Corresponding author at: Institut Nacional d'Educació Física de Catalunya, Av. de l'Estadi, 12-22, 08038 Barcelona, Spain.
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Oliva-Lozano, Michele Kerulis, Rick Cost, Jessica Bartley, George Chiampas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "McLane" ] 1 => array:2 [ "nombre" => "José M." "apellidos" => "Oliva-Lozano" ] 2 => array:2 [ "nombre" => "Michele" "apellidos" => "Kerulis" ] 3 => array:2 [ "nombre" => "Rick" "apellidos" => "Cost" ] 4 => array:2 [ "nombre" => "Jessica" "apellidos" => "Bartley" ] 5 => array:2 [ "nombre" => "George" "apellidos" => "Chiampas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666506924000270?idApp=UINPBA00004N" "url" => "/26665069/0000005900000224/v2_202410292108/S2666506924000270/v2_202410292108/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Individual and region-specific hamstring muscles use during a novel Flywheel Russian belt Deadlift exercise" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro Luis Cosio, Lia Moreno-Simonet, Sandra Mechó, Xavier Padulles, Josep Maria Padulles, Joan Aureli Cadefau" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Pedro Luis" "apellidos" => "Cosio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 1 => array:3 [ "nombre" => "Lia" "apellidos" => "Moreno-Simonet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 2 => array:3 [ "nombre" => "Sandra" "apellidos" => "Mechó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] 3 => array:3 [ "nombre" => "Xavier" "apellidos" => "Padulles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 4 => array:3 [ "nombre" => "Josep Maria" "apellidos" => "Padulles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 5 => array:4 [ "nombre" => "Joan Aureli" "apellidos" => "Cadefau" "email" => array:1 [ 0 => "jcadefau@gencat.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), 08038 Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Department of Radiology, Hospital of Barcelona, SCIAS, 08034 Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Department of Biomedicine, Faculty of Medicine and Health Sciences, Universitat de Barcelona (UB), 08036 Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0003" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Institut Nacional d'Educació Física de Catalunya, <span class="elsevierStyleItalic">Av</span>. de l'Estadi, 12-22, 08038 Barcelona, Spain." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0003" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3717 "Ancho" => 2917 "Tamanyo" => 543782 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Representative T2-weighted magnetic resonance images of the proximal region (25 % of thigh length), middle region (50 % of thigh length) and distal region (75 % of the tight length) before and immediately after the <span class="elsevierStyleItalic">Flywheel Russian belt deadlift</span> training session. BF<span class="elsevierStyleInf">SH</span>, m. biceps femoris short head; BF<span class="elsevierStyleInf">LH</span>, m. biceps femoris long head; ST, m. semitendinosus; SM, m. semimembranosus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">Hamstring strains injuries (HSI) are among the most common musculotendinous injuries in team sports in both males and females, by increasing the burden and financial cost, and decreasing the performance and quality of life of athletes.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Predominantly, repeated sprints are one of the most frequently high-intensity actions in team sports, leading to a higher HSI risk.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> During sprinting, the horizontal ground reaction force is predicted by the hamstrings electromyographic activity and eccentric torque during the late swing phase of the running gait cycle.<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> The late swing phase is a key point of the sprint, involving two simultaneous and damaging events. First, the maximum length of the hamstrings muscle-tendon unit is reached. Concurrently, the hamstrings undergo an active, eccentric lengthening contraction.<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Overall, repeated hamstrings eccentric contractions during repeated late swing phases of the running gait cycle are the main mechanism contributing to HSI.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> In particular, the biceps femoris long head (BF<span class="elsevierStyleInf">LH</span>) has been found to be most important hamstring muscle to decelerate the shaft during the late swing phase.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> The reason is that the lower limbs positioning during the late swing phase causes a greater BF<span class="elsevierStyleInf">LH</span> stretching, and moment arm, compared to the semitendinosus (ST) or semimembranosus (SM) muscles,<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> and explains why biceps femoris strains are the most common HSI in sprint-based team sports in both males and female athletes.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">Focusing on prepare the hamstrings for the repeated eccentric contraction-derived muscle strains during repeated late swing phases of the running gait cycle is therefore essential to both reduce the HSI risk and improve performance.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> Although resistance-based training is the most popular method, different approaches to hamstrings training have been explored, including eccentric training, inertial training, knee-dominant or hip-dominant exercises. The Nordic hamstring exercise has become one of the most widely used exercises to train the hamstrings since it provides a large eccentric workload. However, magnetic resonance imaging (MRI)-based studies have demonstrated that this knee-dominant exercise causes great activations of the ST and biceps femoris short head (BF<span class="elsevierStyleInf">SH</span>).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">10-13</span></a> On the other hand, flywheel inertial training is a recognized training method to reach eccentric overload (EO),<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> allowing to prepare the eccentric phase of a movement. The most commonly used flywheel exercise to train the hamstrings is the flywheel prone leg curl which, similar to the Nordic hamstring exercise, generates a high activation of the ST and BF<span class="elsevierStyleInf">SH</span>, but not BF<span class="elsevierStyleInf">LH</span>.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> Contrary to the above-mentioned knee-dominant exercises, hip-dominant exercises, such as the <span class="elsevierStyleItalic">Russian belt</span> deadlift or the unilateral hip extension conic-pulley, seem to provide the most stimulation to the BF<span class="elsevierStyleInf">LH</span>, compared to the other hamstrings muscles, although modest T2 shift were shown (i.e., 7 % and 6 % respectively).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> The reason is that hip-dominant exercises activate the lateral hamstrings more than the medial hamstrings, representing a 4-times greater activation of the BF<span class="elsevierStyleInf">LH</span> compared to the ST.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Specifically, the product of the physiological cross-sectional area and the hip moment arm is higher for the BF<span class="elsevierStyleInf">LH</span> compared to the ST muscle,<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> so during hip-dominant movements, there is a strong participation of the BF<span class="elsevierStyleInf">LH</span>.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">Therefore, the actions that shifts the center of gravity forward of the transverse axis of the hip joints (e.g., forward bending of the trunk with hip flexion) cause a significant contraction of the lateral hamstring muscles, particularly the BF<span class="elsevierStyleInf">LH</span>.<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> In short, depending on the selected exercise and technique, there is a selective recruitment of the hamstrings, with the BF<span class="elsevierStyleInf">LH</span> being preferentially and eccentrically activated when the hip flexes and/or the knee extends in order to decelerate the movement.<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">Despite the above-mentioned approaches for hamstrings training, the injury incidence has remained unchanged during the last 30 years.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Considering that (i) loading exercises during extensive lengthening reduce the time to return to play, and (ii) active trunk stabilization during exercise decreases reinjury rates,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> it is reasonable that hamstrings training, particularly BF<span class="elsevierStyleInf">LH</span>, should be based on a hip-dominant exercise with special emphasis on working active eccentric lengthening contractions conducted with high loads and long musculotendon lengths.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> Consequently, it is proposed to combine the <span class="elsevierStyleItalic">Russian belt</span> deadlift with flywheel training to build a new <span class="elsevierStyleItalic">Flywheel Russian belt Deadlift</span> (FRD) exercise. Given that the selection of exercises targeting specific muscles in injury prevention or rehabilitation programs can be conducted by muscle functional MRI (mfMRI),<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> the purpose of the study was to determine exercise-induced hamstring muscles activation (T2 shift) immediately after a FRD training session, together with individual muscle-, region- and limb-specific differences.</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Materials and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Experimental approach</span><p id="para0010" class="elsevierStylePara elsevierViewall">One international-level filed hockey male player (age = 22.7 years, mass = 67.0 kg, height = 1.72 cm) voluntarily accepted to participate in the case study, in order to assess hamstring muscles activation before and immediately after the FRD training session. The volunteer gave their written consent that received information about the purpose of the study and associated risks. The experiment was conducted in accordance with the code of ethics of the World Medical Association (Declaration of Helsinki) and was approved by the Ethics Committee for Clinical Research of the Catalan Sports Council (Generalitat de Catalunya) (037/CEICGC/2021).</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Flywheel Russian belt Deadlift exercise</span><p id="para0011" class="elsevierStylePara elsevierViewall">The training session started with a standardized warm-up, consisting of dynamic joint mobilization and 2 sets of 8 repetitions of the FRD exercise under progressively increasing and submaximal effort. Then, the FRD training session consisted of 10 sets of 10 repetitions conducted on a conical flywheel device <span class="elsevierStyleItalic">Proinertial pulley pro C2</span> (Inertial systems S.L., Barcelona, Spain), with a 3-minute rest period between sets. The inertia load was set at 0.124 kg·m², as greater moments of inertia lead to greater EO.<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> Given that the first repetitions of inertial training are used to increase the speed of the flywheel and are considered not to be effective repetitions, the first three repetitions of each set were used to “increase momentum” and were excluded from the data analysis.<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> The standardized starting position during the novel FRD exercise was with the feet on a 30-degree sloping wedge, the lower limbs and the body weight held by a <span class="elsevierStyleItalic">Russian belt</span> attached to the wall, self-selected knee flexion between 0 and 10°, hip flexion down to 90°, and abdominal bracing together with scapular retraction (<a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a>A). Then, the exercise started conducting a hip extension to 0°, i.e., concentric phase, (<a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a>B), and back to hip flexion to the bottom of the range of motion, i.e., eccentric phase. The volunteer was verbally encouraged to perform the concentric phase as fast as possible, and to brake as hard as possible during the last part of the eccentric phase in order to increase EO.<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a></p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Image acquisition and processing</span><p id="para0012" class="elsevierStylePara elsevierViewall">The activation of hamstring muscles before and immediately after the FRD training session was assessed by the T2 shift technique through mfMRI.<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> To minimize the effects of fluid shifts caused by walking, the individual remained recumbent for a minimum of 10 min before basal condition image acquisition, while immediately after the exercise the individual was wheelchair-assisted between the exercise room and the MRI scanner.<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Then, the individual was placed on the magnetic resonance scan <span class="elsevierStyleItalic">Vantage Galan 3T</span> (Cannon Medical Systems, Tochigi, Japan), in supine position with his thighs covered with two overlapped 16-channel Atlas SPEEDER body coils. A custom-made foot-restraint device was used to maximize the repeatability of limb placement in the MRI scanner. T2-weighted imaging was acquired with the following parameters: TE 20, 60, 100 and 140 ms; TR 3200 ms; in-plane resolution 0.25 × 0.25 mm; slice thickness 3 mm; gap 18 mm. Total acquisition time: 6 min. Pre-exercise acquisitions also included axial fat-supressed proton density-weighted imaging with TE 33 ms; TR 2954 ms; in-plane resolution 0.49 × 0.49 mm; slice thickness 3 mm; gap 18 mm. The imaging protocol was conducted in two blocks to cover the extension of hamstring muscles from the distal margin of the ischial tuberosity to the tibial plateau.</p><p id="para0013" class="elsevierStylePara elsevierViewall">Subsequently, a parametric image was generated from the T2 mapping sequence using <span class="elsevierStyleItalic">parametric MRI (pMRI) software v.1.3.3-b</span> (Philadelphia, PA, USA). The MRI data were then evaluated for T2 relaxation time (T2 value) of the hamstring muscles. A circular region of interest (ROI) was defined for the BF<span class="elsevierStyleInf">LH</span>, BF<span class="elsevierStyleInf">SH</span>, ST, and SM muscles in each of the T2 mapping images where these muscles were visible. Intramuscular vascular structures, connective tissue and the boundaries of the muscles were avoided as the T2 values could be affected. ROIs of similar size and anatomical location were placed in the subsequent image sets to ensure positioning identical to that in the basal analysis (<a class="elsevierStyleCrossRef" href="#fig0002">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> A multi-echo 2DFSE T2-weighted was applied to measure the mean T2 value. Images taken at different TEs were fit to a monoexponential time curve to extract the T2 values.<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Region-specific muscle activation for each muscle were computed as the mean T2 absolute value of the different ROIs containing of the areas at 0–30 % (proximal), 30–70 % (middle) and 70–100 % (distal) of thigh length, from the lower border of the ischial tuberosity (0 %) to the upper border of the tibial plateau (100 %).<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> T2 shift was finally calculated by subtracting T2 baseline values from T2 post-exercise values and expressed as a percentage of the difference.<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> Two independent researchers conducted the MRI scanning and the T2 shift analysis.</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Statistical analysis</span><p id="para0014" class="elsevierStylePara elsevierViewall">A four-way mixed model [time (pre, post) x muscle (BF<span class="elsevierStyleInf">SH</span>, BF<span class="elsevierStyleInf">LH</span>, ST, SM) x limb (dominant, non-dominant) x region (proximal, middle, distal)] was conducted to determine exercise-induced hamstring muscles activation (T2 values). Subsequently, a three-way mixed model [muscle (BF<span class="elsevierStyleInf">SH</span>, BF<span class="elsevierStyleInf">LH</span>, ST, SM) x limb (dominant, non-dominant) x region (proximal, middle, distal)] was used to determine differences in hamstring muscles T2 shift immediately after the FRD exercise. Bonferroni's corrected post hoc analysis was conducted if the model showed statistically significant main effects or interaction effects. Data are presented as mean ± standard deviation (SD) and the level of significance was set at <span class="elsevierStyleItalic">p</span> < 0.05. Statistical analysis was performed with SPSS <span class="elsevierStyleItalic">v.27.0.1.0</span> (SPSS Statistics, IBM Corp., Armonk, NY, USA).</p></span></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Results</span><p id="para0015" class="elsevierStylePara elsevierViewall">Representative T2-weighted magnetic resonance images before and immediately after the 10 × 10 FRD training session are presented in <a class="elsevierStyleCrossRef" href="#fig0003">Fig. 3</a>. A significant main effect for time were observed for the T2 values [F(1106) = 51,838.462, <span class="elsevierStyleItalic">p</span> < 0.001]. T2 values substantially increased from the basal condition to immediately after exercise in all regions of all the hamstring muscles in both dominant and non-dominant lower limb (<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>).</p><elsevierMultimedia ident="fig0003"></elsevierMultimedia><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0017" class="elsevierStylePara elsevierViewall">A significant main effect for muscle were observed for T2 shift [F(3106) = 9.557, <span class="elsevierStyleItalic">p</span> < 0.001]. T2 shift of the SM was significantly smaller after the exercise in both dominant and non-dominant limb, compared to BF<span class="elsevierStyleInf">LH</span>, BF<span class="elsevierStyleInf">SH</span> and ST (<a class="elsevierStyleCrossRef" href="#fig0004">Fig. 4</a>). There were no between-limbs [F(1106) = 0.403, <span class="elsevierStyleItalic">p</span> = 0.527] nor between-regions [F(2106) = 1.564, <span class="elsevierStyleItalic">p</span> = 0.214] differences in hamstring muscles T2 shift. There were also no significant muscle-limb [F(3106) = 0.096, <span class="elsevierStyleItalic">p</span> = 0.962], muscle-region [F(5106) = 0.670, <span class="elsevierStyleItalic">p</span> = 0.647], limb-region [F(2106) = 1.152, <span class="elsevierStyleItalic">p</span> = 0.320], nor muscle-limb-region [F(5106) = 0.766, <span class="elsevierStyleItalic">p</span> = 0.576] interactions. Therefore, the most activated muscles by the FRD training session, marked by T2 shift, were the biceps femoris (short head +13.8 %, long head, +12.7 %), followed by the ST (+11.3 %), and lastly the SM (+6.9 %).</p><elsevierMultimedia ident="fig0004"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Discussion</span><p id="para0018" class="elsevierStylePara elsevierViewall">Individual muscle-, region- and limb-specific differences in hamstring muscles activation (T2 shift) were assessed immediately after a novel FRD exercise. The findings of the study highlight that all hamstring muscles were activated during the FRD training session. Particularly, the biceps femoris (i.e., BF<span class="elsevierStyleInf">LH</span> and BF<span class="elsevierStyleInf">SH</span>) was the most activated hamstring muscle, followed by the ST, while the SM was activated to a lesser extent. Finally, there were no between-region nor between-limb differences in hamstring muscles activation after the FRD training session.</p><p id="para0019" class="elsevierStylePara elsevierViewall">The transverse relaxation time (T2 value) of hydrogen protons in skeletal muscle can be quantified by mfMRI. Changes in the T2 value between before and after a single exercise (T2 shift) have been described as a highly reliable and non-invasive indicator of muscle activation during exercise.<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> The proposed FRD exercise significantly increased the T2 shift of all the hamstring muscles, ranging from 6.9 % for the SM to 13.2 % for the biceps femoris. To our knowledge, no previous MRI-based study has reported activations of all hamstring muscles after a single exercise. In fact, a comparative study of four frequently used hamstring exercises (i.e., Nordic hamstring exercise, flywheel leg curl, <span class="elsevierStyleItalic">Russian belt</span> deadlift and hamstrings kick coney-pulley) found that neither exercise was able to significantly target all hamstring muscles.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> As examples, a 4 × 8 flywheel leg curl training session with a moment of inertia of 0.072 kg·m² or body-weighted Nordic hamstring exercise provided large T2 shifts of the ST and BF<span class="elsevierStyleInf">SH</span>,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> and are recommended when the goal is to target knee-dominant hamstring muscles.<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> Conversely, hip-dominant exercises such as the <span class="elsevierStyleItalic">Russian belt</span> deadlift or the hamstrings kick conic-pulley were effective in triggering the activation of the BF<span class="elsevierStyleInf">LH</span> (7 % and 6 %, respectively), although the remaining hamstring muscles were not activated.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Using a <span class="elsevierStyleItalic">Russian belt</span> to hold the body weight and bend the trunk forward together with small knee flexion (between 0° and 10°), the FRD exercise allowed to achieve a more stretched positioning of the hamstrings. Therefore, the stretching of the hamstrings, together with the large EO workload provided by the flywheel inertial device, leads to focusing the exercise on working active eccentric lengthening contractions conducted with high loads and long musculotendon lengths,<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> which are HSI risk factors during the late swing phase of the running gait cycle.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0020" class="elsevierStylePara elsevierViewall">The biomechanical response of each hamstring muscle is heterogeneous, given that they display a variety of force-length properties and angle-specific joint torques.<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> The hereby proposed FRD exercise elicited the greatest activation of the biceps femoris. Specifically, the BF<span class="elsevierStyleInf">LH</span> is more sensitive to hip extension than knee flexion because the peak in the length-tension relationship of the BF<span class="elsevierStyleInf">LH</span> occurs with the hip at 90° and the knee at 0°, the point at which the greatest BF<span class="elsevierStyleInf">LH</span> function is produced.<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Furthermore, lower-limb positioning near to hip flexion (i.e., 90°) with the knee extended (i.e., 0°) selectively activates the BF<span class="elsevierStyleInf">LH</span>.<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> Thus, during hip-dominant exercises (e.g., forward bending of the trunk with hip flexion), the hamstrings are responsible for driving the movement, with a strong participation of the BF<span class="elsevierStyleInf">LH</span>.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Conversely, the BF<span class="elsevierStyleInf">LH</span> involvement is restricted in knee-dominant exercises since hip movement is locked, and explains the large ST and BF<span class="elsevierStyleInf">SH</span> activations during knee-dominant exercises.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">10–13</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> Region-specific (i.e., proximal, middle, distal) differences in hamstring muscles activity during hamstring exercises has been investigated before. The hamstrings kick conic-pulley has shown greater BF<span class="elsevierStyleInf">LH</span> proximal and middle activation compared to the other hamstring muscles, albeit to a small extent.<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> In contrast, the Nordic hamstring exercise and the flywheel leg curl have shown the same ST and BF<span class="elsevierStyleInf">SH</span> activation in all muscle regions, while the <span class="elsevierStyleItalic">Russian belt</span> deadlift seemed to be the unique exercise capable of activate the SM across muscle regions.<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> Given the <span class="elsevierStyleItalic">Russian belt</span> use during the proposed FRD exercise, SM muscle activation was also effective in all regions of the thigh. Similarly, the FRD exercise resulted in no region-specific differences in BF<span class="elsevierStyleInf">LH</span>, BF<span class="elsevierStyleInf">SH</span> and ST activation. Overall, the FRD exercise appears to provide a significant and homogenous (i.e., all muscle regions) hamstring muscles activation.</p><p id="para0021" class="elsevierStylePara elsevierViewall">The present study proposes the combination of the <span class="elsevierStyleItalic">Russian belt</span> deadlift with flywheel training to build a novel <span class="elsevierStyleItalic">Flywheel Russian belt Deadlift</span> exercise which significantly increases the activation of the hamstrings, with special focus on the BF<span class="elsevierStyleInf">LH</span> due to the injury incidence in sprint-based team sports. It has been found that the designed FRD exercise is a promising training method to produce significant active eccentric lengthening contractions conducted with high loads and long musculotendon lengths in the biceps femoris, followed by the ST, and lastly the SM. However, the study presents limitations to consider when interpreting the results. First, the design of the study provides limited sample power, and therefore generalizing the findings should be cautious. In addition, post-exercise muscle recovery indicators (i.e., force-generating capacity, perceived soreness) were not monitored, thus the short-term effect of the FRD exercise on hamstrings neuromuscular capacities is still unknown. Given the limitations of the study, future studies increasing the sample size to achieve greater statistical power, and monitoring hamstrings muscle recovery after a FRD training session are warranted. In addition, studies on the effects of a long-term FRD exercise-based training program on HSI incidence and muscular performance would be meaningful.</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Conclusion</span><p id="para0022" class="elsevierStylePara elsevierViewall">The FRD exercise is able to trigger a homogeneous and consistent activation of all the hamstring muscles (i.e., BF<span class="elsevierStyleInf">LH</span>, BF<span class="elsevierStyleInf">SH</span>, ST and SM) throughout the hamstring regions and both dominant and non-dominant limbs. More specifically, the BF<span class="elsevierStyleInf">LH</span> and BF<span class="elsevierStyleInf">SH</span> were the most activated hamstring muscles, followed by the ST, and lastly the SM. Therefore, training programs in order to strengthen and activate the hamstring muscles, and particularly the BF<span class="elsevierStyleInf">LH</span>, could be improved by the inclusion of the FRD exercise.</p></span><span id="sec0009a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016a">CRediT authorship contribution statement</span><p id="para0022a" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Pedro Luis Cosio:</span> Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Writing – original draft, Writing – review & editing. <span class="elsevierStyleBold">Lia Moreno-Simonet:</span> Conceptualization, Investigation, Data curation, Writing – review & editing. <span class="elsevierStyleBold">Sandra Mechó:</span> Methodology, Investigation, Data curation, Formal analysis, Writing – review & editing. <span class="elsevierStyleBold">Xavier Padulles:</span> Investigation, Writing – review & editing. <span class="elsevierStyleBold">Josep Maria Padulles:</span> Investigation, Writing – review & editing. <span class="elsevierStyleBold">Joan Aureli Cadefau:</span> Conceptualization, Methodology, Investigation, Writing – original draft, Writing – review & editing, Project administration.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres2284105" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1900302" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0002" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0003" "titulo" => "Experimental approach" ] 1 => array:2 [ "identificador" => "sec0004" "titulo" => "Flywheel Russian belt Deadlift exercise" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Image acquisition and processing" ] 3 => array:2 [ "identificador" => "sec0006" "titulo" => "Statistical analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0007" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0008" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0009" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0009a" "titulo" => "CRediT authorship contribution statement" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-05-24" "fechaAceptado" => "2024-06-08" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1900302" "palabras" => array:5 [ 0 => "Eccentric overload" 1 => "Functional magnetic resonance imaging" 2 => "Inertial training" 3 => "Hamstring strains" 4 => "Sprint-based team sports" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Background</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Despite the implementation of specific exercises to reduce hamstrings strain injuries (HSI) risk, the incidence has remained unchanged over the past 30 years. Therefore, the purpose of the study was to analyze hamstrings muscle activation induced by a novel <span class="elsevierStyleItalic">Flywheel Russian belt Deadlift</span> (FRD) exercise, together with individual muscle-, region- and limb-specific differences.</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">The activation of hamstring muscles before and immediately after a 10 × 10 FRD training session was assessed by the T2 shift technique through functional magnetic resonance imaging, in one international-level filed hockey male player. The individual use of the biceps femoris long head (BF<span class="elsevierStyleInf">LH</span>) and short head (BF<span class="elsevierStyleInf">SH</span>), semitendinosus (ST), and semimembranosus (SM) were analyzed, together with the region-specific activation for each muscle.</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">T2 values significantly increased immediately after exercise in all regions of the hamstring muscles in both dominant and non-dominant lower limb. However, the SM muscle showed a lesser activation, compared to BF<span class="elsevierStyleInf">LH</span>, BF<span class="elsevierStyleInf">SH</span> and ST muscles [F(3,106) = 9.557, <span class="elsevierStyleItalic">p</span> < 0.001]. Overall, the most activated muscle by the FRD training session was the biceps femoris (short head +13.8 %, long head, +12.7 %), followed by the ST (+11.3 %), and lastly the SM (+6.9 %).</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusion</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">The novel FRD exercise triggers a homogeneous and consistent activation of hamstring muscles. Particularly, the lateral positioning muscles (i.e., BF<span class="elsevierStyleInf">LH</span> and BF<span class="elsevierStyleInf">SH</span>) were more activated than the medial positioning muscles (i.e., ST and SM). Therefore, the FRD exercise could enhance training programs to strengthen and activate the hamstring muscles, and specifically, the BF<span class="elsevierStyleInf">LH</span>, in order to reduce HSI risk.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1318 "Ancho" => 2450 "Tamanyo" => 102868 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Standardized (A) starting and (B) finishing position of the novel <span class="elsevierStyleItalic">Flywheel Russian belt deadlift</span> exercise.</p>" ] ] 1 => array:8 [ "identificador" => "fig0002" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1153 "Ancho" => 2500 "Tamanyo" => 157365 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Selected magnetic resonance images acquired before and immediately after the <span class="elsevierStyleItalic">Flywheel Russian belt deadlift</span> training session, depicting regions of interest (ROIs). 1, m. biceps femoris short head (BF<span class="elsevierStyleInf">SH</span>); 2, m. biceps femoris long head (BF<span class="elsevierStyleInf">LH</span>); 3, m. semitendinosus (ST); 4, m. semimembranosus (SM).</p>" ] ] 2 => array:8 [ "identificador" => "fig0003" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3717 "Ancho" => 2917 "Tamanyo" => 543782 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Representative T2-weighted magnetic resonance images of the proximal region (25 % of thigh length), middle region (50 % of thigh length) and distal region (75 % of the tight length) before and immediately after the <span class="elsevierStyleItalic">Flywheel Russian belt deadlift</span> training session. BF<span class="elsevierStyleInf">SH</span>, m. biceps femoris short head; BF<span class="elsevierStyleInf">LH</span>, m. biceps femoris long head; ST, m. semitendinosus; SM, m. semimembranosus.</p>" ] ] 3 => array:8 [ "identificador" => "fig0004" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1211 "Ancho" => 2500 "Tamanyo" => 183096 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Mean and standard deviation of the change in the transverse relaxation time (%T2 shift) of the 30 % (proximal), 50 % (middle) and 70 % (distal) regions of thigh length in m. biceps femoris short head (BF<span class="elsevierStyleInf">SH</span>), m biceps femoris long head (BF<span class="elsevierStyleInf">LH</span>), m. semitendinosus (ST), and m. semimembranosus (SM), immediately after the <span class="elsevierStyleItalic">Flywheel Russian belt deadlift</span> training session. All values are given as a percentage of the pre-value. (*) indicates significant T2 shift and (#) indicates substantial differences in SM muscle, compared to BF<span class="elsevierStyleInf">SH</span>, BF<span class="elsevierStyleInf">LH</span> and ST muscles. D, dominant limb; ND, non-dominant limb.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0004" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">(∗) indicates significant post-exercise change from baseline T2 value. %Δ, percentage of delta change; BF<span class="elsevierStyleInf">SH</span>, m. biceps femoris short head; BF<span class="elsevierStyleInf">LH</span>, m. biceps femoris long head; MD, mean difference; ST, m. semitendinosus; SM, m. semimembranosus.</p>" "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col">Region-specific</th><a name="en0002"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BF<span class="elsevierStyleInf">SH</span></th><a name="en0003"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BF<span class="elsevierStyleInf">LH</span></th><a name="en0004"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ST</th><a name="en0005"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SM</th></tr><tr title="table-row"><a name="en0007"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">Pre \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0008"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">Post \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0009"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col">Pre \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0010"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col">Post \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0011"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col">Pre \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0012"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col">Post \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0013"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col">Pre \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0014"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col">Post \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><a name="en0015"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dominant</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0016"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top"><span class="elsevierStyleBold">Proximal</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0017"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup colgroup " colspan="2" align="left" valign="top">Not applicable</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.2 ± 0.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.4 ± 2.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.0 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.7 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">41.0 ± 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">42.8 ± 2.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065b"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0065c"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0065d"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0026"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.1, %Δ = 11.8*</td><a name="en0027"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.7, %Δ = 10.1*</td><a name="en0028"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 1.9, %Δ = 4.5*</td></tr><tr title="table-row"><a name="en0029"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top"><span class="elsevierStyleBold">Middle</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">33.3 ± 1.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">37.0 ± 1.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.1 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.3 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.1 ± 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.0 ± 0.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.1 ± 2.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">42.7 ± 3.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065e"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.7, %Δ = 11.1*</td><a name="en0040"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.2, %Δ = 12.1*</td><a name="en0041"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.0, %Δ = 11.5*</td><a name="en0042"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.6, %Δ = 9.2*</td></tr><tr title="table-row"><a name="en0043"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top"><span class="elsevierStyleBold">Distal</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">35.1 ± 0.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">41.3 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.3 ± 0.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.3 ± 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.0 ± 0.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.5 ± 0.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38.8 ± 2.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">41.7 ± 2.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065f"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0053"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 6.1, %Δ = 17.6*</td><a name="en0054"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 5.1, %Δ = 14.3*</td><a name="en0055"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 5.6, %Δ = 15.9*</td><a name="en0056"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 2.9, %Δ = 7.5*</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top"><span class="elsevierStyleBold">Total</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">34.2 ± 1.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">39.1 ± 2.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.2 ± 1.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.6 ± 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.8 ± 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.9 ± 1.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.3 ± 2.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">42.4 ± 2.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065a"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0067"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" style="border-bottom: 2px solid black">MD = 4.9, %Δ = 14.4*</td><a name="en0068"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" style="border-bottom: 2px solid black">MD = 4.5, %Δ = 12.7*</td><a name="en0069"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" style="border-bottom: 2px solid black">MD = 4.1, %Δ = 11.5*</td><a name="en0070"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" style="border-bottom: 2px solid black">MD = 3.0, %Δ = 7.8*</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3704291.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0071"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-dominant</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0072"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Proximal</span></td><a name="en0073"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup colgroup " rowspan="2" align="left" valign="top" colspan="2">Not applicable</td><a name="en0074"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.6 ± 3.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.6 ± 3.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.3 ± 3.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38.8 ± 1.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.4 ± 0.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.6 ± 0.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0082"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.0, %Δ = 11.6*</td><a name="en0083"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.5, %Δ = 10.5*</td><a name="en0084"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.2, %Δ = 8.7*</td></tr><tr title="table-row"><a name="en0085"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Middle</span></td><a name="en0086"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">38.1 ± 2.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">42.4 ± 2.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.8 ± 1.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">43.0 ± 3.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.4 ± 1.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.5 ± 1.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.9 ± 0.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.6 ± 0.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0095"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.3, %Δ = 11.6*</td><a name="en0096"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 5.2, %Δ = 13.5*</td><a name="en0097"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.1, %Δ = 11.6*</td><a name="en0098"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 1.7, %Δ = 4.9*</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Distal</span></td><a name="en0100"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">37.9 ± 1.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">43.4 ± 1.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.3 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.9 ± 1.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">34.4 ± 0.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38.0 ± 2.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.6 ± 0.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.9 ± 1.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0109"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 5.5, %Δ = 14.7*</td><a name="en0110"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.5, %Δ = 12.6*</td><a name="en0111"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.6, %Δ = 10.6*</td><a name="en0112"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 2.3, %Δ = 6.5*</td></tr><tr title="table-row"><a name="en0113"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Total</span></td><a name="en0114"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">38.0 ± 2.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">42.9 ± 2.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.8 ± 2.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">41.4 ± 3.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.2 ± 2.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.0 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.0 ± 0.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38.2 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0123"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.9, %Δ = 13.2*</td><a name="en0124"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.7, %Δ = 12.7*</td><a name="en0125"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.8, %Δ = 11.1*</td><a name="en0126"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 2.2, %Δ = 6.1*</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3704293.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0127"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Combined</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0128"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Proximal</span></td><a name="en0129"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup colgroup " rowspan="2" align="left" valign="top" colspan="2">Not applicable</td><a name="en0130"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.4 ± 2.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.5 ± 2.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.1 ± 2.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.7 ± 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.2 ± 2.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">41.7 ± 2.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0138"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.1, %Δ = 11.7*</td><a name="en0139"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.6, %Δ = 10.3*</td><a name="en0140"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 2.6, %Δ = 6.6*</td></tr><tr title="table-row"><a name="en0141"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Middle</span></td><a name="en0142"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">35.7 ± 3.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">39.7 ± 3.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.4 ± 2.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">41.1 ± 3.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.2 ± 1.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.3 ± 0.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.5 ± 2.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.2 ± 3.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0151"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.0, %Δ = 11.4*</td><a name="en0152"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.7, %Δ = 12.8*</td><a name="en0153"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.0, %Δ = 11.5*</td><a name="en0154"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 2.7, %Δ = 7.0*</td></tr><tr title="table-row"><a name="en0155"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Distal</span></td><a name="en0156"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">36.5 ± 1.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">42.3 ± 1.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.8 ± 1.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.6 ± 1.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">34.7 ± 0.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.3 ± 1.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.2 ± 2.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.8 ± 2.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0165"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 5.8, %Δ = 16.1*</td><a name="en0166"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.8, %Δ = 13.4*</td><a name="en0167"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.6, %Δ = 13.3*</td><a name="en0168"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 2.6, %Δ = 7.0*</td></tr><tr title="table-row"><a name="en0169"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Total</span></td><a name="en0170"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">36.1 ± 2.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">41.0 ± 3.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.0 ± 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.5 ± 2.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.5 ± 2.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39.4 ± 1.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0176"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.7 ± 2.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.3 ± 3.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0179"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.9, %Δ = 13.8*</td><a name="en0180"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 4.6, %Δ = 12.7*</td><a name="en0181"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 3.9, %Δ = 11.3*</td><a name="en0182"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">MD = 2.6, %Δ = 6.9*</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3704292.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Region-specific T2 values, mean difference (MD) and percentage of the difference (%Δ) of hamstring muscles before and immediately after the <span class="elsevierStyleItalic">Flywheel Russian belt deadlift</span> training session.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and prevalence of hamstring injuries in field-based team sports: a systematic review and meta-analysis of 5952 injuries from over 7 million exposure hours" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. 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