Asymmetric and Symmetric Study in Clinical Rehabilitation, Exercise Science, Clinical Biomechanics, and Biomedical Engineering: Technologies, Advances, and Applications

A special issue of Symmetry (ISSN 2073-8994). This special issue belongs to the section "Life Sciences".

Deadline for manuscript submissions: closed (31 October 2023) | Viewed by 18296

Special Issue Editors


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Guest Editor
Institute of Clinical Rehabilitation, University of Physical Education in Kraków, 31-571 Kraków, Poland
Interests: rehabilitation medicine; sports medicine; exercise science; biomechanics; bioengineering
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Co-Guest Editor
1. Department of Physiotherapy, Faculty of Health Sciences, Medical College Krakow, Jagiellonian University, Krakow, Poland
2. Oleksy Medical & Sports Sciences, Łańcut, Poland
Interests: rehabilitation medicine; sports medicine; exercise science; return to sport; injury risk; biomechanics; bioengineering
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The asymmetry in musculoskeletal systems is widely considered a strong factor of tissue overload and increased risk of injury. Due to the tensegrity model, all asymmetrical tension transmitted throughout musculofascial structures may lead to microtrauma, even in distant parts of the body. Moreover, it has been reported in the literature that tissues which are overloaded are prone to microtrauma, which causes a decrease in muscle strength and endurance manifested as increased muscle fatigue. It has also been reported that approximately 80 percent of healthy people have rotated body patterns, and thus, fascial tension in specific body parts may cause the body to be more prone to asymmetry. Moreover, asymmetrical joints’ range of motion may lead to changes in muscle and tendon length, and to changes in neuromuscular control of those muscles’ contractions. Therefore, muscles on one side may contract in unnatural lengthening and on the opposite side, in unnatural shortening. None of these situations create an optimal condition for effective contraction and force production. The microinjuries of motor units may lead to a decrease in muscle strength and endurance which may be visible as increased fatigue level. However, it is crucial not only to recognize the existence of such asymmetries, but also to understand the underlying mechanisms which allow for successive treatment, rehabilitation, or sport training individualization. Therefore, this Special Issue is aimed at highlighting the explanations for the observed asymmetry in the musculoskeletal system, particularly emphasizing mechanisms of tissue overload and injury from a biomechanical, rehabilitation and sport perspective. Research papers that provide empirical evidence for new explanations of musculoskeletal system asymmetry, risk factors causing asymmetrical tension, tissue overload and injury, and treatment methods, as well as theoretical papers that introduce new explanations are encouraged.

Prof. Dr. Anna Mika
Guest Editor

Dr. Łukasz Oleksy
Co-Guest Editor

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Keywords

  • symmetry and asymmetry of musculoskeletal system
  • tissue overload
  • biomechanics of microtrauma
  • sport injury
  • rehabilitation
  • tissue bioengineering

Published Papers (8 papers)

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Research

12 pages, 1100 KiB  
Article
Composite Score of Readiness (CSR) as a Data Reduction Technique for Monitoring the RTS Process in Footballers following ACL Reconstruction
by Łukasz Oleksy, Anna Mika, Renata Kielnar, Miłosz Szczudło, Henryk Racheniuk, Olga Adamska, Marian Rzepko, Aleksandra Królikowska, Paweł Reichert, Robert Prill and Artur Stolarczyk
Symmetry 2023, 15(2), 298; https://doi.org/10.3390/sym15020298 - 21 Jan 2023
Cited by 1 | Viewed by 1773
Abstract
In recent years, many studies on the safe return to sport (RTS) have been published, but there are still no clear and validated guidelines. After ACL reconstruction between limbs, asymmetry of muscle strength affects knee mechanics during walking and running, and asymmetrical joint [...] Read more.
In recent years, many studies on the safe return to sport (RTS) have been published, but there are still no clear and validated guidelines. After ACL reconstruction between limbs, asymmetry of muscle strength affects knee mechanics during walking and running, and asymmetrical joint kinematics and kinetics are considered as a strong risk factor of musculoskeletal injury. Therefore, proper diagnosis of any motor deficits remaining after ACL reconstruction seems particularly important. The aim of this study was to analyze how many tests should be included in the RTS test battery and which of them are most indicative for functional deficits related to anterior cruciate ligament (ACL) reconstruction. Sixty-five male football players (age 18–25 years) were divided into three groups: ACL group—after ACL rupture and reconstruction, mild injury group—post mild lower limb injuries, and the control group—without injuries. They performed five tests: Functional Movement Screen, Tuck Jump Assessment, Y-balance Test, Hop Test for Distance, and Isokinetic Test. The Composite Score of Readiness (CSR) index was calculated and expressed as the sum of z-scores. The multiple regression model for all tests was calculated, and then redundant variables were excluded. We observed that all tests significantly influenced the final CSR index. The Y-balance Test, Tuck Jump Assessment, and Isokinetic Test for knee flexion influenced the final CSR index the most, which means that these tests are greatly indicative of functional deficits related to ACL reconstruction. The strength of the extensor (quadriceps) muscle and the quadriceps/hamstring ratio appeared to be non-sensitive for testing functional deficits related to ACL reconstruction. If the test battery includes 4–5 tests, it better differentiates the athletes following ACL reconstruction from those after mild injuries, even if they all were cleared to play. Full article
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7 pages, 241 KiB  
Article
Injury Symmetry in Judo
by Wiesław Błach, Łukasz Rydzik, Arkadiusz Stanula, Wojciech J. Cynarski and Tadeusz Ambroży
Symmetry 2023, 15(1), 13; https://doi.org/10.3390/sym15010013 - 21 Dec 2022
Cited by 3 | Viewed by 1148
Abstract
Background: Each combat sport carries different risks of injury due to the specifics of the sport (including the weight categories and sex) and the fighting techniques used according to different sports regulations. The purpose of this study is to examine injury symmetry in [...] Read more.
Background: Each combat sport carries different risks of injury due to the specifics of the sport (including the weight categories and sex) and the fighting techniques used according to different sports regulations. The purpose of this study is to examine injury symmetry in judo. Methods: Injuries recorded in 195 people (93 women, 102 men) suffered during top-level judo tournaments were verified. Using the European Judo Union medical questionnaire, information on injuries was obtained from each injured athlete. Results: Based on the analysis of the results, it can be concluded that injuries are almost evenly distributed on the left and right sides of the body in both men and women. In women, there were 129 injuries to the left side (41.2%), 134 injuries to the right (42.8%), and 50 (16.0%) to the middle part of the body. Conclusions: injuries in judo are evenly distributed and slightly more common on the right side. Injuries occur at a greater rate during defending maneuvers than attacking maneuvers in judo. Identification and monitoring of who (tori or uke) and which side of the body sustains an injury are crucial and important in injury prevention. This knowledge makes it possible to modify existing sports regulations by eliminating behaviors (e.g., certain types of defense) to improve the safety of athletes participating in top-level competitions and the training process in terms of ensuring safety in both attack and defense. Full article
11 pages, 1894 KiB  
Article
Does Mobility of the Ankle Joint Depends on Length of the Free Part of the Achilles Tendon?
by Tomasz Wawrzyński, Bernadeta Angelika Pietrzak and Anna Mika
Symmetry 2022, 14(11), 2313; https://doi.org/10.3390/sym14112313 - 4 Nov 2022
Viewed by 2638
Abstract
The aim of our study was to evaluate whether the length of the free part of the Achilles tendon affects the mobility of the ankle joint in active motion without a load, as well as in functional motion with a body-weight load. We [...] Read more.
The aim of our study was to evaluate whether the length of the free part of the Achilles tendon affects the mobility of the ankle joint in active motion without a load, as well as in functional motion with a body-weight load. We examined 36 healthy people, aged 21 to 30 years, and divided them into two groups: 1 (n = 15)—participants with a normal range of dorsiflexion in the ankle joint (20° or more), and 2 (n = 21)—participants with a reduced range of dorsiflexion in the ankle joint (below 20°). The length of the free part of the Achilles tendon was measured using ultrasonography. Ankle joint range of dorsiflexion was assessed, and a weight-bearing lunge test (WBLT) was conducted. Group 1 performed the WBLT better and demonstrated significantly greater Achilles tendon length compared to Group 2. A moderate, significant correlation was observed between ankle joint range of dorsiflexion and Achilles tendon length (r = 0.53, p < 0.05); between WBLT and Achilles tendon length (r = 0.61, p < 0.05); as well as between ankle joint range of dorsiflexion and WBLT (r = 0.63, p < 0.05). Thus, we can suggest that both the length of the tendon (measured by USG) and the ankle range of motion under a body-weight load (measured by WBLT) are good indicators regarding the range of foot dorsiflexion, but only up to specific values (6 cm of tendon length and 11 cm of WBLT reach). Therefore, Achilles tendon length, e.g., after injury and during tendon healing, may be monitored using the method of ultrasound imaging presented in this study. Full article
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10 pages, 1040 KiB  
Article
Asymmetry in Muscle Strength, Dynamic Balance, and Range of Motion in Adult Symptomatic Hip Dysplasia
by Haifang Wang, Hailong Yu, Yonghwan Kim and Tingting Chen
Symmetry 2022, 14(4), 748; https://doi.org/10.3390/sym14040748 - 5 Apr 2022
Cited by 7 | Viewed by 2867
Abstract
Hip dysplasia (HD) is a typical developmental abnormality of the hip joint, and discomfort is often found in adulthood. This study compared patients with symptomatic HD in muscle strength, dynamic balance, and range of motion (ROM) with healthy individuals. Patients included those who [...] Read more.
Hip dysplasia (HD) is a typical developmental abnormality of the hip joint, and discomfort is often found in adulthood. This study compared patients with symptomatic HD in muscle strength, dynamic balance, and range of motion (ROM) with healthy individuals. Patients included those who complained of unilateral pain although the lateral center edge angle (LCEA) exhibited bilateral abnormality. Participants (n = 95; men: 46, women: 49) were divided into symptomatic and asymptomatic sides, and a healthy group without a history of hip joint disease (n = 70; men: 30, women: 40) was compared. Hip flexion, extension, abduction, and adduction were performed at an angular velocity of 30°/s using an isokinetic strength test device. The Y-balance test was conducted to measure dynamic balance, and ROM was measured using an electronic goniometer to evaluate flexion, extension, adduction, abduction, and internal and external rotations. In addition, the pain visual analog scale (VAS) and hip and groin outcome scale (HAGOS), a subjective evaluation of the hip joint, were evaluated. ROM (flexion, abduction, internal rotation, and external rotation) was significantly decreased in the HD symptomatic sides of men and women compared to those of the healthy group and the asymptomatic side, and the dynamic balance, flexion, and abduction muscle strength were also lower on the symptomatic sides. Although the LCEA of the HD asymptomatic side was lower than that of the healthy group, there were no significant differences in VAS, flexion, extension, abduction ROM, and extension strength compared to those of healthy individuals. In conclusion, patients with HD were mostly bilateral, and on the symptomatic side, there was a decrease in ROM, dynamic balance, and muscle strength; however, on the asymptomatic side, the function was relatively close to normal. Full article
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15 pages, 2117 KiB  
Article
The Association between Symmetrical or Asymmetrical High-Arched Feet and Muscle Fatigue in Young Women
by Renata Woźniacka, Łukasz Oleksy, Agnieszka Jankowicz-Szymańska, Anna Mika, Renata Kielnar and Artur Stolarczyk
Symmetry 2022, 14(1), 52; https://doi.org/10.3390/sym14010052 - 1 Jan 2022
Viewed by 1820
Abstract
The foot arches are responsible for proper foot loading, optimal force distribution, and transmission throughout the soft tissues. Since the foot arch is an elastic structure, able to adapt to forces transmitted by the foot, it was reported that low arch is related [...] Read more.
The foot arches are responsible for proper foot loading, optimal force distribution, and transmission throughout the soft tissues. Since the foot arch is an elastic structure, able to adapt to forces transmitted by the foot, it was reported that low arch is related to excessive foot pronation, while high arched foot is more rigid and inflexible. Therefore, it is also probable, that foot arch alterations may change the force transmission via myofascial chains. The objective of this study was to evaluate the effect of symmetrical and asymmetrical excessive feet arching on muscle fatigue in the distal body parts such as the lower limbs, trunk, and head. Seventy-seven women (25.15 ± 5.97 years old, 62 ± 10 kg, 167 ± 4 cm) were assigned to three groups according to the foot arch index (Group 1—both feet with normal arch, Group 2—one foot with normal arch and the other high-arched, Group 3—both feet with high-arch). The bioelectrical activity of the right and left hamstrings muscles, erector spine, masseter, and temporalis muscle was recorded by sEMG during the isometric contraction lasting for 60 s. The stable intensity of the muscle isometric contraction was kept for all the time during the measurement. Mean frequency difference (%), slope (Hz), and intercept (Hz) values were calculated for muscle fatigue evaluation. No differences were observed in fatigue variables for all evaluated muscles between the right and left side in women with symmetrical foot arches, but in the group with asymmetric foot arches, the higher muscle fatigue on the normal-arched side compared to the high-arched side was noted. Significantly greater values of the semitendinosus—semimembranosus muscle frequency difference was observed on the normal-arched side compared to the high-arched side (p = 0.04; ES = 0.52; −29.5 ± 9.1% vs. −24.9 ± 8.4%). In the group with asymmetric foot arches, a significantly higher value of lumbar erector spinae muscle frequency slope (p = 0.01; ES = 1.32; −0.20 ± 0.04 Hz vs. −0.14 ± 0.05 Hz) and frequency difference (p = 0.04; ES = 0.92; −7.8 ± 3.1% vs. −4.8 ± 3.4%) were observed on the high-arched foot side compared to the side with normal foot arching. The thoracic erector spine muscle frequency slope was significantly larger in women with asymmetrical arches than in those with both feet high-arched (right side: p = 0.01; ES = 1.25; −0.20 ± 0.08 Hz vs. −0.10 ± 0.08 Hz); (left side: p = 0.005; ES = 1,17; −0.19 ± 0.04 Hz vs. −0.13 ± 0.06 Hz) and compared to those with normal feet arches (right side: p = 0.02; ES = 0.58; −0.20 ± 0.08 Hz vs. −0.15 ± 0.09 Hz); (left side: p = 0.005; ES = 0.87; −0.19 ± 0.04 Hz vs. −0.14 ± 0.07 Hz). In the group with asymmetric foot arches, the frequency difference was significantly higher compared to those with both feet high-arched (right side: p = 0.01; ES = 0.87; −15.4 ± 6.8% vs. 10.4 ± 4.3%); (left side: p = 0.01; ES = 0.96; 16.1 ± 6.5% vs. 11.1 ± 3.4%). In the group with asymmetric foot arches, a significantly higher value of the masseter muscle frequency difference was observed on the high-arched side compared to the normal-arched side (p = 0.01; ES = 0.95; 6.91 ± 4.1% vs. 3.62 ± 2.8%). A little increase in the longitudinal arch of the foot, even though such is often not considered as pathological, may cause visible changes in muscle function, demonstrated as elevated signs of muscles fatigue. This study suggests that the consequences of foot high-arching may be present in distal body parts. Any alterations of the foot arch should be considered as a potential foot defect, and due to preventing muscle overloading, some corrective exercises or/and corrective insoles for shoes should be used. It can potentially reduce both foot overload and distant structures overload, which may diminish musculoskeletal system pain and dysfunctions. Full article
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10 pages, 3246 KiB  
Article
Walking Practice Combined with Virtual Reality Contributes to Early Acquisition of Symmetry Prosthetic Walking: An Experimental Study Using Simulated Prosthesis
by Kazuki Fukui, Noriaki Maeda, Makoto Komiya, Shogo Tsutsumi, Keita Harada, Sayo Kuroda, Masanori Morikawa and Yukio Urabe
Symmetry 2021, 13(12), 2282; https://doi.org/10.3390/sym13122282 - 1 Dec 2021
Cited by 1 | Viewed by 2822
Abstract
Virtual reality (VR)-based rehabilitation has been used in lower limb amputees; however, the extent to which VR is effective in reacquiring symmetrical gait in lower limb amputees is unclear. The purpose of this study was to confirm whether a VR intervention is effective [...] Read more.
Virtual reality (VR)-based rehabilitation has been used in lower limb amputees; however, the extent to which VR is effective in reacquiring symmetrical gait in lower limb amputees is unclear. The purpose of this study was to confirm whether a VR intervention is effective in obtaining a simulated prosthetic gait. The participants were 24 healthy males who had never worn a simulated prosthesis. They were divided into three groups: VR, tablet, and control groups. The intervention consisted of 5 min of in situ stepping on parallel bars and watching a video of a simulated prosthetic leg walker on a head-mounted display or a tablet. Measurements included Gait Up parameters during a 10-m walk and immersion scores. After the intervention, there was a significant interaction between walking speed and leg swing speed in the VR group. The rate of improvement in walking speed and immersion scores was significantly higher in the VR group than in the other two groups, and there was a significant positive correlation between the rate of improvement and immersion scores. Compared to the tablet and control groups, the VR group showed the highest rate of immersion and improvement in walking speed. Full article
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8 pages, 966 KiB  
Article
Bilateral Strength Asymmetry in Elite Youth Soccer Players: Differences between Age Categories
by Maros Kalata, Mikulas Hank, David Bujnovsky, Jakub Michalek, Matej Varjan, Egon Kunzmann, Frantisek Zahalka and Tomas Maly
Symmetry 2021, 13(11), 1982; https://doi.org/10.3390/sym13111982 - 20 Oct 2021
Cited by 3 | Viewed by 1740
Abstract
The strength asymmetry of athletes as a negative health and performance factor is increasingly being researched in sports with a high load on the dominant limb when some specific unilateral movements, such as passing, jumping, and tackling, are required. This study aimed to [...] Read more.
The strength asymmetry of athletes as a negative health and performance factor is increasingly being researched in sports with a high load on the dominant limb when some specific unilateral movements, such as passing, jumping, and tackling, are required. This study aimed to determine the level of isokinetic strength bilateral asymmetry (BA) among knee extensors (KEs) and knee flexors (KFs) of elite youth soccer players. The sample (n = 87) consisted of three age categories of under 13 (U13), under 15 (U15), and under 17 (U17) years old. Isokinetic dynamometry was used to obtain the maximum peak torque of the KEs and KFs in the dominant and non-dominant lower limbs during concentric muscle contraction. The analysis revealed significantly lower values (p < 0.05) of BA in KEs in U17 than in younger categories, U13 and U15, and higher values (p < 0.05) of BA in KFs in the U15 category than in the U17category. The majority of the players in the U15 category (68%) reached KFs BA higher than 10% in comparison with U13 players (50%) and U17 players (28% of players) (p < 0.05). Our results showed a significant effect of age category on BA levels in young soccer players. High incidences of increased BA in the lower limbs occurred in the younger categories (U13, U15) and subsequently decreased in the later adolescent stages. Full article
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8 pages, 582 KiB  
Article
Study of the Association between Postural Misalignments in School Students
by João Pedro Gouveia, Pedro Forte, Joana Ribeiro and Eduarda Coelho
Symmetry 2021, 13(10), 1959; https://doi.org/10.3390/sym13101959 - 18 Oct 2021
Viewed by 1758
Abstract
Nowadays, postural misalignments prevalence in students is increasingly evident and its early detection is the best way to prevent complications in adulthood. It is also known that postural problems appear to have association between them. The aim of this study was to characterize [...] Read more.
Nowadays, postural misalignments prevalence in students is increasingly evident and its early detection is the best way to prevent complications in adulthood. It is also known that postural problems appear to have association between them. The aim of this study was to characterize and study the association between spine, scapular and pelvic girdles postural misalignments in 213 school students (124 males and 89 females), aged between 10 and 20 years, from Escola Básica e Secundária de Santa Maria (EBSSM). To understand the relation between postural misalignments we compare the head positioning with the shoulder girdle, the shoulder girdle with the dorsal spine and the lumbar spine with the pelvic girdle. The postural assessment was made by visual scan analysis in a symmetrograph based on photogrammetry and the Adams. We found high percentages of postural misalignments in all subjects. High prevalence was observed in the posterior view of the frontal plane in the head lateral flexion, shoulders vertical asymmetry, scoliosis and in the presence of gibbosity, whereas, in the right view of the sagittal plane forward head posture and protracted shoulders were observed. The lumbar scoliosis was more prevalent in subjects with iliac crest’s asymmetry (p < 0.001) and forward head posture was significantly related to the subjects with protracted shoulders (p = 0.010). The protracted shoulders were more prevalent in subjects with dorsal hyperkyphosis (p = 0.048) and lumbar hyperlordosis was related to the subjects with pelvic anteversion (p < 0.001). The students’ postural assessment showed a wide variety of postural misalignments. It also seems evident that there is a relationship between their occurrences. It should be highlighted the importance of postural assessment in physical education (PE) classes to determine postural misalignments among school students. Full article
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