Clinical utility of tensiomyography for muscle function analysis in athletes

Figures & data

Figure 1 Flowchart of the literature search and the selection process.

Table 1 TMG protocols used in scientific literature

Protocol	Description	Study (year)	ICC	Sample
Incremental until reaching maximum stimulus	It starts with an intensity of 20–30 mA and increases progressively in 10 mA or in 5 mA until reaching the maximal stimulator output (110 mA).	García-García et al^Citation7	0.98^b–0.97^a	Professional soccer players
		García-García et al^Citation9	0.97^b–0.99^a
		García-García^Citation15	-	Professional cyclists
		García-García et al^Citation16	-
		García-García et al^Citation17	0.92^b–0.97^a
		García-García et al^Citation13	0.97–0.99
		García-García et al^Citation18	0.94–0.96	Elite kayakers
Incremental until reaching “plateau”	It starts with an intensity of 20 mA- 30 mA and increases progressively, generally in 10 mA until the Dm suffers a descent or a flattening of the curve called “plateau”	Alvarez-Diaz et al^Citation19	-	Soccer players
		Loturco et al^Citation20	-	Professional soccer players
		Gil et al^Citation21	-
		Loturco et al^Citation22	-	Elite athletes^c
		Giovanelli et al^Citation12	-	Mountain marathon runners
		de Paula Simola et al^Citation11	-	Cyclists strength athletes
		Wiewelhove et al^Citation10	0.92–0.95^a 0.91–0.94^b	Elite Juniors tennis players
A single or some stimulis at specific intensities	A single concrete intensity stimulus is applied and a only displacement-time curve is obtained	Rey et al^Citation23	-	Soccer players
		Rey et al^Citation24	-
		Rey et al^Citation8	0.86^b–0.95^a
		García-Manso et al^Citation25	-	Ultraendurance triathletes
		Rodríguez-Ruiz et al^Citation26	-	Elite volleyball players
		Rodríguez-Ruiz et al^Citation27	-

Notes: ^aDm; ^bTc; ^cjumper, runners, throwers.

Abbreviation: ICC: Intraclass correlation coefficient. Confidence Interval 95%.

Table 2 Characteristics of the studies that assessed specific muscle performance effects

Study (year)	Sample (n)	Mean Age ± SD (years)	Muscle Performance/Effect/Exercise assessed	Muscles	Results	Conclusions
de Hoyo et al^Citation32	18 elite soccer players	18.20±2.45	Power output, Countermovement Jump and 10-m-Sprint Test with RF Kinesio taping	VL and VM of the dominant limb	↑performance test ↑ Tr in VM and VL with Kinesio ↓ Ts in VL	Kinesio taping does not produce a short-term improvement in muscle performance
de Paula Simona et al^Citation11	25 male (14 experienced strength athletes +11 well-trained male cyclists)	Strength: 24.1±2.0 Cyclists: 25.5±4.8	6-day intensive training (11 sessions of strength + endurance)	VL of the dominant lower limb	↓ in Dm, V10, and V90 in strength athletes ↓ only in Dm in cyclists ↑ correlation (r =0.878) between Tc and muscle fiber type	Dm, V10, and V90 are able to detect fatigue after intensive strenght training while only Dm seems to be sensitive after intensive endurance training
Díez-Vega et al^Citation41	16 professional female volleyball players	20.32±1.68	4 months of training and physical conditioning	VM, FR, VL, BF and ST	↑in Vrn in all muscles except VM in both limbs were Vrn was maintained Only Vrn*	Mechanical adaptations in VL are related to the requirements of volleyball
Díez-Vega et al^Citation52	16 professional female volleyball players	20.32±1.68	4 months of training and physical conditioning	VM, FR, VL and BF	Changes in both in Dm and Tc in all muslces	TMG is enough sensitive to detect changes in volleybal
García-García^Citation15	10 profesional road cycling	27.5±5.5	VO2max cycling test	VM, VL, RF and BF	Positive correlations between: VO2max and Dm of RF and BF Wmax and Dm of BF	Dm of BF and RF is related to the performance of a bicycle test
García-García at al^Citation16	10 professionals road cyclists	27.5±5.5	Cycling Season (preparatory period and Competitive period)	VM, VL, RF an BF	↑in Tc between preparatory and competitive period in VM, VL and left RF ↓ in TC of BF ↓ in Dm in competitive period in all muscle excep left VM Differences between Tc values in all muscles for both periods*	Differences between the knee extensors (↑Tc) and the knee flexor (↓Tc) TMG can help to control the training load, provide training effect information, asymmetries or muscle imbalances.
García-García at al^Citation7	37 subjects (21 professional soccer player +16 CG)	Soccer players: 27.2±3.3 Non-soccer players: 22.2±1.9	10-week soccer training	VM, VL, RF and BF	↓ in Tc of VM, VL and RF ↓ in Dm of VM and RF ↑ in Dm of BF ↓ in Td and Tr of VL and RF ↑ in Td of BF	Tc, Td and Dm apperar to be more sensitive to soccer players neuromuscular changes
García-García^Citation13	50 elite cyclists	19.7±2.4	Maximal incremental cycling test	VM, VL, RF and BF	Wmax related: ↑ in Tc of RF and Dm of VM and VL ↓in Vrn of BF	TMG parameters can partially explain the performance in a specific cycling test
García-Manso et al^Citation31	12 professionals soccer players	25.89±5.86	Cold-water immersions	VL of the dominant leg	↓in Dm* ↓in Vd and Vc ↑ in Ts and Tr when exposure to cold water is prolonged.	↑ muscle stiffness ↓in response velocity and contraction velocity
García-Manso et al^Citation25	19 male triathletes	37.9±7.1	Ultraendurance triathlon	RF and BF	↑ in Tc, Dm and Tr of BF* ↓ in Td of RF*	Large loss in contractile capacity reflected in changes in the neuromuscular response
García-Manso et al^Citation42	16 subjects accustomed to strength training	21.1±2.6	Arm-curl with bar: HV and HL	BB	1º set ↑ Vc and ↓in Tr, Ts and Dm of HL and HL ↑ Siffness in HV ↓Stiffness in HL 3 first sets	HL firsts to show fatigue
García-Manso et al^Citation35	10 young female gymnasts	13.2±1.8	Stretching protocols: contract-relax and static-stretching.	BF of the dominant leg	↑ in velocity of deformation, Stiffness and Ts ↓ in Tr ↓V3mm after stretching	Both protocols similar responses in evaluated parameters
Gil et al^Citation21	20 elite soccer players	23.3±4.8	Countermovement jump, drop jump and sprint test	RF and BF	↓ in Dm of BF and RF in higher contact time ↓ in Dm of BF in higher strength index No correlations between TMG and height of jumps and sprints velocity	Moderate association between TMG and factors linked to a stretch-hortening cycle related task performance
Giovanelli et al^Citation12	25 male runners	42.8±9.9	Uphill marathon	VL	↓ in Tc, Ts, Tr and Td ↑ in Dm	↓muscle stiffness ↑muslce sensibility to the electrical stimulus
Gutierrez-Vargas et al^Citation29	18 marathon runners	35.6±6.9	Marathon race	RF and VM	↑ in Dm and Tc of RF* Smaller effects in VM Linear correlation between the Δ% of Tc in RF and CPK	↓ in lower-limb stiffness and high rates of neuromuscular fatigue accompanied by several products of muscle damage
López-Fernández et al^Citation39	16 amateur soccer players	22.17±3.43	Soccer simulation protocol in two surfaces	RF and BF	↓ in Tr of RF on natural grass ↓ in Ts of RF and Ts and Tr of BF on artificial turf ↑ in Tc of BF on artificial turf No significant differences between both surfaces	Artificial turf does not cause greater muscular fatigue than natural grass in soccer players
Loturco et al^Citation20	22 male elite soccer players	23.8±4.2	8-week training period	RF and BF from dominant leg	↓in BF and comparing pre- and post-tests ↑ in Tc and Td and ↓in Dm and Vc of RF	Vc is capable of detecting functional changes in the muscle mechanical properties
Loturco et al^Citation22	41 elite track and field athletes (22 power athletes, 19 endurance)	Power: 27.2±3.6 Endurance: 27.1±6.9	Squat jump, countermovement jump and drop jump	RF and BF	↓ in Tc, Dm and TD in power athletes ↑ in performance in jumps in power athletes	Significant correlations between TMG values and vertical jumping ability in elite athletes
Murray et al^Citation43	12 elite squash players	14.2±1.4	Foam Roller	Anterior thigh of the treated leg	No effect on Tc, Dm or Td	No effect on muscle contractility marckers
Raeder et al^Citation37	23 (14 male and 9 female) strength-trained athletes of combat and intermittent game sports	Men: 24.1±2.0 Women: 25.4±1.9	6-days intensified strength training	VM	↓ Dm and V90 after training period* Td and Tc remained unaffected	Male athletes fatigued greater Dm and V90 remained reduced following three days
Rey et al^Citation23	62 Spanish male professional soccer players	26.9±4.9	Quadriceps flexibility and passive straight leg raise	RF and BF dominant leg	↑in Dm of RF in higher quadriceps flexibility No correlations between TMG and hamstrings flexibility	Relationships between TMG parameters and flexibility in soccer players are not clear
Rojas-Barrionuevo et al^Citation33	12 high-performance male gymnasts	20.6±2.6	Tumbling session	GM, VL, RF, VM, BF	↓Td and Tc values in all muscle groups Max Dm in VM and RF at 15ʹ ↓ VL, VM and GM values during the first 30 mins	TMG allows estimating the states of activation-enhancing of the musculature responsible of jumping in tumblers
Rojas-Barrionuevo et al^Citation40	14 high-performance male gymnasts	20.7±3.1	Training protocol in three surfaces (trampoline, tumbling and gymnastics floor)	VL, VM, BF, RF, GM	↑ fatigue levels and recovery time in VM and BF in trampoline	The muscle response varies in a different way according to the gymnastic surface used
Rojas-Valverde et al^Citation44	10 male professional soccer players	27.78±2.87	4 official matches	RF	↓ in Tc and ↑ in Dm during championship	As the season progresses TMG is sensitive to changes in response to physical training
Rodriguez-Matoso et al^Citation30	11 highly experienced male body boarders	28.17±2.89	High-level bodyboard competition	RF, VL, VM, BF and ST	↓ in Ts of RF, VL, VM and ST in both legs ↓ in Tr of VM ↑ in Dm of all muscles analysed ↑in Vrn of right RF and left ST*	Performance causes fatigue in the knee extensor and flexor muscles.
Peterson & Quiggle^Citation45	5 female Division I National Collegiate Athletics Association basketball players	20±1.0	20-week training	RF, BF and AL	No significantly differents in Tc and Dm in weekly values Correlation between Tc and external measures of IMA™*	TMG may be better suited for detecting internal load alterations from relative external load
Rusu et al^Citation46	30 junior soccer players	16±0.4	6-week training	RF	↓ in Tc of EG ↑in Tc of CG ↑ in Dm of EG ↓ in Dm of CG	↑ in muscle tone in EG ↓Tc correlated to an↑ in Dm
Ubago et al^Citation38	15 female amateur rugby players	23.4±4.42	Repeated-Sprint ability shuttle test	RF and BF	↑ in Tc and Dm of RF in sand with regard natural grass	Repetitive-sprint-actions on sand regarding the natural grass produces higher levels of muscle fatigue on RF but not on BF
Valenzuela et al^Citation47	14 Olympic women’s Rugby Sevens team	27±5	Wingate test	VM, RF and VL	↓in Dm, Vd and Td of VL in higher PPO	TMG parameters of VL were strongly related to the power production capacity
Wiewelhove et al^Citation36	22 (11 males and 11 females) well-trained team sport athletes	23.0±2.7	6-day running-based HIIT	RF and BF	↓in Tc in both muscles* Dm was unaltered	Tc of the RF and BF may be a potential marker for monitoring fatigue and recovery
Wiewelhove et al^Citation10	14 male junior tennis players	14.9±1.2	4-day HIIT	RF of the dominant limb	No changes during the study in Dm, Tc, Ts and Td	TMG parameters were not sensitive enough to detect changes in elite youth athletes
Zubac et al^Citation50	10 male elite kickboxing athletes	22.1±4.1	2-weeks tapering period by gradual body-mass loss	VL, VM AND BF of dominant leg	↓ in Tc of BF and VL ↓ in Dm of BF There is a moderate association between TC and Creatine kinase activity	TMG could be used in the tapering period to check the muscle fatigue level

Note: *p-value<0.05.

Abbreviations: BB, biceps brachii; VL, vastus lateralis; VM, vastus medialis; RF, rectus femoris; ST, semitendinosus; BF, biceps femoris; AL, adductor longus; GM, gastrocnemius medialis; TA, tibialis anterior; HV, high volume; HL, high load; Dm, maximal displacement; Tc, contraction time; Td, delay time; Ts, sustained time; Tr, half-relaxation time; Vrn, normalized response speed; Vd, velocity of muscle deformation at the onset of contraction (10% Dm); Vc, velocity of the mean contraction observed between 10% Dm and 90% Dm ($Dm/dt); V_3mm,speed of response at 3 mm deformation; V₁₀ and V₉₀, rate of deformation development until 10% Dm (10%Dm/Δtime) and 90% Dm (90%Dm/Δtime; CPK, creatine phosphokinase; EG, experimental group; CG, control group.

Table 3 Tc, Dm, Vrn and Vc reference values in different sports modalities. Data are presented as mean (SD).

Sport	Muscle	Paper		Tc(ms)	Dm(mm)	Vrn (mm/s)	Vc (mm/s)−^Citation1
Male cyclists A - García-García et al^Citation16 n=10 B - García-García et al^Citation13 n=50	VM	A	PP	28.7 (5.5)	7.2 (2.3)
			CP	40.6 (14.4)	8.3 (1.5)
		B	^−	22.9 (2.0)	8.3 (1.3)	35 (3)
VL	A	PP	28.3 (4.9)	5.8 (1.6)
		CP	40.6 (10.2)	5.0 (1.4)
		B	^−	23.4 (2.3)	6.4 (1.3)	34 (3)
	RF	A	PP	35.9 (6.9)	8.6 (3.0)
		CP	45.9 (16.2)	7.4 (2.8)
		B	^−	29.0 (4.2)	8.3 (2.0)	28 (5)
	BF	A	PP	35.9 (9.9)	6.1 (2.3)
		CP	28.2 (5.2)	5.2 (2.3)
		B	^−	35.6 (7.9)	7.5 (2.2)	23 (4)
Female rugby Valenzuela et al^Citation47 n=14	VM			23.4 (3.4)	6.71 (0.97)
	VL			21.5 (2.8)	4.68 (1.61)
	RF			29.4 (4.1)	9.60 (2.08)
Male tennis players Wiewelhove et al^Citation10 n=14	RF		D	31.3 (3.9)	8.8 (1.9)
Mountain marathoners Giovanelli et al^Citation12 n=9	VL			25.8 (5.4)	6.6 (1.7)
Male Tumbling gymnasts Rojas-Barrionuevo et al^Citation33 n=12	VL			22.94 (5.15)	7.38 (2.34)	36.31 (7.18)
	VM			22.71 (2.50)	9.17 (1.39)	35.60 (3.83)
	RF			31.39 (6.05)	10.11 (1.61)	26.29 (4.70)
	GM			28.43 (10.64)	3.95 (1.12)	31.27 (10.75)
Bodyboarders Rodriguez-Matoso et al^Citation30 n=11	VL		Left		5.3 (1.6)	31.6 (1.9)
			Right		4.7 (1.4)	29.4 (4.1)
	VM		Left		6.8 (1.6)	28.5 (5.4)
			Right		6.7 (2.19)	30.1 (5.8)
	RF		Left		7.4 (2.4)	24.1 (4.2)
			Right		8.5 (2.2)	24.3 (3.2)
	BF		Left		6.6 (2.5)	22.4 (7.4)
			Right		4.8 (2.3)	30.6 (10.8)
	ST		Left		9.2 (3.5)	17.1 (2.2)
			Right		7.2 (2.5)	20.6 (4,5)
Ulta-endurance triathlon García-Manso et al^Citation25 n=19	BF		Left	59.7	6.8
			Right	26.7	4.7
Acrobatic gymnastics Vernetta-Santana et al^Citation34 n=11	VM			24.09 (4.53)	8.55 (1.39)	34.2 (6.05)
	VL			23.34 (3.1)	8.43 (2.21)	34.80 (4.52)
	RF			30.25 (6.73)	10.00 (3.7)	27.58 (5.70)
	BF			36.38 (1.50)	9.0 (2.01)	23.85 (6.21)
	GM			22.51 (3.45)	3.74 (1.28)	36.24 (5.18)
Kayakers top-level García-García et al^Citation18 n=7 Female n=4 men	DL		F	15.6 (0.8)	4.4 (0.8)
		M	16.0 (3.2)	5.2 (0.0)
	TR		F	49.0 (25.4)	5.8 (1.3)
		M	47.8 (31.3)	8.0 (4.7)
	LD		F	28.5 (5.4)	10.5 (4.)
		M	25.3 (8.7)	11.6 (2.9)
Beach volleyball men Rodríguez-Ruiz et al^Citation53 n=14	VM		Left	28.2 (15.5)	8.5 (2.0)
		Right	26.4 (10.3)	8.4 (1.5)
	RF		Left	29.2 (4.7)	9.2 (3.2)
		Right	31.3 (5.5)	9.2 (3.1)
	VL		Left	26.3 (3.2)	5.6 (1.4)
		Right	24.7 (4.3)	6.4 (1.1)
	BF		Left	25.7 (15.6)	3.9 (2.4)
		Right	24.2 (12.4)	4.3 (2.3)
Beach volleyball women Rodríguez-Ruiz et al^Citation53 n=10	VM		Left	24.9 (10.8)	7.6 (1.2)
		Right	26.4 (11.1)	6.5 (2.0)
	RF		Left	28.3 (5.8)	8.0 (2.3)
		Right	28.7 (4.4)	8.0 (1.7)
	VL		Left	24.6 (1.2)	5.6 (1.2)
		Right	24.4 (2.2)	5.5 (1.0)
	BF		Left	37.6 (17.5)	5.7 (2.7)
		Right	32.2 (16.0)	6.4 (2.0)
Volleyball M/F Rodríguez-Ruiz et al^Citation27 n=83 female n=83 men	VM					52.99/56.67
	RF					52.24/52.29
	VL					59.79/61.58
	BF					55.28/43.10
Male soccer players A - Alenton-Geli et al^Citation54 n=38 B - Alenton-Geli et al^Citation55 n=38 C - Alvarez-Diaz et al^Citation19 n=38 E - García-García et al^Citation7 n=37 F - García-García et al^Citation9 n=16 G - García-Manso et al^Citation31 n=12 H – Gil et al^Citation21 n=20 I – Loturco et al^Citation56 n=24 J – Rey et al^Citation24 n=31 K - Rojas-Valverde et al^Citation57 n=23	VM	F		25.0 (1.4)	9.1 (1.3)		0.29 (0.04)
		C	D	22.9 (2.0)	7.7 (1.5)
		ND	22.5 (2.1)	8 (1.9)
		K	D	25.25 (2.96)	8.29 (1.49)
		ND	25.45 (2.66)	9.01 (1.57)
		E	AT	35.2 (5.4)	8.4 (1.4)
		PP	28.7 (6.7)	7.2 (1.1)
		B		22.5 (2.1)	7.8 (1.7)
	RF	F		30.9 (3.3)	10.4 (2.3)		0.27 (0.06)
		C	D	26.6 (4.1)	13.6 (28.9)
		ND	27 (5.7)	8.8 (2.9)
		I	D	27.7 (7.9)	7.99 (3.44)		0.154 (0.067)
			ND	26.7 (6.0)	7.31 (3.25)		0.140 (0.053)
			H	D	19.74 (3.16)	6.16 (1.90)
			ND	21.27 (3.61)	6.98 (2.50)
			K	D	29.95 (2.32)	8.42 (3.15)
			ND	30.84 (5.17)	9.49 (2.43)
			E	AT	38.3 (3.3)	9.8 (2.4)
			PP	31.5 (5.8)	8.6 (2.4)
			J		28.2 (2.6)	11.1 (3.9)
				29.1 (4.0)	11.2 (2.3)
		B		26.8 (59)	11.2 (20.5)
	VL	F		26.1 (3.0)	7.2 (2.2)		0.22 (0.07)
			C	D	22.1 (2.3)	5.5 (1.6)
			ND	23 (3.2)	6 (2.3)
			K	D	24.68 (4.0)	7.29 (2.47)
			ND	23.70 (4.0)	7.29 (2.51)
			E	AT	36.9 (4.4)	5.9 (1.5)
			PP	28.5 (7.2)	5.5 (1.8)
			B		22.6 (2.8)	5.8 (2)
		G		26.31 (3.04)	5.12 (2.27)		22.08 (9.63)
	BF	F		34.5 (6.6)	7.0 (1.7)		0.16 (0.03)
			C	D	24.9 (6.5)	4.7 (2.1)
			ND	24.2 (7.0)	4.5 (2.2)
			I	D	19.2 (3.4)	3.02 (1.64)	0.074 (0.040)
			ND	19.8 (5.5)	3.10 (2.04)		0.073 (0.044)
			H	D	29.53 (11.09)	7.18 (3.39)
			ND	26.71 (9.89)	6.21 (3.0)
			K	D	25.96 (6.37)	5.67 (1.88)
			ND	27.88 (6.85)	6.56 (2.54)
			E	AT	28.8 (5.9)	5.3 (1)
			PP	29.8 (4.6)	6.6 (1.9)
			J		26.7 (4.7)	5.5 (1.7)
				26.9 (3.6)	5.3 (1.8)
		B		24.6 (6.7)	4.6 (2.1)
	ST	C	D	35.8 (5.89)	9.4 (2.7)
			ND	35.1 (6.2)	9.7 (2.8)
	GM	C	D	22.3 (2.4)	3.1 (1)
			ND	21.8 (2.7)	3 (1)
			K	D	25.91 (4.63)	3.61 (1.61)
			ND	25.42 (3.65)	3.15 (1.09)
		A		22.1 (2.5)	3.1 (1)
	GL	C	D	20.7 (2.4)	3.7 (1.3)
			ND	21.5 (5.5)	3.8 (1.3)
			K	D	21.63 (2.92)	3.86 (1.38)
			ND	22.92 (3.33)	4.17 (1.38)
			A		21.1 (4.3)	3.7 (1.3)
	AL	K	D	19.85 (3.89)	3.66 (1.87)
			ND	19.30 (4.08)	3.73 (2.48)
		ST	B		35.4 (6)	9.6 (2.7)

Abbreviations: SD, Standard deviation; Tc, contraction time; Dm, maximal displacement; Vrn, normalized response speed; VM, vastus medialis; PP, preparation period; CP, competition period; VL, vastus lateralis; RF, rectus femoris; BF, biceps femoris; GM, gastrocnemius medialis; DL, deltoideus; F, female; M, male; TR, trapezius; LD, latissimus dorsi; ST, semitendinosus; D, dominant side; ND, non-dominant side; GL, gastrocnemius lateralis; AL, adductor longus.

Figure 2 Algorithm implemented by the TMG-BMC tensomyography® software to determine the lateral (LS) and functional symmetry (FS).

Table 4 Characteristics of the studies that assessed injuries prevention and rehabilitation

Study (year)	Sample (n)	Mean Age ± SD	Injury	Muscle Group	Results	Conclusions
Álvarez-Diaz et al^Citation60	40 competitive Soccer players	22.3±6.9	ACLR	VM, VL, RF, ST, BF, GM and GL	↓ Ts and Tr for VL, Tc for RF and Tc and Dm for BF in both sides ↓Tc for VL, ST and GM, Tr for GL and Td for GL in injured side ↑Tr for VM and Ts for Gm in injured side ↓Tr for RF and Td for BF uninjured side ↑% SM in VM, VL, RF, and GM	↑ resistance to fatigue in VL, VM and RF in both sides ↑ Muscle contraction velocity and tone in BF, VL, VM and RF in both sides Changes in gastrocnemius only in the injury side ↑% SM between both sides
Alvarez-Diaz et al^Citation61	40 Competitive male soccer players	22.3±6.8	ACL	VM, VL, RF, ST, BF, GM and GL	↑Tc for VM, VL, RF ↑Tc and Dm for BF ↑Tc, Tr and Dm and ↓Ts for GM for GM ↑Tc for VM, VL, RF, ST, BF	The vastbmajority of TMG parameters were higher in the injured compared to the control group. Effects were worst in the quadriceps and GM compared to the hamstrings and GL
Alentorn-Geli et al^Citation55	40 soccer players	22.3±6.8	Complete ACL tear	VM, VL, RF, ST and BF	↑Tr for VL, Tc for FR, Tc, Tr and Ts for RF, and Tr Dm for BF in injury side	↓resistance to fatigue and muscle stiffness (ST and BF), may be an injury risk factor for ACL injury
Alentorn-Geli et al^Citation54	40 Competive male soccer players	22.3±6.8	ACL tear	GM and GL	↑Tr and Dm for GM in injured group	↓resistance to fatigue and muscle stiffness of GM GM and GL may not be an injury risk factor for ACL
Atiković et al^Citation59	1 artistic gymnastic Olympic medallist	19	Spinal cord injury	BF, ES, GMx, RF	95% LS for BF, 76% for ES, 92% GMx and 79% for RF	↓LS for ES and RF ↑LS for Gmx ↑values for ES and GMx
Maeda et al^Citation62	10 (3 men +7 women) with previus ACLR hisotry	Men: 23.9±4.4 Women: 21.6±3.1	ACLR	VM, VL, RF, BF	↑Dm for VM compared with non-ACLR side ↑Tr for VM and BF in both sides	↑Muscle contraction velocity and tone in antagonist could prevent ACL injury

Abbreviations: ACL, anterior cruciate ligament; ACLR, Anterior cruciate ligament reconstruction; AL: adductor longus; VM, vastus medialis; VL, vastus lateralis; RF, rectus femoris, ST, semitendinous; BF, biceps femoris; GM, gastrocnemius medialis; GL, gastrocnemius lateralis; ES, erector spinae, GMx, gluteus maximus; LS, lateral symmetry; % SM, percentage of symmetry; Dm, maximal displacement; Tc, contraction time; Td, delay time; Ts, sustained time; Tr, half-relaxation time; CG, control group.

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