeutic management of children and adolescents with NSCLBP, which is, to date, an imitation of the adult model. It would be interesting to confirm these results on the basis of a larger cohort and to reassess the same children and adolescents in adulthood to identify whether the EMG phenomenon, as known in NSCLBP adults, appears over time.

Management and control of the low back pain as an important health problem in the industrial societies necessitates to investigate how the risk of this disease is affected by aging. Since the abnormalities of the lumbopelvic kinematics are related to the existence or risk of low back injuries, the objective of this dissertation was set to find the age-related differences in lumbopelvic kinematics when performing basic trunk motions reaching to range of motion in different anatomical planes. A cross-sectional study was designed where sixty asymptomatic individuals between 20–70 years old with no confounding health condition, no current or previous highly physically demanding occupation and a body mass index between 22 and 30, were divided in five equally-sized and gender-balanced age groups, and attended two sessions of data collection to perform three repetitions of self-selected slow and fast trunk forward bending and backward return, as well as one left and right lateral bending and axial twist. Following an extensive literature review, the lumbar contribution (LC) to the trunk motion, the mean absolute relative phase (MARP) between the thoracic and pelvic motions as well as variation in MARP under repetitive motions, denoted by deviation phase (DP) were selected and used for the assessment of age-related differences in lumbopelvic kinematics during forward bending and backward return tasks. Lumbopelvic kinematics during the lateral bending and axial twist tasks were assessed using the lumbar and pelvic ranges of motion (ROMs) and coupled motion ratios (CMRs) as respectively the maximum flexion/rotation in the primary (i.e., intended) and the secondary (i.e., coupled) planes of trunk motion, where the latter was normalized to the conjugate ROM for better comparison. The results showed age-related differences between the age groups above and under 50 years of age generally. A smaller LC during the forward bending and backward return tasks were observed in the older versus younger age groups, suggesting that the synergy between the active and passive lower back tissues is different between the older and younger people, which may affect the lower back mechanics. Also, smaller MARP and DP suggesting a more in-phase and more stable lumbopelvic rhythm were observed in the older versus younger age groups, which may be a neuromuscular strategy to protect the lower back tissues from excessive strain, in order to reduce the risk of injury. Furthermore, the coupled motion of lumbar spine in the transverse plane during the lateral bending to the left, and the coupled motion of pelvis in the sagittal plane during the axial twist to the right were larger in older versus younger age groups. In summary, the lumbopelvic kinematics changes with aging, especially after the age of 50 which implies alterations in the active and passive tissue responses to the task demands, as well as the neuromuscular control patterns. Drawing a conclusion regarding ii the effect of aging on the risk of low back pain from these results requires a further detailed knowledge on age-related differences in spinal active and passive tissue properties.

Myocardial infarction (i.e., a heart attack) is the most common heart disease in the United States. Mitral valve regurgitation, or the backflow of blood into the atrium from the left ventricle, is one of the complications associated with myocardial infarction. In this dissertation, a validated model of a sheep heart that has suffered myocardial infarction has been employed to study mitral valve regurgitation. The model was rebuilt with the knowledge of geometrical changes captured with MRI technique and is assigned with anisotropic, inhomogeneous, nearly incompressible and highly non-linear material properties. Patch augmentation was performed on its anterior leaflet, using a simplified approach, and its posterior leaflet, using a more realistic approach. In this finite element simulation, we virtually installed an elliptical patch within the central portion of the posterior leaflet. To the best of the author’s knowledge, this type of simulation has not been performed previously. In another simulation, the effect of patch within the anterior leaflet was simulated. The results from the two different surgical simulations show that patch implantation helps the free edges of the leaflets come close to one another, which leads to improved coaptation. Additionally, the changes in chordal force distributions are also reported. Finally, this study answers a few questions regarding mitral valve patch augmentation surgeries and emphasizes the importance of further investigations on the influence of patch positioning and material properties on key outcomes. The ultimate goal is to use the proposed techniques to assess human models that are patient-specific.

Change in papillary muscle motion as a result of left ventricular (LV) remodeling after posterolateral myocardial infarction is thought to contribute to ischemic mitral regurgitation. A finite element (FE) model of the LV was created from magnetic resonance images acquired immediately before myocardial infarction and 8 weeks later in a cohort of 12 sheep. Severity of mitral regurgitation was rated by two-dimensional echocardiography and regurgitant volume was estimated using MRI. Of the cohort, 6 animals (DC) received hydrogel injection therapy shown to limit ventricular remodeling after myocardial infarction while the control group (MI) received a similar pattern of saline injections. LV pressure was determined by direct invasive measurement and volume was estimated from MRI. FE models of the LV for each animal included both healthy and infarct tissue regions as well as a simulated hydrogel injection pattern for the DC group. Constitutive model material parameters for each region in the FE model were assigned based on results from previous research. Invasive LV pressure measurements at end diastole and end systole were used as boundary conditions to drive model simulations for each animal. Passive stiffness (C) and active material parameter (Tmax) were adjusted to match MRI estimations of LV volume at end systole and end diastole. Nodal positions of the chordae tendineae (CT) were determined by measurements obtained from the excised heart of each animal at the terminal timepoint. Changes in CT nodal displacements between end systole and end diastole at 0 and 8-week timepoints were used to investigate the potential contribution of changes in papillary muscle motion to the progression of ischemic mitral regurgitation after myocardial infarction. Nodal displacements were broken down into radial, circumferential, and longitudinal components relative to the anatomy of the individual animal model. Model results highlighted an outward radial movement in the infarct region after 8 weeks in untreated animals, while radial direction of motion observed in the treated animal group was preserved relative to baseline. Circumferential displacement decreased in the remote region in the untreated animal group after 8 weeks but was preserved relative to baseline in the treated animal group. MRI estimates of regurgitant volume increased significantly in the untreated animal group after 8 weeks but did not increase in the treated group. The results of this analysis suggest that hydrogel injection treatment may serve to limit changes in papillary muscle motion and severity of mitral regurgitation after posterolateral myocardial infarction.

Cette thèse a porté sur la construction de densités d'énergie de déformation permettant de décrire le comportement non linéaire de matériaux anisotropes tels que les tissus biologiques souples (ligaments, tendons, parois artérielles etc.) ou les caoutchoucs renforcés par des fibres. Les densités que nous avons proposées ont été élaborées en se basant sur la théorie mathématique des polynômes invariants et notamment sur le théorème de Noether et l'opérateur de Reynolds. Notre travail a concerné deux types de matériaux anisotropes, le premier avec une seule famille de fibre et le second avec quatre familles. Le concept de polyconvexité a également été étudié car il est notoire qu'il joue un rôle important pour s'assurer de l'existence de solutions. Dans le cas d'un matériau comportant une seule famille de fibre, nous avons démontré qu'il était impossible qu'une densité polynomiale de degré quelconque puisse prédire des essais de cisaillement avec un chargement parallèle puis perpendiculaire à la direction des fibres. Une densité polynomiale linéaire combinée avec une fonction puissance a permis de contourner cet obstacle. Dans le cas d'un matériau comportant quatre familles de fibre, une densité polynomiale a permis de prédire correctement des résultats d'essai en traction bi-axiale extraits de la littérature. Les deux densités proposées ont été implémentées avec la méthode des éléments finis et en langage C++ dans le code de calcul universitaire FER. Pour se faire, une formulation lagrangienne totale a été adoptée. L'implémentation a été validée par des comparaisons avec des solutions analytiques de référence que nous avons exhibée dans le cas de chargements simples conduisant à des déformations homogènes. Des exemples tridimensionnels plus complexes, impliquant des déformations non-homogènes, ont également été étudiés. / This thesis has focused on the construction of strain energy densities for describing the non-linear behavior of anisotropic materials such as biological soft tissues (ligaments, tendons, arterial walls, etc.) or fiber-reinforced rubbers. The densities we have proposed have been developed with the mathematical theory of invariant polynomials, particularly the Noether theorem and the Reynolds operator. Our work involved two types of anisotropic materials, the first with a single fiber family and the second with a four-fiber family. The concept of polyconvexity has also been studied because it is well known that it plays an important role for ensuring the existence of solutions. In the case of a single fiber family, we have demonstrated that it is impossible for a polynomial density of any degree to predict shear tests with a loading parallel and then perpendicular to the direction of the fibers. A linear polynomial density combined with a power-law function allowed to overcome this problem. In the case of a material made of a four-fiber family, a polynomial density allowed to correctly predict bi-axial tensile test data extracted from the literature. The two proposed densities were implemented in C++ language in the university finite element software FER by adopting a total Lagrangian formulation. This implementation has been validated by comparisons with reference analytical solutions exhibited in the case of simple loads leading to homogeneous deformations. More complex three-dimensional examples, involving non-homogeneous deformations, have also been studied.

Understanding the mechanisms of cardiovascular disease progression is essential in developing novel therapies to combat this disease that contributes to 1 in 3 deaths in the United States every year. Endothelial dysfunction and its effects on vessel growth and remodeling are key factors in the progression and localization of atherosclerosis. Much of our understanding in this area has come from in-vivo and in-vitro experiments however perfused organ culture systems provide an alternative approach. Organ culture systems can provide a more controlled mechanical and biochemical environment compared to in-vivo models. This study focused on furthering development of this organ culture model by introducing a novel device to produce flow waveforms at the high frequencies and low mean flows seen in the mouse model. The device is capable of monitoring pressure, flow, diameter, and nitric oxide release. Each individual mechanism in the system was integrated via a computer using a custom Labview interface. The performance of the device was characterized by developing physiologic, physiologic-oscillatory, low, low-oscillatory waveforms and sinusoidal waveforms at frequencies ranging from 1-10 Hz. Overall this system provides a robust model to test the effects of flow on various biological markers both in real-time and after culture.

Previous research in the Ouachita Mountains, Arkansas suggests that, on relatively thin soils overlying bedrock, individual trees locally thicken the regolith by root penetration into bedrock. However, that work was conducted mainly in areas of strongly dipping and contorted rock, where joints and bedding planes susceptible to root penetration are more common and accessible. This project extended this concept to the Cumberland Plateau, Kentucky, with flat, level-bedded sedimentary rocks. Spatial variability of soil thickness was quantified at three nested spatial scales, and statistical relationships with other potential influences of thickness were examined. In addition, soil depth beneath trees was compared to that of non-tree sites by measuring depth to bedrock of stumps and immediately adjacent sites. While soil thickness beneath stumps was greater in the Ouachita Mountains compared to the Kentucky sites, there were no statistically significant differences in the difference between stump and adjacent sites between the two regions. In both regions, however, soils beneath stumps are significantly deeper than adjacent soils. This suggests the local deepening effects of trees occur in flat-bedded as well as steeply dipping lithologies. Regression results at the Cumberland Plateau sites showed no statistically significant relationship between soil depth and geomorphic or stand-level ecological variables, consistent with a major role for individual tree effects. Nested analysis of variance between 10 ha stands, 1.0 ha plots, and 0.1 ha subplots indicates that about 67 percent of total depth variance occurs at, or below, the subplot level of organization. This highly localized variability is consistent with, and most plausibly explained by, individual tree effects. The effects of biomechanical weathering by trees are not limited to areas with strongly dipping and contorted bedrock. Variability of soil depth in the Cumberland Plateau is likely influenced by positive feedbacks from tree root growth, that these interactions occur over multiple generations of growth, and that the effects of trees are the dominant control of local soil thickness. Since lateral lithological variation was minimal, this study also provides evidence that the positive feedback from biomechanical weathering by trees leads to divergent development of soil thickness.

Background Whole-body vibration (WBV) as a training modality is established in the fields of sport, fitness, rehabilitation, and clinical intervention. WBV exercises are performed thereby while standing on a motor driven oscillating platform device. Therefore, the scientific interest in WBV is a steadily increasing field in sports science and research. It has been shown that WBV training elicits various biological and physiological effects in men. Nevertheless, there are only a small number of studies examining WBV effects on neuromuscular performance of the lower extremities in elderly people. Furthermore, the results of these studies show many discrepancies that may be caused by limitations referring to the different applied training protocols and vibration loads. In addition, there is still a deficit of information for effective but safe recommendations for WBV application for trunk and neck muscles. Therefore, this doctoral thesis deals with three major aspects of WBV as an exercise modality in strength training: (1) the recommendation of optimal vibration loads (VbLs) for the lower extremities as an essential element of the WBV exercise parameters in older adults, (2) the evaluation of these VbLs in a WBV training intervention for elderly people with regard to feasibility and chronic effects on neuromuscular performance of the lower limbs, and (3) the allocation of information for effective but safe advices for VbLs for trunk and neck muscles. These aspects are further specified toward five hypotheses (H1, H2, H3, H4, and H5) by findings and limitations of the current state of literature. Methods The five hypotheses are evaluated within three research papers (studies 1 to 3). The first study (S1) evaluated the optimal VbL determined by the combination of three biomechanical variables (vibration frequency, vibration amplitude, and knee angle) in older adults (H1). Therefore, the neuromuscular activity of the quadriceps femoris and hamstring muscles in 51 healthy subjects were measured during WBV exposure using surface electromyography (EMG). Maximal voluntary contractions (MVCs) were conducted prior to the measurements to normalise the EMG signals. A three-way mixed ANOVA was performed to analyse the different effects of the biomechanical variables on muscle activity. Study 2 (S2) represents a randomised controlled trial to assess the results of S1 implemented in a WBV training protocol and therefore to evaluate the feasibility and effectiveness of a six-week WBV intervention (H2, H3, and H4). A total of 21 subjects was allocated randomly into either a WBV training or control group. While the WBV group completed a six-week WBV training programme the control group was asked not to change their current level of physical activity during the study. Before and after the intervention period, jump height was measured during a countermovement jump (CMJ). In addition, isokinetic knee extension and flexion strength parameters were recorded using a motor-driven dynamometer. The Borg scale for ratings of perceived exertion (RPE scale) was used to evaluate the intensity of WBV exercises within each training session. Changes from pre- to posttest were analysed by a paired sample t-test (within-group comparisons) and independent sample t-test (between-group comparisons). The intention of study 3 (S3) was to analyse the impact of biomechanical variables on neuromuscular activity of different trunk and neck muscles during WBV (H5) filling the lack of information in current literature. Those biomechanical variables were assumed, which current literature suggests as having the lowest risk of negative side effects on the head. Surface EMG was used to record the neuromuscular activity in 28 healthy subjects. EMG signals were normalised to prior measured MVC. Different effects of the biomechanical variables were analysed by an ANOVA for repeated measurements. Results The findings of S1 showed that the biomechanical variables affect the level of neuromuscular activity of thigh muscles in older adults in different dimensions which confirms H1. The maximum levels of muscle activity were significantly reached at high amplitude and high frequency, whereas the factor “knee angle” only significantly affected the quadriceps femoris. Furthermore, WBV led to a higher muscle activation of the quadriceps femoris (74.1 % MVC) than of the hamstring muscles (27.3 % MVC). The main findings in S2 were an increased multi-joint strength performance of the lower limbs during a countermovement jump in the WBV group, whereas values of the control group remained unchanged after the intervention, thus confirming H2. There were no statistically significant differences in isokinetic maximal strength, mean power, or work values in knee extension or flexion in both groups (rejecting H3). In addition, the subjective perceived exertion of the WBV exercises and respective training parameters ranged between moderate rating levels of 7 and 13 of the Borg scale and indicate WBV intervention as a feasible and safe training program for elderly people, which is consistent with H4. Finally, the outcomes of S3 confirmed H5 as the biomechanical variables affect the level of neuromuscular activity of the trunk and neck in different dimensions. The maximum levels of muscle activity were significantly reached at high amplitude and high frequency, while knee angles had similar effects on the VbL. WBV led to a higher muscle activation of the lower back muscles (27.2% MVC) than of neck muscles (8.5 % MVC) and the abdominal muscles (3.6 % MVC). Conclusion A maximised VbL for WBV training in older adults depends on specific combinations of the biomechanical variables (vibration frequency, vibration amplitude, and knee angle). In addition, a WBV training based on this age-specific high VbL is a feasible, suitable and effective training program for elderly people to prevent age-related reduction of muscle performance in the lower extremities. Furthermore, the combination of biomechanical variables recommended in literature as safe for preventing harmful transmissions to the head, only elicit low to moderate muscle activation of the upper body. The findings of this thesis represent fundamental research in the field of WBV and may help to improve further research in this area. Finally, this thesis may help coaches and therapists to enhance the quality of WBV training in practical application. / Hintergrund Ganzkörpervibration (Whole-Body Vibration, WBV) hat sich als Trainingsanwendung im Sport-, Fitness, Rehabilitationsbereich und klinischen Bereich etabliert, wobei die Übungen dabei im Stehen auf einer Vibrationsplatte durchgeführt werden. In diesem Zusammenhang ist auch das wissenschaftliche Interesse am Vibrationstraining ein stetig wachsendes Feld in den Bereichen der Sportwissenschaft und Forschung. Bisher konnte gezeigt werden, dass Vibrationstraining verschiedene biologische als auch physiologische Reaktionen beim Menschen hervorruft. Dennoch gibt es nur wenige Untersuchungen, die sich mit den Auswirkungen des Vibrationstrainings auf die neuromuskuläre Leistung der unteren Extremitäten bei älteren Menschen beschäftigen. Des Weiteren weißen die Ergebnisse dieser wenigen Studien viele Widersprüchlichkeiten auf, welche durch die unterschiedlich verwendeten Trainingsvorgaben und Vibrationsbelastungen verursacht sein könnten. Darüber hinaus besteht noch ein großes Defizit an grundlegenden Informationen hinsichtlich effektiver, aber dennoch sicherer Vorgaben in der Anwendung des Vibrationstrainings im Bereich der Rumpf- und Nackenmuskulatur. Vor diesem Hintergrund beschäftigt sich die vorliegende Dissertation mit drei wesentlichen Aspekten des Vibrationstrainings: (1) die Empfehlung von optimalen Vibrationsbelastungen (VbL) als wesentlicher Bestandteil des Vibrationstrainingsplans der unteren Extremitäten älterer Menschen, (2) die Evaluierung dieser VbL anhand einer auf Vibrationstraining basierter Intervention mit älteren Menschen hinsichtlich Durchführbarkeit und Auswirkungen auf die neuromuskuläre Leistung der unteren Gliedmaßen, und (3) Angaben für effektive und sichere VbL für Rumpf- und Nackenmuskulatur bereitzustellen. Mit der Aufarbeitung von Ergebnissen und Defiziten des aktuellen Forschungsstands werden diese Aspekte durch die Formulierung von fünf Hypothesen (H1, H2, H3, H4, and H5) weiter spezifiziert. Methodik Die fünf Hypothesen werden in drei wissenschaftlichen Veröffentlichungen (Studie 1 bis 3) untersucht. Die erste Studie (S1) befasste sich mit der optimalen VbL für ältere Personen (H1), welche durch die Kombination von drei biomechanischen Variablen (Vibrationsfrequenz, Vibrationsamplitude und Kniewinkel) bestimmt wird. Hierzu wurde die neuromuskuläre Aktivität der vorderen und hinteren Oberschenkelmuskulatur von 51 gesunden Probanden unter Vibration mittels Oberflächen-Elektromyografie (EMG) gemessen. Vor den Messungen wurden maximale muskuläre Kontraktionen durchgeführt, um die EMG zu normalisieren. Um die unterschiedlichen Auswirkungen der biomechanischen Variablen zu analysieren wurde eine drei-faktorielle Varianzanalyse durchgeführt. Studie 2 (S2) entspricht einer randomisierten kontrollierten Studie, welche die Ergebnisse aus S1 in einem Trainingsplan verwendet, um die Durchführbarkeit und Effektivität eines sechs wöchigen Vibrationstrainings zu untersuchen (H2, H3, und H4). Hierfür wurden 21 Probanden zufällig einer Vibrationstrainings- oder einer Kontrollgruppe zugeteilt. Während die Vibrationsgruppe ein sechs wöchiges Vibrationstraining absolvierte, wurden die Teilnehmer der Kontrollgruppe gebeten ihre körperliche Aktivität während des Studienzeitraums nicht zu verändern. Vor und nach dem Untersuchungszeitraums wurde die Sprunghöhe während eines „countermovement jump“ (CMJ) erfasst. Weiterhin wurden isokinetische Kraftmessgrößen der Kniegelenkbeugung und –streckung an einem Dynamometer ermittelt. Die Borgskala zur Erfassung des subjektiven Belastungsempfindens wurde eingesetzt, um die Intensität der Übungen des Vibrationstrainings innerhalb einer Trainingseinheit zu messen. Veränderungen der Messgrößen zwischen Eingangs- und Abschlusstest wurden statistisch mit einem t-Test für abhängige (innerhalb einer Gruppe) und einem t-Test für unabhängige Stichproben (zwischen den Gruppen) untersucht. Ziel der dritten Studie (S3) war es den Einfluss der biomechanischen Variablen auf die muskuläre Aktivierung verschiedener Rumpf- und Nackenmuskeln (H5). Hierzu wurden solche biomechanische Variablen ausgesucht, welche laut derzeitigem Wissensstand jeweils das geringste Risiko von Nebenwirkungen für den Kopf ausüben. Mittels Oberflächen-EMG wurde die muskuläre Aktivität von 28 Probanden erfasst. EMG Signale wurden zu vorangegangenen MVC Messungen normalisiert. Die Unterschiedlichen Effekte der biomechanischen Variablen wurden mittels einer Varianzanalyse für Messwiederholungen analysiert. Ergebnisse Die Ergebnisse von S1 konnten zeigen, dass die biomechanischen Variablen den neuromuskulären Aktivierungsgrad der Oberschenkelmuskulatur bei älteren Personen unterschiedlich beeinflussen und somit H1 bestätigen. Der höchste Grad der Aktivierung wurde deutlich mit einer großen Amplitude und hohen Frequenz erreicht, wobei der Kniewinkel ausschließlich die vordere Oberschenkelmuskulatur beeinflusst. Zudem, führte der Vibrationseinfluss zu einer größeren Muskelaktivität der Oberschenkelvorderseite (74.1 % MVC) als der –rückseite (27.3 % MVC). Die Resultate von S2 hinsichtlich des CMJ Tests bestätigen H2, da es in der Vibrationstrainingsgruppe zu einer gesteigerten gelenksübergreifender Kraftleistung in den Beinen kam, aber keine Veränderungen in der Kontrollgruppe feststellbar waren. Hingegen kam es in keiner Gruppe zu statistisch signifikanten Veränderungen der isokinetischen Messgrößen (Maximalkraft, Kraftleistung, Muskelarbeit), wodurch H3 abgelehnt wird. Das subjektive Belastungsempfinden der Übungen und des Belastungsgefüges des Vibrationstrainings liegt zwischen moderaten Bewertungsstufen von 7 bis 13 der Borgskala und weist daraufhin, dass Vibrationstraining ein praktikables und sicheres Übungsprogramm für ältere Menschen ist und somit H4 bestätigt. Die Ergebnisse von S3 konnten H5 bestätigen, da die biomechanischen Variablen den neuromuskulären Rumpf- und Nackenmuskulatur unterschiedlich beeinflussen. Der höchste Grad der Aktivierung wurde deutlich mit einer großen Amplitude und hohen Frequenz erreicht, wobei der Kniewinkel sich ähnlich auf die VbL auswirkt. Der Vibrationsstimulus führte zudem zu einer höheren Aktivierung der unteren Rückenmuskulatur (27.2% MVC) als der Nacken- (8.5 % MVC) und Bauchmuskulatur (3.6 % MVC). Schlussfolgerungen Die maximale muskuläre Belastung älterer Personen in einem Vibrationstrainings hängt von bestimmten Kombinationen der biomechanischen Variablen (Vibrationsfrequenz, Vibrationsamplitude und Kniewinkel). Zudem ist ein Vibrationstraining, das auf altersspezifischen Vibrationsbelastungen basiert ein machbares, angemessenes und effektives Trainingsprogramm für älteren Menschen, um einem altersbedingten Abnehmen der muskulären Leistungsfähigkeit vorzubeugen. Weiterhin führt die Verbindung von biomechanischen Variablen, welche laut bisherigem Forschungsstand als sicher gegen schädliche Vibrationsübertragungen zum Kopf gelten, nur zu leichten bis moderaten Muskelaktivierung im Oberkörper. Die Ergebnisse dieser Dissertation liefern einen Beitrag zur Grundlagenforschung auf dem Gebiet des Vibrationstrainings und können weiteren Forschungsarbeiten hilfreich sein. Darüber hinaus kann diese Arbeit helfen die Qualität von Vibrationstrainingsangeboten zu verbessern und somit zum praktischen Nutzen beitragen.

Background: Football (Soccer) is arguably the most popular sport in the international sporting arena. A survey conducted by FIFA (Fédération International de Football Association) (FCPA, 2000) indicated that there are 240 million people who regularly play soccer around the world. Internationally, there are 300 000 clubs with approximately 1.5 million teams. In South Africa, there were 1.8 million registered soccer players in 2002/2003 (Alegi, 2004). Although youth players are predominantly amateurs and have no financial value for their clubs or schools, their continued health and safety are still of vital importance. There are some clubs which contract development players at 19 years of age in preparation for playing in their senior sides and these young players should be well looked after, to ensure a long career playing soccer. Being able to predict injuries and prevent them would be of great value to the soccer playing community. Aims: The main aim of this research was to create a statistical predictive equation combining biomechanics, balance and proprioception, plyometric strength ratios of ND/Bil (Non dominant leg plyometrics/ Bilateral plyometrics), D/Bil (Dominant leg plyometrics/ Bilateral plyometrics) and ND+D/Bil (Non dominant leg + dominant leg plyometrics/ Bilateral plyometrics) and previous injuries to determine a youth soccer player's risk of the occurrence of lower extremity injuries. In the process of reaching this aim it was necessary to record an epidemiological profile of youth soccer injuries over a two season period. It was also necessary to record a physical profile of, and draw comparisons between, school and club youth soccer players. Following the creation of the prediction model a preventative training programme was created for youth soccer players, addressing physical shortcomings identified with the model. Design: A prospective cohort study Subjects: Schoolboy players from two schools in the North West Province, as well as club players from three age groups were used for this study. Players from the U/16 and U/18 teams in the two schools were tested prior to the 2007 season. Players from the U/17, U/18 and U/19 club development teams were tested prior to the 2008 season. The combined total number of players in the teams amounted to 110 players. Method: The test battery consisted of a biomechanical evaluation, proprioceptive and plyometric testing and an injury history questionnaire. The Biomechanical evaluation was done according to the protocol compiled by Hattingh (2003). This evaluation was divided into five regions with a dysfunction score being given for each region. A single limb stance test was used to test proprioception. A Sergeant jump test was utilised using the wall mark method to test plyometric jumping height. A previous injury questionnaire was also completed on all players prior to testing. Test subjects from the schools were tested with the test battery prior to commencement of the 2007 season. The testing on the club teams was undertaken prior to the 2008 season. Injuries were recorded on the prescribed injury recording form by qualified Physiotherapists at weekly sports injury clinics at each of the involved schools and clubs. The coaching staff monitored exposure to training activities and match play on the prescribed recording forms. These training and match exposure hours were used, along with the recorded injuries for creating an epidemiological profile. Injuries were expressed as the amount of injuries per 1000 play hours. Logistical regression was done by using the test battery variables as independent variables and the variable injured/not injured as dependent variable (Statsoft, 2003). This analysis created prediction functions, determining which variables predict group membership of injured and non injured players. Results: There were 110 youth players involved in the research study from seven teams and four different age groups. There were two groups of U/16 players, an U/17 group, three U/18 groups and an U/19 group. The players were involved in a total of 7974 hours of exposure to training and match play during the seasons they were monitored. The average age of the players was 16.6 years. The majority of players were right limb dominant (83.6%) and 65.7% of players failed a single limb stance test. The mean jump height for both legs combined was 33.77cm, with mean heights of 22.60cm for dominant leg jump and 22.66cm for the non dominant leg. In the biomechanical evaluation of the lower leg and foot area, the average youth player presented with adaptation of toes, normal or flat medial foot arches, a normal or pronated rear foot in standing and lying and a normal or hypomobile mid-foot joint. Between 42.7% and 51.8% of players also presenting with decreased Achilles tendon suppleness and callusing of the transverse foot arch. The youth profile for the knee area indicated that the players presented with excessive tightness of the quadriceps muscles, normal patella tilt and squint, normal knee height, a normal Q-angle, a normal VMO: VL ratio and no previous injuries. This profile indicated very little dysfunction amongst youth players for the knee area. For the hip area, the youth profile was described as follows: There was shortening of hip external rotators, decreased Gluteal muscles length, normal hip internal rotation and no previous history of injury. Between 38.2% and 62.7% of players also exhibit shortened muscle length of the adductor and Iliopsoas muscles and decreased length of the ITB (Iliotibial Band). In the Lumbo-pelvic area there was an excessive anterior tilt of the pelvis with normal lumbar extension, side flexion, rotation and lumbar saggital view without presence of scoliosis. Between 58.18% and 65.45% of players presented with an abnormal coronal view and decreased lumbar flexion. Between 41.81% and 44.54% of players also presented with leg length, ASIS, PSIS, Cleft, Rami and sacral rhythm asymmetry. The similarity of the results for these tests in all players contributed to a new variable called 'SIJ dysfunction'. This was compiled from the average of the scores for Leg length, ASIS, PSIS, Cleft, Rami and Sacral rhythm, which was also considered for inclusion in the prediction model. The neurodynamic results of youth players indicated that approximately between 44.54% and 50.91% of players presented with decreased Straight leg raise and prone knee bend tests. The total combined dysfunction scores for the left and right sides were 17.091 and 17.909 respectively, indicating that there were higher levels of dysfunction on the right side than the left. This increased unilateral dysfunction could probably be attributed to limb dominance and increased use of the one leg for kicking and passing during the game. In the epidemiological study on youth players, there were a total of 49 training injuries and 52 match injuries. The total injury rate for youth players was 12.27 injuries/1000 hours, with a total match injury rate of 37.12 injuries/1000 match hours. The combined training injury rate was 7.17 injuries/1000 training hours. 87.13% of injuries were of the lower limb area and the individual areas with the highest percentage of injuries were the Ankle (25.74%), Knee (19.80%), Thigh (15.84%) and Lower leg (14.85%).The totals for youth players indicated that sprains (30.69% of total), strains (27.72% of total) and contusions (27.72% of total) were the most common causative mechanism of injuries. The severity of injuries show 'zero day' (no time off play) injuries to be the most common type (35.64%), followed by 'slight' (1 to 3 days off play) (33.66%) and 'minor' (4 to 7 days off play) (14.85%). School players had higher injury rates than club players but the severity of injuries to club players was higher, with longer absences from play. Non-contact injuries accounted for 52.47% of the total with 46.53% being contact injuries. School players had lower levels of non-contact injuries than club players, which correlated well with lower dysfunction scores recorded for school players during the biomechanical evaluations. This demonstrated that there was a definite relationship between levels of biomechanical dysfunction and the percentage of non-contact injuries in youth players, which formed the premise of the creation of a prediction model for non-contact youth soccer injuries. The next step in the creation of a prediction model was to identify the variables that discriminated maximally between injured and non-injured players. This was done using stepwise logistic regression analysis. After the analysis, ten variables with the largest odds ratios were selected for inclusion in the prediction model to predict non-contact injuries in youth soccer players. The prediction model created from the stepwise analysis presented as follows: P (injury)= exp(-8.2483 -1.2993a + 1.8418b + 0.2485c + 4.2850d + 1.3845e + 1.3004f-1.1566g + 1.8273h-0.9460i-0.5193j) l + exp(-8.2483-1.2993a + 1.8418b+ 0.2485c + 4.2850d + 1.3845e + 1.3004f-1.1566g + 1.8273h-0.94601-0.5193J) a = Toe dysfunction b = Previous ankle injury c = Ankle dysfunction d = SIJ dysfunction e = Lumbar Extension f = Straight Leg Raise g = Psoas length h = Patella squint i = Gluteal muscle length j = Lumbar dysfunction P = probability of non contact injury exp(x) = e x , with e the constant 2.7183 In the ankle area, the toe positional test, previous ankle injury history and combined ankle dysfunction score were included in the prediction model. In the knee area, the patella squint test was included in the model. In the hip area, the Psoas component of the Thomas test was included, along with the Gluteal muscle length test. In the Lumbo-pelvic area, the SIJ dysfunction (average of Leg length, ASIS, PSIS, Rami, Cleft and Sacral rhythm tests), lumbar extension test and lumbar dysfunction scores were included in the prediction model. In the neurodynamic area, the Straight leg raise test was included in the prediction model. The prediction model therefore contained tests from all five the bio mechanical areas of the body. Overall, this model correctly predicted 86.91% of players as either injured or not-injured. The I value (effect size index for improvement over chance) of the prediction model (1=0.67), along with the sensitivity (65.52%), specificity (94.87%), overall correct percentage of prediction (86.91%) and Hosmer and Lemeshow interferential goodness-to-fit value (X 2(8) = 0.7204), all demonstrated this prediction model to be a valid and accurate prediction tool for non-contact youth soccer injuries A second prediction model, for the prediction of hip and groin injuries amongst youth players, was also created. The prediction model created from the stepwise analysis for groin injuries presents as follows: P (Groin injury)^ exp(-116.2 + 33.5383d + 14.5108k + 4.1972m + 1.9330e + 10.7006f-14.4028n + 48.8751p) l + exp(-116.2 + 33.5383d+14.5108k + 4.1972m + 1.9330e + 10.7006f-14.4028n + 48.8751p) d = SIJ dysfunction k = Previous knee injury m = Previous hip injury e = Lumbar extension f = Straight leg raise n = Limb dominance p = ND/Bil plyometric ratio P = probability of groin injury exp(x) = ex, with e the constant 2.7183 The prediction model for hip and groin injuries included the variables of SIJ dysfunction, previous knee injury, previous hip injury, lumbar extension, straight leg raise, limb dominance and the ratio of non-dominant leg to bilateral legs plyometric height. When all the validifying tests were examined, the I-value (0.64868), sensitivity (66.67%), specificity (98.01%), false negatives (1.98%), false positives (33.33%), Hosmer and Lemeshow goodness-to-fit value (X2(8) = 0.77) and the overall percentage of correct prediction (96.26%) all reflected that this model was an accurate prediction tool for hip and groin injuries amongst youth soccer players. Conclusion: This study showed that it was possible to create a prediction model for non-contact youth soccer injuries based on a pre-season biomechanical, plyometric and proprioceptive evaluation along with a previous injury history questionnaire. This model appears as follows: P (injury)= exp(-8.2483 -1.2993a + 1.8418b + 0.2485c + 4.2850d + 1.3845e + 1.3004f - 1.1566g + 1.8273h - 0.9460i - 0.5193J) l + exp(-8.2483-1.2993a+ 1.8418b + 0.2485c + 4.2850d + 1.3845e + 1.3004f-1.1566g+1.8273h-0.94601-0.5193J) a = Toe dysfunction b=Previous ankle injury c = Ankle dysfunction d= SIJ dysfunction e=Lumbar Extension f = Straight Leg Raise g = Psoas length h = Patella squint i = Gluteal muscle length j = Lumbar dysfunction P = probability of non contact injury exp(x) = ex, with e the constant 2.7183 It was also possible to create a prediction model for non contact hip and groin injuries, which appears as follows: P (Groin injury)= exp(-116.2 + 33.5383d + 14.5108k + 4.1972m + 1.9330e + 10.7006f-14.4028n + 48.8751p) l + exp(-116.2 + 33.5383d + 14.5108k + 4.1972m + 1.9330e + 10.7006f-14.4028n + 48.8751p) d = SIJ dysfunction k = Previous knee injury m = Previous hip injury e = Lumbar extension f = Straight leg raise n = Limb dominance p = ND/Bil plyo metric ratio P = probability of groin injury exp(x) = ex, with e the constant 2.7183 It was also possible to create a prediction model for non contact hip and groin injuries, which appears as follows: P (Groin injury)= exp(-116.2 + 33.5383d + 14.5108k + 4.1972m + 1.9330e + 10.7006f-14.4028n + 48.8751p) l + exp(-116.2 + 33.5383d + 14.5108k + 4.1972m + 1.9330e + 10.7006f-14.4028n + 48.8751p) d = SIJ dysfunction k = Previous knee injury m = Previous hip injury e = Lumbar extension f = Straight leg raise n = Limb dominance p = ND/Bil plyo metric ratio P = probability of groin injury exp(x) = ex, with e the constant 2.7183 Using the hip and groin prediction model, combined with the injury prediction model, injuries in youth soccer players can be predicted. The data for each player should first be substituted into the injury prediction model, to determine the chance of getting injured during the season. The data should then be substituted into the hip and groin injury prediction model, determining the chance of hip and groin injuries during the season. The results from the groin injury prediction model could then be used to exclude groin injuries amongst players. A negative result for the hip and groin injury, which showed a false negative percentage of 1.98%, could be used to determine that an injury that was predicted using the overall injury prediction model, would not be a hip and groin injury. A positive result in the groin injury test could, however, not exclude injuries to other body areas that were predicted by the overall injury prediction model, so the groin injury prediction model could only be used to exclude hip and groin injuries. / Thesis (Ph.D. (Education)--North-West University, Potchefstroom Campus, 2009.