Top

Sports Medicine

Published in:

01-08-2018 | Systematic Review

Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis

Authors: Myles Murphy, Mervyn Travers, William Gibson, Paola Chivers, James Debenham, Sean Docking, Ebonie Rio

Published in: Sports Medicine | Issue 8/2018

Abstract

Background

Mid-portion Achilles tendinopathy is prevalent within both the athletic and non-athletic populations and loading protocols for Achilles tendinopathy are effective over time, though the rate of symptom change throughout rehabilitation is unknown.

Objective

The objective of this study was to determine the rate of change in pain and function over time in patients while completing a loading protocol for mid-portion Achilles tendinopathy.

Methods

A systematic review and longitudinal meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases PubMed, CINAHL (Ovid) and CINAHL (EBSCO) were searched for articles published from inception until 31 July, 2017. Our search focused on clinical trials and cohort studies examining changes in pain and function when completing a loading protocol for mid-portion Achilles tendinopathy. The primary outcome measure assessing pain and function was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire.

Results

A total of 31 separate cohorts (24 studies) were eligible, with follow-up ranging from 2 weeks to 6 months. The data were pooled to create the mean (standard deviation) of change from baseline at each time point. The data demonstrated an improvement in pain and function as early as 2 weeks that appeared to peak at 12 weeks with a mean (standard deviation) of 21.11 (6.61) points of change on the VISA-A.

Conclusion

The improvement in pain and function during rehabilitation suggests future research should be directed toward investigating contributing mechanisms as tendon structure on imaging does not change within 2 weeks and muscular hypertrophy is not seen for at least 4 weeks following the inception of a loading protocol. Systematic Review Registry: PROSPERO registration number: CRD42017062737 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=62737)

Available only for authorised users

Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409–16. https://doi.org/10.1136/bjsm.2008.051193.CrossRefPubMed

Habets B, van Cingel RE. Eccentric exercise training in chronic mid-portion Achilles tendinopathy: a systematic review on different protocols. Scand J Med Sci Sports. 2015;25(1):3–15. https://doi.org/10.1111/sms.12208.CrossRefPubMed

van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19(5):835–41. https://doi.org/10.1007/s00167-010-1374-z.CrossRefPubMedPubMedCentral

Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50(19):1187–91. https://doi.org/10.1136/bjsports-2015-095422.CrossRefPubMedPubMedCentral

Lopes AD, Hespanhol LC, Yeung SS, Costa LOP. What are the main running-related musculoskeletal injuries? Sports Med. 2012;42(10):891–905. https://doi.org/10.1007/bf03262301.CrossRefPubMedPubMedCentral

Albers IS, Zwerver J, Diercks RL, Dekker JH, Van den Akker-Scheek I. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population: a cross sectional study. BMC Musculoskelet Disord. 2016;17(1):16. https://doi.org/10.1186/s12891-016-0885-2.CrossRefPubMedPubMedCentral

Couppe C, Svensson RB, Silbernagel KG, Langberg H, Magnusson SP. Eccentric or concentric exercises for the treatment of tendinopathies? J Orthop Sports Phys Ther. 2015;45(11):853–63. https://doi.org/10.2519/jospt.2015.5910.CrossRefPubMed

Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360–6.CrossRefPubMed

Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42–7. https://doi.org/10.1007/s001670000148.CrossRefPubMed

10.

Silbernagel KG, Thomee R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35(6):897–906. https://doi.org/10.1177/0363546506298279.CrossRefPubMed

11.

Silbernagel KG, Thomee R, Thomee P, Karlsson J. Eccentric overload training for patients with chronic Achilles tendon pain: a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports. 2001;11(4):197–206.CrossRefPubMed

12.

Beyer R, Kongsgaard M, Hougs Kjaer B, Ohlenschlaeger T, Kjaer M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(7):1704–11. https://doi.org/10.1177/0363546515584760.CrossRefPubMed

13.

Meyer A, Tumilty S, Baxter GD. Eccentric exercise protocols for chronic non-insertional Achilles tendinopathy: how much is enough? Scand J Med Sci Sports. 2009;19(5):609–15. https://doi.org/10.1111/j.1600-0838.2009.00981.x.CrossRefPubMed

14.

Allison GT, Purdam C. Eccentric loading for Achilles tendinopathy: strengthening or stretching? Br J Sports Med. 2009;43(4):276–9. https://doi.org/10.1136/bjsm.2008.053546.CrossRefPubMed

15.

Arnoczky SP, Lavagnino M, Egerbacher M. The mechanobiological aetiopathogenesis of tendinopathy: is it the over-stimulation or the under-stimulation of tendon cells? Int J Exp Pathol. 2007;88(4):217–26. https://doi.org/10.1111/j.1365-2613.2007.00548.x.CrossRefPubMedPubMedCentral

16.

Shalabi A, Kristoffersen-Wilberg M, Svensson L, Aspelin P, Movin T. Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med. 2004;32(5):1286–96. https://doi.org/10.1177/0363546504263148.CrossRefPubMed

17.

O’Neill S, Watson PJ, Barry S. Why are eccentric exercises effective for achilles tendinopathy? Int J Sports Phys Ther. 2015;10(4):552–62.PubMedPubMedCentral

18.

Rio E, Kidgell D, Moseley GL, Gaida J, Docking S, Purdam C, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 2016;50(4):209–15. https://doi.org/10.1136/bjsports-2015-095215.CrossRefPubMed

19.

Maquirriain J. Leg stiffness changes in athletes with Achilles tendinopathy. Int J Sports Med. 2012;33(7):567–71. https://doi.org/10.1055/s-0032-1304644.CrossRefPubMed

20.

Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277–83. https://doi.org/10.1136/bjsports-2014-094386.CrossRefPubMed

21.

Gabriel DA, Kamen G, Frost G. Neural adaptations to resistive exercise: mechanisms and recommendations for training practices. Sports Med. 2006;36(2):133–49.CrossRefPubMed

22.

DeFreitas JM, Beck TW, Stock MS, Dillon MA, Kasishke PR 2nd. An examination of the time course of training-induced skeletal muscle hypertrophy. Eur J Appl Physiol. 2011;111(11):2785–90. https://doi.org/10.1007/s00421-011-1905-4.CrossRefPubMed

23.

de Jonge S, Tol JL, Weir A, Waarsing JH, Verhaar JA, de Vos RJ. The tendon structure returns to asymptomatic values in nonoperatively treated achilles tendinopathy but is not associated with symptoms: a prospective study. Am J Sports Med. 2015;43(12):2950–8. https://doi.org/10.1177/0363546515605077.CrossRefPubMed

24.

de Vos RJ, Heijboer MP, Weinans H, Verhaar JA, van Schie JT. Tendon structure’s lack of relation to clinical outcome after eccentric exercises in chronic midportion Achilles tendinopathy. J Sport Rehabil. 2012;21(1):34–43.CrossRefPubMed

25.

de Vos RJ, Weir A, Tol JL, Verhaar JA, Weinans H, van Schie HT. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med. 2011;45(5):387–92. https://doi.org/10.1136/bjsm.2010.076398.CrossRefPubMed

26.

Gardin A, Movin T, Svensson L, Shalabi A. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis. Skeletal Radiol. 2010;39(5):435–42. https://doi.org/10.1007/s00256-009-0798-3.CrossRefPubMed

27.

van Ark M, Cook JL, Docking SI, Zwerver J, Gaida JE, van den Akker-Scheek I, et al. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. J Sci Med Sport. 2016;19(9):702–6. https://doi.org/10.1016/j.jsams.2015.11.006.CrossRefPubMed

28.

Murphy M, Travers MJ, Gibson W, Chivers P, Debenham J, Docking S, et al. The rate of improvement of pain and function in mid-portion Achilles tendinopathy with loading protocols: a systematic review and longitudinal meta-analysis. In: Figshare.2018. Available from: https://figshare.com/articles/The_rate_of_improvement_of_pain_and_function_in_mid-portion_Achilles_tendinopathy_with_loading_protocols_A_Systematic_Review_and_Longitudinal_Meta-Analysis_/6143210. Accessed 5 May 2018.

29.

Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35(5):335–41.CrossRefPubMedPubMedCentral

30.

Scott A, Docking S, Vicenzino B, Alfredson H, Murphy RJ, Carr AJ, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. Br J Sports Med. 2013;47(9):536–44. https://doi.org/10.1136/bjsports-2013-092329.CrossRefPubMedPubMedCentral

31.

Murphy M, Rio E, Debenham J, Docking S, Travers MJ, Gibson W. Evaluating the progress of mid-portion Achilles tendinopathy during rehabilitation: a review of outcome measures for self-reported pain and function. Int J Sports Ther. 2018;13(2):283–92. https://doi.org/10.26603/ijspt20180283.CrossRef

32.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. https://doi.org/10.1136/bmj.b2700.CrossRefPubMedPubMedCentral

33.

Higgins JPT, Sterne JAC, Savović J, Page MJ, Hróbjartsson A, Boutron I, Reeves B, Eldridge S. A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev. 2016. https://doi.org/10.1002/14651858.cd201601.CrossRef

34.

Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919.CrossRefPubMedPubMedCentral

35.

Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. http://www.handbook.cochrane.org. Accessed 5 May 2018.

36.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefPubMedPubMedCentral

37.

Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. https://doi.org/10.1136/bmj.328.7454.1490.CrossRefPubMed

38.

Dechartres A, Trinquart L, Boutron I, Ravaud P. Influence of trial sample size on treatment effect estimates: meta-epidemiological study. BMJ. 2013;346:f2304. https://doi.org/10.1136/bmj.f2304.CrossRefPubMedPubMedCentral

39.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.CrossRefPubMedPubMedCentral

40.

Ishak KJ, Platt RW, Joseph L, Hanley JA, Caro JJ. Meta-analysis of longitudinal studies. Clin Trials. 2007;4(5):525–39. https://doi.org/10.1177/1740774507083567.CrossRefPubMed

41.

Balius R, Álvarez G, Baró F, Jiménez F, Pedret C, Costa E, et al. A 3-arm randomized trial for Achilles tendinopathy: eccentric training, eccentric training plus a dietary supplement containing mucopolysaccharides, or passive stretching plus a dietary supplement containing mucopolysaccharides. Curr Ther Res Clin Exp. 2016;78:1–7. https://doi.org/10.1016/j.curtheres.2016.11.001.CrossRefPubMedPubMedCentral

42.

Bell KJ, Fulcher ML, Rowlands DS, Kerse N. Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial. BMJ. 2013;346:f2310. https://doi.org/10.1136/bmj.f2310.CrossRefPubMedPubMedCentral

43.

Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion Achilles tendinopathy: a randomized double-blinded prospective study. Am J Sports Med. 2017;45(9):2034–43. https://doi.org/10.1177/0363546517702862.CrossRefPubMed

44.

Brown R, Orchard J, Kinchington M, Hooper A, Nalder G. Aprotinin in the management of Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2006;40(3):275–9. https://doi.org/10.1136/bjsm.2005.021931.CrossRefPubMedPubMedCentral

45.

de Vos RJ, Weir A, Visser RJ, de Winter T, Tol JL. The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2007;41(7):e5. https://doi.org/10.1136/bjsm.2006.032532.CrossRefPubMed

46.

Kearney RS, Parsons N, Costa ML. Achilles tendinopathy management: a pilot randomised controlled trial comparing platelet-richplasma injection with an eccentric loading programme. Bone Joint Res. 2013;2(10):227–32. https://doi.org/10.1302/2046-3758.210.2000200.CrossRefPubMedPubMedCentral

47.

Knobloch K, Schreibmueller L, Kraemer R, Jagodzinski M, Vogt PM, Redeker J. Gender and eccentric training in Achilles mid-portion tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):648–55. https://doi.org/10.1007/s00167-009-1006-7.CrossRefPubMed

48.

Maffulli N, Walley G, Sayana MK, Longo UG, Denaro V. Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disabil Rehabil. 2008;30(20–22):1677–84. https://doi.org/10.1080/09638280701786427.CrossRefPubMed

49.

McAleenan M, McVeigh JG, Cullen M, Sayers F, McCrea K, Baxter D. The effectiveness of night splints in achilles tendinopathy: a pilot study. Physiother Pract Res. 2010;31(1):28–33.

50.

Munteanu SE, Scott LA, Bonanno DR, Landorf KB, Pizzari T, Cook JL, et al. Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2015;49(15):989–94. https://doi.org/10.1136/bjsports-2014-093845.CrossRefPubMed

51.

Pearson J, Rowlands D, Highet R. Autologous blood injection to treat achilles tendinopathy? A randomized controlled trial. J Sport Rehabil. 2012;21(3):218–24.CrossRefPubMed

52.

Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37(3):463–70. https://doi.org/10.1177/0363546508326983.CrossRefPubMed

53.

Rompe JD, Nafe B, Furia JP, Maffulli N. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 2007;35(3):374–83. https://doi.org/10.1177/0363546506295940.CrossRefPubMed

54.

Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport. 2007;10(1):52–8. https://doi.org/10.1016/j.jsams.2006.05.008.CrossRefPubMed

55.

Stasinopoulos D, Manias P. Comparing two eccentric exercise programmes for the management of Achilles tendinopathy: a pilot trial. J Bodyw Move Ther. 2013;17(3):309–15. https://doi.org/10.1016/j.jbmt.2012.11.003.CrossRef

56.

Stevens M, Tan CW. Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. J Orthopaed Sports Phys Ther. 2014;44(2):59–67. https://doi.org/10.2519/jospt.2014.4720.CrossRef

57.

Tumilty S, Mani R, Baxter GD. Photobiomodulation and eccentric exercise for Achilles tendinopathy: a randomized controlled trial. Lasers Med Sci. 2016;31(1):127–35. https://doi.org/10.1007/s10103-015-1840-4.CrossRefPubMed

58.

Tumilty S, McDonough S, Hurley DA, Baxter GD. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(5):733–9. https://doi.org/10.1016/j.apmr.2011.08.049.CrossRefPubMed

59.

Tumilty S, Munn J, Abbott JH, McDonough S, Hurley DA, Baxter GD. Laser therapy in the treatment of achilles tendinopathy: a pilot study. Photomed Laser Surg. 2008;26(1):25–30. https://doi.org/10.1089/pho.2007.2126.CrossRefPubMed

60.

Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. Br J Sports Med. 2011;45(5):421–8. https://doi.org/10.1136/bjsm.2009.057968.CrossRefPubMed

61.

Zhang BM, Zhong LW, Xu SW, Jiang HR, Shen J. Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Chin J Integr Med. 2013;19(12):900–4. https://doi.org/10.1007/s11655-012-1218-4.CrossRefPubMed

62.

Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res. 1986;208:65–8.

63.

Herrington L, McCulloch R. The role of eccentric training in the management of Achilles tendinopathy: a pilot study. Phys Ther Sport. 2007;8(4):191–6. https://doi.org/10.1016/j.ptsp.2007.07.001.CrossRef

64.

Drew BT, Smith TO, Littlewood C, Sturrock B. Do structural changes (eg, collagen/matrix) explain the response to therapeutic exercises in tendinopathy: a systematic review. Br J Sports Med. 2014;48(12):966–72. https://doi.org/10.1136/bjsports-2012-091285.CrossRefPubMed

65.

Rio E, Moseley L, Purdam C, Samiric T, Kidgell D, Pearce AJ, et al. The pain of tendinopathy: physiological or pathophysiological? Sports Med. 2014;44(1):9–23. https://doi.org/10.1007/s40279-013-0096-z.CrossRefPubMed

66.

Tompra N, van Dieen JH, Coppieters MW. Central pain processing is altered in people with Achilles tendinopathy. Br J Sports Med. 2016;50(16):1004–7. https://doi.org/10.1136/bjsports-2015-095476.CrossRefPubMed

67.

McAuliffe S, Synott A, Casey H, Mc Creesh K, Purtill H, O’Sullivan K. Beyond the tendon: Experiences and perceptions of people with persistent Achilles tendinopathy. Musculoskelet Sci Pract. 2017;29:108–14. https://doi.org/10.1016/j.msksp.2017.03.009.CrossRef

68.

Travaline JM, Ruchinskas R, D’Alonzo GE Jr. Patient-physician communication: why and how. J Am Osteopath Assoc. 2005;105(1):13–8. https://doi.org/10.7556/jaoa.2005.105.1.13.PubMedCrossRef

69.

Cook CE. Clinimetrics corner: the minimal clinically important change score (MCID): a necessary pretense. J Man Manip Ther. 2008;16(4):E82–3. https://doi.org/10.1179/jmt.2008.16.4.82E.CrossRefPubMedPubMedCentral

70.

Silbernagel KG, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up. Am J Sports Med. 2011;39(3):607–13. https://doi.org/10.1177/0363546510384789.CrossRefPubMed

71.

van der Plas A, de Jonge S, de Vos RJ, van der Heide HJ, Verhaar JA, Weir A, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46(3):214–8. https://doi.org/10.1136/bjsports-2011-090035.CrossRefPubMed

72.

Murphy M, Travers MJ, Gibson W. Is heavy eccentric calf training superior to wait-and-see, sham rehabilitation, traditional physiotherapy and other exercise interventions for pain and function in mid-portion Achilles tendinopathy. Syst Rev. 2018;7(58):1–7. https://doi.org/10.1186/s13643-018-0725-6.CrossRef

Title: Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis
Authors: Myles Murphy
Mervyn Travers
William Gibson
Paola Chivers
James Debenham
Sean Docking
Ebonie Rio
Publication date: 01-08-2018
Publisher: Springer International Publishing
Published in: Sports Medicine / Issue 8/2018
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI: https://doi.org/10.1007/s40279-018-0932-2

At a glance: The STEP trials

Springer Medicine

Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis

Abstract

Background

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2018

Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group

Change of Direction Speed: Toward a Strength Training Approach with Accentuated Eccentric Muscle Actions

Correction to: Principles of Exercise Prescription, and How They Influence Exercise-Induced Changes of Transcription Factors and Other Regulators of Mitochondrial Biogenesis

Trading Health Risks for Glory: A Reformulation of the Goldman Dilemma

Pacing Decision Making in Sport and the Effects of Interpersonal Competition: A Critical Review

Association of Lower Limb Compression Garments During High-Intensity Exercise with Performance and Physiological Responses: A Systematic Review and Meta-analysis