Cool technology

I have been reading a lot about new technologies recently. Mostly because I am working on some textile wearable tech projects and also because I believe it is important to understand where this field is taking us to be able to make a difference with athletes. Rapid feedback and the ability to analyse performance “in-vivo” it has always been my passion, and I can see the future of our profession being very similar to the scenes we see in Formula 1. Of course, I still think the human element of informing/working with coaches and athletes is of paramount importance for successful implementation, but if we want to be ahead of the game, we need to know what’s coming and try to implement it as quickly as possible.

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For this reason, I have always been reading scientific papers in various areas of knowledge to understand what other experts are doing and how their findings can help us moving forward. A couple of papers caught my eye in the last couple of weeks.

First, this paper form John Rogers’ group on a “Miniaturized Battery-Free Wireless Systems for Wearable Pulse Oximetry” published on advanced science news showing what is possible to do with flexible tiny sensors mounted on the fingertip.

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This is a pretty impressive device, millimeter-scale, battery-free optoelectronic systems capable of capturing photoplethysmograms and quantitative information on blood oxygenation, heart rate, and heart rate variability transmitting data wirelessly and battery free. While this is still experimental work, the potential for such device in the sporting domain could be quite amazing also linking it to there sensors for a true body sensor network.

The other work is a review on the same journal covering the recent advances in bio integrated optoelectronics devices. The papers shows some pretty impressive epidermal electronics devices capable of measuring various physiological aspects.

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Finally a paper published on Scientific Reports few months ago on a new paradigm in sweat based biosensors which provides a promising new approach and another paper on the same journal on a portable biosensor to measure cortisol.

Minimally invasive methods and wearable sensors are the only way to improve our understanding of sports performance in elite athletes, so definitively more is better. However, we still need platforms capable of working well in the “real world” and not in laboratory conditions as well as valid, reliable and practical tools to provide relevant information for influencing training/nutrition/recovery paradigms. Until then, we need to read with interest, but be careful that sometimes promising technologies may not be as good as they look like on paper (unicorns can only be found in fairy tales).

Twenty years from the the first paper

Recently, I have been tidying up files on old hard drives to move the files to cloud based storage in order to have easier access and reduce cluttering. Going back to old files brings back lots of memories and it is a good exercise in learning back about the development and activities I did in my career/life so far. Old pictures appear and old manuscripts written and never submitted also show up. Finally, old analysis files, notes, correspondence reminds you of many hours spent discussing/debating/working on various projects with many people. Working in Sport and Science gave me tremendous opportunities to meet really clever people and learn from them. One of them was my old mentor Prof. Bosco. It is amazing how many things which are now relevant in the sports science industry were introduced by him in the 90s and still stand strong. One of the many realisations of going through old files was that our first paper on whole body vibration was published 20 years ago. Yes 20! I was at the beginning of the PhD journey and this was one of the first projects conducted with the team I was coaching at the time.

The paper was published on Biology of Sport, and I had the help of some great people to make sense of the data and improve the writing to make it good enough to be accepted and published. The article is here, and I still treasure the notes/comments of Professors Josefz Tihanyi and Atko Viru both working with Prof. Bosco at the time on various collaborative efforts to understand better many aspects of strength training.

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This paper was the beginning of a series of efforts to understand more about the possibility to use vibration as an exercise intervention, and it was a follow-up to the work performed by Vladimir Issurin on segmental applications in athletes. I still remember the pride of the first acceptance letter. I also remember the sudden interest this experimental modality (at the time) raised in the sporting and academic World. Since then, hundreds of papers have been published on this topic by many research groups around the World and most seem to suggest that our intuition of using such modality to improve strength in various populations was not far-fetched. Sadly, marketing has got in the way with many commercial interests which have somehow impaired the development of such modality in my view, rather than exploiting better applications and safer guidelines. Also, it is kind of gone out of fashion and replaced by “newer” modalities. I do see in fact in many places I visit (gyms, hotels, fitness centres) some vibration platforms in corners mostly unused. It is sad to notice that young practitioners don’t seem to be interested in the applications of vibration anymore, however I am still convinced that there is still plenty of scope for its use not only in Sport but also to help various populations as evidenced by my work with colleagues at the Italian Auxology Institute. Finally, there is a lot of potential for applications in rehabilitation and for the elderly.

I remember the beginnings, when speaking at conferences I met loads of skeptics (lots of heads shaking in my first few talks at conferences) and had quite a few grant applications turned down. Things got better later on in my career (but funding agencies don’t seem to like non-pharmacological interventions…). However, fact is that 20 years from that paper, there is now a scientific community studying vibration and successfully showing what works and what does not work. Many still trying to figure out the exact mechanisms. The number of papers has exponentially increased, and while I marginally contribute to that literature still as my interests have changed, I am proud to have been part of the “pioneers” which started the scientific debate and evolution which for sure is providing some patients and sports people with another avenue to improve performance and quality of life. On the other end, what I am less proud of, is the fact that an industry of gurus and pseudo experts developed as a consequence of the work done by many institutions which have “confused” the end users rather than improving the outcomes and have barely invested in the scientific developments. This is similar to many other “industries’ in the sporting/fitness World where “experts” tend to appear and disappear when commercial gains become available and/or disappear. But that’s a topic for another post…as now it is time to be grateful for the journey which started with that paper 20 years ago under the mentorship of some of the greatest sports scientists in history.


Digressing. The middle aged man calf syndrome

In the last couple of months I have tried to “up the ante” with training load to further increase my fitness and start to enjoy more the Aquathlon/Duathon/Triathlon local competitions I compete in with other people my age. Physical activity is important to maintain/improve fitness but also to help with our mental wellbeing (see the evidence here). For me it is also a way to keep up with my super active family and a social opportunity to meet other people. But of course, to do it safely I need to train. Training is done progressively, within reasons and adequate to my fitness levels, and most of all trying to get some routine times to have consistency. But despite all this I have fallen victim of the classic party pooper for anybody involved in running activities after a certain age. I am in this with many other colleagues/friends my age. All former athletes at some level, very active and all recently affected like me by the “old man calf syndrome” or as we jokingly describe it “being shot by the invisible sniper while running“.

Calf strains are in fact common. The most common calf injury is a tear of the medial gastrocnemius muscle (Tennis Leg) but other structures including the lateral gastrocnemius, and soleus also may be the cause of muscular pain experienced suddenly while running. In my case, I seem to favour the soleus, but in general, I see many like me struggling with this. If you want to know more about the anatomical structures, make sure you read this very recent amazing paper from Bosterlee et al. which used imaging to do a 3D reconstruction the soleus (see image below).

(from DOI: 10.7717/peerj.4610/fig-1)

And if you want to read more about the gastrocnemius structure, read this really good paper here.

In the literature to date, there is an absence of definitive data relating to risk factors for calf muscle strain injuries. Despite the fact that is really common, there seems to be very few studies on this. A recent systematic review does suggest that strong evidence exists for an association between increased age and future calf strain as well as previous injuries and recurrence. So, there it is, you get older you increase risk, you get your first “pop” and you are going to get more. However, the systematic review clearly indicated that there is a lack of well controlled studies on this and the causes still need to be worked out (albeit we can all agree that for sure it is multifactorial).

Many things should be looked at: 1) blood flow to the calf muscles might be compromised with age, 2) neuromuscular function in the whole lower limb is negatively affected by age, 3) tendons are affected by age and activity and are still mechanosensitive in older adults, 4) tendon elasticity is affected by age and activity. Despite the fact that activity helps reducing the negative effects of ageing on musculoskeletal structures, we are often bound to many hours of “desk work” which has major negative influences on blood flow and neuromuscular function of the lower leg.

Therefore, there is a plethora of things which can cause the injury to occur in the first place and then re-occurr. While research is needed to understand the cause and possibly the best way to reduce the chances of occurrence (albeit it is common advice to strengthen the muscles, increase tendon elasticity and neuromuscular control paired with an adequate pair of running shoes), some advice exists on recovery modalities.

The usual conservative treatment initially should consists of rest, ice, compression, elevation (RICE). Non Steroidal Anti Inflammatory Drugs can be utilized, though this is controversial. Patients can utilize cryotherapy, massage, passive range of motion, and progressive exercise to reduce the symptoms.

In general, Grade I injuries, which present with partial tearing with no loss of muscle integrity, heal in a few days to a few weeks. Grade II muscle strains (10–50% of muscle disruption with loss of strength) need one to 6 weeks before the patient can return to training. Grade III injuries could take up to six months for return to activity as they involve loss of more than 50% of muscle integrity and have noticeable defects. Re-injury is frustrating and common, and therefore a cautious approach to return to training and competition should be used.

For sure, there is no magic pill or magic bandage which can “fix” you, unless you are after some placebo effect.

So here it is for research groups interested in soft tissue injuries in ageing athletes: there is a lot which needs to be done to understand more about the aetiology of calf strains, its prevention and rehabilitation.

We need your help to keep our competitive souls going and avoid the disappointment of limping to the finish line.