Charles Cotteret

Despite the growing clinical use of dry needling, the anatomical accuracy and safety of ultrasound-unguided approaches to the soleus remain insufficiently standardized and validated. This study aimed to evaluate (i) the anatomical accuracy and safety of a standardized ultrasound-unguided dry needling protocol targeting the mid-third of the soleus, (ii) intra- and inter-rater reliability of key procedural outcomes, and (iii) agreement between ultrasound imaging and cadaveric dissection as validation methods for needle placement. An experimental cross-sectional cadaveric study was conducted on five fresh-frozen human cadavers (10 lower limbs), yielding 24 dry needling events. Two physiotherapists with different levels of dry needling experience (intermediate: 5 years; advanced: >10 years) performed the protocol independently. A blinded sonographer assessed needle tip location and quantitative safety margins using high-resolution ultrasound. Anatomical dissection was subsequently performed to confirm final needle placement in a subset of approaches. Outcomes included soleus placement accuracy, septum puncture (lateral and posterior/deep), and neurovascular/vascular compromise. Reliability was assessed using percentage agreement and Cohen's kappa. Accurate needle placement within the soleus was achieved in 22/24 procedures (91.7%), with 2 failures (8.3%), both performed by the intermediate-experience physiotherapist. Lateral septum puncture occurred in 5/24 cases (20.8%), and posterior/deep septum puncture in 3/24 cases (12.5%). No puncture of the tibial neurovascular bundle or vascular structures was observed (0%). Intra-rater agreement for the advanced physiotherapist was 100% across dichotomous outcomes. Inter-rater agreement was 80% for soleus accuracy and overall procedural success. Ultrasound imaging and cadaveric dissection demonstrated 100% agreement across accuracy and safety outcomes in the advanced physiotherapist approaches. In this cadaveric model, a standardized ultrasound-unguided dry needling protocol targeting the soleus achieved high anatomical accuracy with no neurovascular injury, and showed excellent agreement between ultrasound and dissection for the advanced operator.

Introduction: Deep dry needling (DDN) is commonly applied in physiotherapy to treat musculoskeletal pain. The quadratus femoris (QF) muscle, located in the ischiofemoral space (IFS), represents a clinically relevant yet anatomically complex target. However, limited evidence exists on the safety, accuracy, and reliability of non-ultrasound-guided DDN in this region. Aims: To assess the safety and accuracy of a standardized, non-ultrasound-guided DDN approach to the QF muscle, and to evaluate the intra- and inter-rater reliability of key procedural outcomes. Additionally, to determine the agreement between ultrasound imaging and anatomical dissection as validation methods for needle placement. Methods: An experimental cross-sectional study was conducted on five fresh cadavers (n = 24 approaches) by two physiotherapists with different DN experience. A standardized dry needling protocol was executed without ultrasound guidance, and anatomical and procedural variables were documented. Reliability (intra/inter-rater) was assessed for needle size, sciatic nerve (SN) puncture, IFS targeting, and overall success. In a subset, needle placement was validated through ultrasound and subsequent dissection. Results: The IFS was reached in 70.8% of procedures, and the SN was punctured in 16.7%. Inter-rater reliability for needle size was poor (κ = 0.04). Agreement between ultrasound and dissection was excellent for the ischiofemoral location and success (100%) and moderate for non SN puncture (90%; κ = 0.62). Conclusions: The standardized protocol demonstrated moderate accuracy and revealed a relevant clinical risk when targeting the quadratus femoris muscle. While inter-rater reliability was limited, agreement between ultrasound and dissection methods was high, supporting their complementary use for validating needle placement in anatomically complex procedures.

Introduction: Shear wave elastography (SWE) has been widely used to assess the mechanical properties of peripheral nerves, including the sciatic nerve. However, the relationship between sciatic nerve stiffness and posterior chain flexibility remains unclear. Therefore, we aimed to examine differences in sciatic nerve stiffness and shear wave speed (SWS) based on limb dominance and hamstring flexibility, and to explore their association with posterior chain mobility assessed through AKE and ASLR tests in healthy individuals. Methods: An observational study was conducted on 25 healthy, physically active participants (49 lower limbs). Sciatic nerve stiffness was measured using SWE at a standardized location in the posterior thigh. Posterior chain flexibility was assessed using the Active Knee Extension (AKE) and Active Straight Leg Raise (ASLR) tests. Participants were categorized based on hamstring flexibility, and comparisons were made between dominant and non-dominant limbs. Results: Participants with limited hamstring flexibility exhibited significantly higher AKE and ASLR values (p < 0.001) and showed an increased stiffness and SWS towards greater sciatic nerve (p = 0.05), although correlations between SWE values and flexibility tests were not significant. No significant differences were found between dominant and non-dominant limbs in AKE (p = 0.28), ASLR (p = 0.47), SWE (p = 0.38), or SWS (p = 0.34) values. Conclusions: Although no significant correlations were found between SWE parameters and flexibility tests, individuals with limited posterior chain mobility exhibited higher sciatic nerve stiffness in healthy participants.

To enhance athletic performance and reduce the risk of injury, load quantification has allowed for a better understanding of the individual characteristics of the physical demands on soccer players during training or competition. In this regard, it appears crucial to summarize scientific evidence to provide useful information and future directions related to the speed and acceleration profiles of male soccer players. This review aims to evaluate the findings reflected in the available literature on both profiles in football, synthesizing and discussing data from scientific articles, while providing insights into quantification methods, employed thresholds, tracking systems, terminology, playing position, and microcycle day. Therefore, it is hoped that this narrative review can support objective decision-making in practice for coaches, sports scientists, and medical teams regarding individualized load management and the appropriate selection of metrics, to explore current trends in soccer player profiles.

The velocity and acceleration of a soccer player varies depending on the specific demands of the field position as well as individual characteristics, establishing the need to determine relative profiles by position. A cross-sectional study was conducted in 18 semi-professional soccer players to determine (i) the specific demands of external load according to playing position, (ii) distances covered at different intensities and the number of sprints, and (iii) the number of accelerations at moderate and high intensity. GPS tracking systems were used to collect data, and the relative acceleration profiles were analyzed based on initial velocity (0–7 km/h; 7.1–14.3 km/h; >14.3 km/h), intensity (moderate 50–75% and high > 75% of maximal acceleration), number of sprints/accelerations, and distance covered. Additionally, relative speed profiles were evaluated through the distance covered at moderate intensity (40–60% Vmax), high intensity (60–75.5% Vmax), very high intensity (>75.5% Vmax), total distance, and number of sprints. Statistically significant differences were observed in the distance covered at moderate and high intensity (midfielders), distance covered sprinting (center backs), and acceleration at moderate and high intensity in all positions (p < 0.05). These findings will enhance the monitoring of external loading strategies and prescription of specific training exercises for soccer players based on their respective playing position, ultimately contributing to optimized performance.

Objective: Currently, ultrasound imaging (USI) is considered a feasible tool in the evaluation of structural and textural muscle differences due to aging. The main aim of this study was to evaluate sonographic changes in muscular structure and function after a 12-week multicomponent training program in pre-frailty individuals. Design: A prospective, randomized, clinical trial was carried out. Participants: Thirty-two pre-frailty subjects were recruited and randomly divided into a multicomponent training program group (n = 16; Multicomponent group) and a conventional care group (n = 14; Control group) with a 12-week follow up. Main outcome measures: Rectus femoris thickness, cross-sectional area (CSA), echointensity, echovariation and vastus lateralis pennation angle tests were carried out to assess the structure and echotexture, and the force–velocity (F-V) profile for muscle power and muscle strength was employed to assess the functional parameters. Results: Statistically significant differences (p < 0.05) were shown for the left rectus femoris echointensity and in the functional parameter of muscle power after a 12-week program for the multicomponent training group compared to the conventional care group. Conclusions: Pre-frailty elderly subjects showed a decrease in rectus femoris echointensity (RF-EI) and an increase in the functional parameter of muscle power after a 12-week multicomponent training program compared to the control group.