Is Enhanced-Eccentric Resistance Training Superior to Traditional Training for Increasing Elbow Flexor Strength?

Protocols for strengthening muscle are important for fitness, rehabilitation, and the prevention of myotendinous injuries. In trained individuals, the optimal method of increasing strength remains unclear. The purpose of this study was to compare the effects of a traditional method of strengthening with a method that allowed for enhanced-eccentric training, on changes in elbow flexor strength in trained subjects. Thirty-nine (8 male, 31 female) trained subjects with normal elbow function participated in this study. Subjects were rank-ordered according to isometric force production and randomly assigned to one of three training groups: control (CONT), traditional concentric/eccentric (TRAD), and concentric/enhanced-eccentric (NEG). The training groups completed 24 training sessions. An evaluator blinded to training group performed all testing. Mixed model ANOVA techniques were used to determine if differences existed in concentric one repetition maximum strength, and isometric force production among groups. Changes in peak and average isokinetic force production were also compared. Type 1 error was maintained at 5%. While both groups improved concentric one repetition maximum (NEG = 15.5%, TRAD = 13.8%) neither training group statistically differed from changes demonstrated by the CONT group. Nor did either training group show significant improvements in isometric or isokinetic force production over the CONT group. These results do not support the superiority of enhanced-eccentric training for increasing force production in trained subjects.Key words: Concentric, specificity, negative training, one-repetition maximum, isokinetic     

How Will the Introduction of Primary Certificate Training Programs Change Vascular Surgery Training Programs?

New requirements for vascular surgery training allow several routes to Board eligibility in the specialty. Individuals can enter vascular residency directly from medical school, after 3 years of surgical residency, or after completion of the traditional 5 years of surgery training. Vascular surgery program directors will be faced with the challenges of obtaining institutional support, designing an acceptable educational program, and working closely with the general surgery program director to ensure both programs are successful. Faculty in the vascular program may find working with residents right out of medical school or after only 3 years of surgery training to be a challenge, especially in terms of developing the requisite technical skills. Residents must be able to demonstrate mastery of the six competencies in addition to the skills of vascular surgery. Because, in some ways, this new vascular training scheme is an experiment in redesigning all surgical education, the vascular community will need to carefully evaluate the results by monitoring the practices of those who graduate from these programs.     

Whose Appendicectomy? – Do Laparoscopic Appendicectomies Impair SHO Training?

INTRODUCTION

Open appendicectomy is an ideal procedure for junior surgical trainees to develop operative skills. However, in recent years, we have noticed a decline in the number of appendicectomies performed by basic surgical trainees and a shift towards increasing use of laparoscopic appendicectomy. The aim of this study was to determine whether the growing popularity of laparoscopic appendicectomy is having a detrimental impact on the training experience of SHOs.

PATIENTS AND METHODS

We undertook a retrospective review of all cases of appendicectomies performed in one district hospital over a 7-year period (August 1999 to August 2006.) A standard performa was used to extract data from the original case notes of these patients relating to the operating surgeon and technique.

RESULTS

Data were obtained for 857 appendicectomies. Between February 2002 and July 2003, there was asignificant decline in the proportion of appendicectomies performed by SHOs from 78.7% to 29.3% (P < 0.001). Either side of this decline there were no significant changes in the proportion of SHO appendicectomies. The number of appendicectomies performed laparoscopically only began to rise after February 2004, with ayear-on-year increase. The number of appendicectomies performed by SHOs remained stable during this time. No laparoscopic appendicectomy was performed by an SHO.

CONCLUSIONS

We found no evidence that the popularisation of laparoscopic appendicectomy has contributedtothe decline of appendicectomies performed by SHOs. Nevertheless, with the continual rise in popularity of this procedure, it is important to balance training opportunities for both junior and higher surgical trainees.     

Evidence-based practice: friend or foe?

Chiropractic is an increasingly-recognised health profession and systematic reviews of the effectiveness of manipulation for back pain are responsible for much of that recognition. Establishement on this basis, however demands that the profession learns to operate in the new clinical culture of evidence based practice if it is to progress. This calls for changes in emphases in education for self-monitoring through clinical adit. Evidence based practice can remain a positive factor in the future role of chiropractic provided that the profession and its educators invest meaningfully in arrangements which will allow them to respond to the evidence as it emerges.     

Do Men Outperform Women During Orthopaedic Residency Training?

Background

Orthopaedic surgery residency has one of the lowest percentages of women (13.1%) of all primary surgical specialties. There are many possible reasons for this, including bias during the selection process.

Questions/purposes

We therefore asked whether performance during residency might adversely bias the selection of future female orthopaedic residents by researching whether males and females perform equally in orthopaedic surgery residency.

Methods

Ninety-seven residents enrolled in our residency between 1999 and 2009; six males and one female left the program, leaving 90 residents (73 males, 17 females) as the study cohort. Resident performance was compared for OITE scores, ABOS results, faculty evaluations, and in a resident graduate survey.

Results

Males and females had similar faculty evaluations in all ACGME competency areas. Males and females had similar mean OITE scores for Years 2–5 of residency, although males had higher mean scores at Years 3 through 5. Males and females had similar mean ABOS Part 1 scores and ABOS Part 1 pass rates; however, fewer males than females took more than one attempt to pass. Males and females had similar Part 2 pass rates or attempts. For the 45 resident graduates surveyed, females pursued fellowships equally to males, worked slightly less hours in practice, and reported higher satisfaction with their career choice.

Conclusions

For the 90 residents at one residency program, we observed no differences between males’ and females’ performance. Although females pursue orthopaedic residency less frequently than males, performance during residency should not bias their future selection.     

Could Low-Frequency Electromyostimulation Training be an Effective Alternative to Endurance Training? An Overview in One Adult

This preliminary study aimed to investigate the effects of a six-week low-frequency electromyostimulation training (10Hz) on the cardiovascular, respiratory and muscular systems. To that purpose, aerobic capacity, knee extensor muscles strength and architecture, muscle sympathetic nervous activity, blood pressure and heart rate have been evaluated in one healthy male subject (33 year-old, 1.73 m, 73 kg). Results showed improvement of aerobic capacity (+4.5% and +11.5% for maximal oxygen uptake and ventilatory threshold) and muscle strength (+11% and +16% for voluntary and evoked force). Moreover, for the first time, this study demonstrated low-frequency training effects on muscle architecture (+3%, +12% and -11% for muscle thickness, pennation angle and fascicle length) and cardiovascular parameters (-22%, -18% and -21% for resting muscle sympathetic nervous activity, heart rate and mean blood pressure). Interestingly, these results suggest that this method may have beneficial effects on all systems of the body. The investigation of training effects on muscle architecture and cardiovascular parameters should therefore be pursued since highly deconditioned subjects are likely to fully benefit from these adaptations.

Key points

• These results confirmed that 5 weeks of low-frequency electrical stimulation have beneficial effects on aerobic capacity and muscle strength.
• This study demonstrated that low-frequency electrical stimulation applied for as short as 5 weeks have a great impact on muscle architecture and cardiovascular parameters and control.
• This type of training might therefore be interesting for rehabilitation of patients who are unable to perform endurance exercises.

Key words: Electrical stimulation, aerobic capacity, muscle architecture, muscle sympathetic nervous activity     

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Background  

Elevated blood pressure (BP) is associated with increased cardiovascular risks manifested by ischemic heart disease and stroke. Studies of cardiothoracic surgeons and neurosurgeons suggest surgery induces a hemodynamic stress malresponse. However, it is unclear whether these occur in orthopaedic surgeons.