ABSTRACT It is well documented that both motoneuron output and the effectiveness of activated Ia afferents to discharge soleus α-motoneurons decrease during eccentric (muscle lengthening) contractions. Evidence suggests that these modulations can be explained by recurrent inhibition and greater presynaptic inhibition of Ia afferents. However, the influence of angular velocity on the modulation of the effectiveness of activated Ia afferents to discharge α-motoneurons observed during eccentric contractions remains unclear. We investigated the influence of angular velocity on spinal mechanisms involved in the effectiveness of activated Ia afferents to discharge α-motoneurons during eccentric plantar flexor contractions using 16 healthy adults. We used both simple and conditioned Hoffmann reflex with different conditioning techniques to assess presynaptic inhibition, heteronymous Ia facilitation and heteronymous recurrent inhibition coupled with electromyography during eccentric contractions of the plantar flexors at three angular velocities. Our results showed that during eccentric contractions, the effectiveness of Ia afferents to discharge α-motoneurons was lower at 90°·s⁻¹ than 60°·s⁻¹ and 20°·s⁻¹ angular velocities. A similar velocity-dependent pattern was observed for heteronymous recurrent inhibition, decreasing at 90°·s⁻¹ when compared with 60°·s⁻¹ and 20°·s⁻¹. In contrast, presynaptic inhibition of Ia afferents was not different between the velocities. These demonstrate a differential influence of angular velocity on spinal recurrent inhibitory mechanisms during eccentric contractions and support distinct functional roles of recurrent and presynaptic inhibition in modulating α-motoneurons discharge with increasing movement velocity. The findings provide new insights into the velocity-dependent and mechanism-specific modulation of spinal inhibitory circuits during eccentric contractions. KEY POINTS During eccentric contractions in soleus muscle, the effectiveness of activated Ia afferents to discharge α-motoneurones decreases with increasing angular velocity, indicating a velocity-dependent modulation. Presynaptic inhibition of Ia afferents does not differ between angular velocities, suggesting that it does not contribute to the observed changes. Heteronymous recurrent inhibition from the quadriceps to the soleus increases with angular velocity, indicating that increasing movement velocity promotes a functional reorganization of intermuscular recurrent inhibition. These findings suggest a differential functional role of the two spinal inhibitory mechanisms, indicating that increasing angular velocity primarily influences recurrent postsynaptic inhibition rather than presynaptic inhibition.

Objectives In select sports, bodyweight categories (BCs) serve to increase competitiveness and fairness. We aimed to analyse current Para Powerlifting BC impacts on performance-related factors and refine these for each sex. Methods Retrospective records; 2013–2023 ( n = 6802 athletes) were collated. An evolutionary strategy, with a specific ‘fitness function’ and simplified genetic algorithm was employed to develop optimised BCs with the same overall number of categories ( n = 10 ) for each sex. Spearman's rank correlations determined performance versus bodyweight relationships. Chi-squared goodness of fit tests determined distribution of the athletic pool amongst categories. The impact of changing the BCs on retrospective competition results was explored with paired samples Wilcoxon tests. Significance was set at p < 0.01. Results The evolutionary strategy provided optimised BCs for senior males and females resulting in better distribution of the athlete pool, fewer BCs with a significant bodyweight-performance correlation (4 versus 1 across sexes) and no statistical difference in competitiveness compared to current BCs. Neither the current nor optimised bodyweight schemes were suitable for junior competitions. Conclusion The results may inform future rule updates in Para Powerlifting. Sports using athlete classification (e.g., bodyweight, age) should consider the efficacy of categorisation methods and adopt an analytical approach to ensure competitive fairness.

ABSTRACT:Najafi, A, Nosaka, K, Javidi, M, Naddafha, S, Kumagawa, D, Bertochi, GFA, and Latella, C. Acute effects of accentuated eccentric loading in comparison to traditional resistance loading on velocity and other parameters in concentric and eccentric phases in barbell back squat. J Strength Cond Res 40(6): 629-637, 2026-We investigated the acute effects of accentuated eccentric loading (AEL) vs. traditional resistance loading (TRL) on concentric and eccentric velocities and related parameters during barbell back squat (BBS). We hypothesized that AEL at 85% or 100% of 1 repetition maximum (1RM) in the first eccentric repetition would enhance the concentric velocity in subsequent repetitions. Fourteen resistance-trained men (age: 28.9 ± 7.8 years, body mass: 83.7 ± 9.4 kg, BBS 1RM/body mass ratio: 1.42 ± 0.23) completed TRL BBS at 65% 1RM, followed by BBS with AEL85 (85%/65% 1RM for eccentric/concentric) and AEL100 (100%/65% 1RM) in a randomized order. Each protocol consisted of 3 sets of 5 repetitions. One additional TRL set was performed at the end to examine fatigue. The rating of perceived exertion (RPE; 0-10 scale) was recorded after each set. Concentric peak and mean velocity, force, and power, along with eccentric mean and peak velocity, and peak force and power in each repetition were obtained using GymAware PowerTool. A 3-way repeated-measures ANOVA showed no significant differences between the 3 protocols for changes in the outcome measures over repetitions and sets. Across all sets and protocols, concentric mean velocity (mean ± SD ) was lowest in the first repetition (0.61 ± 0.09 m·s -1 ), increased in the second (0.68 ± 0.07), peaked in the third (0.69 ± 0.07), and decreased in the fourth (0.67 ± 0.08) and fifth repetitions (0.65 ± 0.09). RPE (mean ± SD ) was highest in AEL100 (8.5 ± 0.9), followed by AEL85 (8.0 ± 1.1) and TRL (6.9 ± 1.1), with all protocols differing significantly from one another. These indicate that AEL did not affect velocity-related measures in moderately resistance-trained individuals.

PURPOSE:To provide up-to-date, evidence-based minimum standards for medaling and contemporary normative strength values in Para Powerlifting. METHODS:This was a retrospective analysis of competition data from the World Para Powerlifting database and an online open-access data set (openpowerlifting.org). Athletes ≥15 years of age competing from 2013 to 2025 were separated by competitive level: national, regional, or international (World Cup, World Championship, and Paralympic Games). Subgroup analysis was performed on World Para Powerlifting defined age categories: rookie (15-17), next gen (18-20), and legend (≥45). We determined the 50th percentile value for each competitive weight class and used this as the anchor for proposed minimum standards to determine medal-winning performances compared with those currently implemented by World Para Powerlifting originally based on percentages of the world record (25%-55% across age categories and competition levels). Normative values were calculated according to relative strength performance and defined according to deciles for each age, sex, and competition level. RESULTS:Records from 6064 male and 3187 female competitor entries were included. The proposed standards were, on average, 51 kg greater for males and 29 kg greater for females than current standards. In 41% of all categories, current minimum standards were reflective of the first percentile of all actual competition performances. For normative strength, the highest values were observed among elite athletes competing at the Paralympic Games, followed by World Championships, World Cups, regional competitions, and, finally, national events. CONCLUSION:The proposed standards and normative data presented here provide premise for discussion around medal-eligibility criteria and athlete development benchmarks within Para Powerlifting.

Interhemispheric inhibition (IHI) acts between hemispheres to decrease motor cortical excitability. IHI changes during movement preparation, but it is unknown whether altering IHI, independent of other factors, alters movement initiation. For the index finger abductor muscle (first dorsal interosseous; FDI), IHI is weaker during contralateral index abduction than adduction. Thus, this study aimed to modulate IHI through contralateral contraction and measure resultant changes in reaction time. Fifteen healthy participants (age 19–39 years) completed a reaction-time task requiring brief left index finger abduction. Prior to reactions, participants started either a sustained isometric abduction or adduction contraction of the right index finger. Single- or paired-pulse transcranial magnetic stimulation (TMS) elicited motor evoked potentials (MEPs) from left FDI in the late pre-movement phase. For each contralateral contraction direction, unconditioned and conditioned MEPs (preceded by suprathreshold TMS over the other hemisphere at 10 or 40 ms) were recorded. Conditioned MEPs, expressed relative to unconditioned MEPs, provided measures of short-interval IHI (SIHI) and long-interval IHI (LIHI). Left index finger reaction time was also measured. Linear mixed models showed that reaction time was 9 ± 9 ms (6

Background: Voluntary activation is a measure of neural drive, typically measured during maximal contractions, and provides insight into motor function. This systematic review examined voluntary activation assessment of the ankle plantar flexors in healthy and pathological populations, and the association of participant age and positioning (knee and ankle joint angles) with voluntary activation level. Methods: A systematic review and meta-analyses were conducted. Six electronic databases were systematically searched for studies that assessed voluntary activation of the ankle plantar flexors using the interpolated twitch technique or the central activation ratio. Meta-analyses were performed using an inverse variance, random-effects maximal likelihood model of continuous outcomes within SPSS Statistics, and subsequent meta-regression performed for age, knee angle and ankle angle. Methodological quality was assessed using the Analytical Cross-Sectional Studies Checklist from the Joanna Briggs Institute. Results: A total of 74 studies were included, 5 included participants with pathological conditions (2 Achilles tendinopathy and 3 stroke) and 69 included only healthy participants. The meta-analysis demonstrated plantar flexion voluntary activation levels for healthy populations of 91 %, 90 % for Achilles tendinopathy and 35 % for stroke. Older age was associated with lower voluntary activation (β ​= ​−0.072; p ​= ​0.035) and greater knee flexion angle was associated with higher voluntary activation (β ​= ​−0.033; p ​= ​0.045). No association of voluntary activation and ankle position was demonstrated (β ​= ​−0.070, p ​= ​0.488). Majority of the included studies were judged to have low methodological quality (97 %). Conclusions: Voluntary activation was comparable between healthy participants and Achilles tendinopathy, and significantly lower in people following stroke. Age and knee joint position but not ankle joint position was associated with the level of plantar flexor voluntary activation.

ABSTRACT:van den Hoek, DJ, van den Hoek, AK, Latella, C, Bastia, D, and Garrett, JM. The evolution of normative strength values in powerlifting 2000 to 2024: A retrospective, cross-sectional analysis. J Strength Cond Res 40(2): e147-e154, 2026-We aimed to identify and describe the evolution of normative strength values in unequipped, drug-tested powerlifting athletes this century, and provide recommendations for the frequency of future normative data updates. Competition data were sourced from openpowerlifting.org for athletes aged ≥12 years competing in unequipped, drug-tested events between 2000 and 2024. Absolute and relative strength values (squat, bench press, deadlift, and summative total) were analyzed by sex and United Nations age classifications. Spearman's rho was used to assess trends in median strength values over time. The sample comprised 850,972 entries (mean [ SD ] age: 30.3 [13.3] years, body mass 82.4 [21.2] kg). From 2000 to 2024, median male squat increased from 185 to 200 kg ( ρ = 0.130), and female deadlift from 114 to 142.5 kg ( ρ = 0.199). Weak-to-moderate increases in absolute and relative strength were observed in squat and deadlift performance across most age categories, with the most pronounced improvements occurring among adolescents and young adults. Bench press strength showed minimal change for males (129-125 kg to 127.5 kg; ρ = -0.041, p < 0.001) and weak improvements for females (50-55 kg to 65 kg; ρ = 0.131, p < 0.001). Comparison with earlier pooled norms revealed that current medians frequently exceed historical values. For squat and deadlift, median values typically increase by 2.5-7.5 kg within a 5-year period, representing a minimally important performance difference for competitive outcomes. Therefore, we recommend normative data be updated at 5-year intervals to reflect current performance benchmarks in these lifts.

Purpose Anterior cruciate ligament reconstruction (ACLR) can cause arthrogenic muscle inhibition (AMI) or persistent muscle weakness that impairs physical function and return to sport. Deficits in voluntary activation (one method to measure AMI) are thought to contribute to AMI, however, the specific neurophysiological underpinnings remain inconclusive. The primary objective of this study was to explore changes in intracortical excitability (inhibition and facilitation) of the quadriceps representation in the primary motor cortex pre- and post-ALCR. Our secondary objective was to explore changes in hamstrings intracortical excitability pre- and post-ALCR. Methods Prospective case-series pre-post-ACLR. Single- and paired-pulse transcranial magnetic stimulation (TMS) was delivered over the motor cortex with responses recorded via surface electromyography from the active vastus medialis (quadriceps) and semitendinosus (hamstrings). TMS outcomes were short- and long-interval-intracortical-inhibition (SICI, LICI) and short-interval-intracortical-facilitation (SICF). Data are reported as median (interquartile range [IQR]) and analysed using non-parametric analysis of variance, with significance accepted when p ​< ​0.05. Results Twenty-one participants (38% female) with a mean (standard deviation) age of 24.5 (4.7) years were included. Following ACLR participants had increased quadriceps inhibition (SICI, p ​= ​0.005) and facilitation at all SICF peaks (Peak 1: p ​< ​0.05, Peak 2: p ​= ​0.016, Peak 3: p ​< ​0.05). There were no changes following ACLR in quadriceps LICI (p ​= ​0.108). No differences were detected in hamstring excitability. Conclusion In the acute post-operative period following ACLR, there is increased activity within some intracortical pathways. The altered excitability of SICI and SICF circuits might contribute to long-term issues, such as impaired voluntary activation resulting in arthrogenic muscle inhibition, in post-ACLR patients.

ABSTRACT:Dougan, A, Latella, C, Nagatani, T, Lockie, RG, O'Brien, E, and Haff, GG. The effect of resisted sprint training on force-velocity profile change: A systematic review and meta-analysis. J Strength Cond Res 39(11): 1203-1215, 2025-This meta-analysis evaluated the effectiveness of resisted sprint training (RST) compared with unresisted sprint training (URST) programs to positively influence horizontal force-velocity (F-V) profile variables and acceleration performance in trained individuals. Searches were conducted through PubMed, Web of Science, and SPORTDiscus without year restriction. Included studies (a) used RST by towing/pushing a load as a training modality, (b) were published in a scientific journal, (c) were published in English, (d) were an original intervention, (e) measured pre- and postintervention horizontal F-V profiles, (f) identified training parameters including RST load used, (g) the training intervention was ≥4 weeks in duration or ≥8 sessions, and (h) included a control group that performed URST. After screening, 7 studies met the inclusion criteria. Raw data (mean ± SD or range) were extracted, and standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated for all outcomes. Significance was set at p < 0.05. Resisted sprint training significantly improved force (SMD = 0.47, CI: [0.12-0.83], p = 0.002), power (SMD = 0.53 [0.17-0.88], p < 0.001), RF peak (SMD = 0.70 [0.03-1.37], p = 0.029), and 5 m (SMD = -0.81 [-1.26 to 0.36], p < 0.001), 10 m (SMD = -0.80 [-1.39 to 0.21], p = 0.007), and 20 m sprint performance (SMD = -1.09 [-1.60 to 0.59], p < 0.001) during sprinting when compared with URST. Resisted sprint training represents an efficient means to increase key horizontal F-V profile variables. The findings suggest that RST may complement or be favored over URST to improve early-to-mid acceleration performance, horizontal force, or power, but further research is required in elite sprint athletes and to determine the effect that RST load and volume have on the adaptability of the F-V profile.

Background. Non-invasive brain stimulation (NIBS) is sometimes used alongside medication to alleviate motor symptoms in people with Parkinson's disease (PD). However, the evidence supporting NIBS's effectiveness for improving motor function in PD patients is uncertain. Objective. This umbrella review aims to synthesize recent systematic reviews and meta-analyses that have evaluated the effectiveness of NIBS in improving motor function in people with PD, with a key focus being to examine the quality of the evidence presented. Methods. The review protocol was registered in PROSPERO (CRD42022380544) and conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy was guided by the Population, Intervention, Comparison, and Outcome framework, focusing on individuals with idiopathic PD (Hoehn and Yahr stages 1-4). The review included studies comparing various NIBS techniques (eg, repetitive transcranial magnetic stimulation and transcranial direct current stimulation) to sham or alternative treatments, targeting motor and cognitive regions. Six databases were searched up to June 2024. Methodological quality was assessed using Assessment of Multiple Systematic Reviews 2 (AMSTAR2), and random-effects meta-analyses were performed to pool standardized mean differences (SMDs). Results. The final analysis included 31 meta-analyses and 10 systematic reviews. Overall, the reviews were rated as moderate quality (54% average for AMSTAR2). NIBS showed a small-to-moderate effect on motor function (Unified Parkinson's Disease Rating Scale-Section III scores; SMD = -0.80), functional mobility (gait speed and timed-up-and-go; SMD = -0.39), and freezing of gait (SMD = -0.58), but no significant effect on balance. Conclusion. NIBS offers small-to-moderate benefits for motor symptoms and functional movement in PD, though it does not significantly impact balance. Practitioners should consider the variety of techniques and treatment parameters before application.

Aims:Compare quadriceps voluntary activation, corticospinal and intracortical excitability between people with and without hip osteoarthritis (OA). Exploratory objectives include quantifying the association of corticospinal/intracortical excitability with voluntary activation, corticospinal/intracortical excitability with hip related pain, and motor threshold with motor cortex inhibition and facilitation. Methods:Case-control study including participants with clinically and radiologically confirmed hip OA and non-OA controls. Quadriceps voluntary activation was assessed using twitch interpolation via femoral nerve stimulation. Single- and paired-pulse transcranial magnetic stimulation over the motor cortex assessed resting motor threshold (RMT), active motor threshold (AMT), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF) and silent period. Generalized linear models assessed outcomes (p ​< ​0.05). Results:We included 17 hip OA (76% female) and 24 controls (92% female) with a mean (standard deviation) age of 58.7 (7.9) years. Compared to controls, people with hip OA had reduced quadriceps voluntary activation (β ​= ​-5.29, 95% confidence intervals [CI], -0.79--9.79) and increased ICF (β ​= ​0.22, 95%CI, 0.01-0.43). People with hip OA did not differ from controls in RMT (β ​= ​-4.76, 95%CI, -14.08-4.56), AMT (β ​= ​-2.13, 95%CI, -7.12-2.86), SICI (β ​= ​-0.02, 95%CI, -0.15-0.006) or silent period (β = 8.72, 95%CI, -24.75-42.20). More facilitation was associated with increased hip pain (β = 24.55, 95%CI, 6.93-42.18), and more inhibition was associated with less voluntary activation (β = 10.50, 95%CI, 2.00-18.99). Conclusion:People with hip OA demonstrate reduced quadriceps voluntary activation and complex changes in motor cortex excitability compared to controls. These findings suggest that hip OA can alter quadriceps neuromuscular function (facilitation associated with pain, inhibition associated with activation), thus having implications for rehabilitation.

Although the impacts of traditional sets (TS) versus cluster (CL) sets resistance training have been broadly explored among recreationally trained populations, no studies have previously compared these set configurations among elite Judokas. Twenty-two elite male and female Judokas (age = 17.5 ± 1.2 years) performed identical periodized 4-week hypertrophy and strength blocks (8 weeks in total). Following this, for the final 4-week power training block, the cohort was separated into either TS (n = 11) or CL (n = 11) set structures. CL were prescribed by including 45-second intra-set rest every two repetitions. One-repetition maximum (1RM) and peak barbell velocities of the back squat and bench press, and countermovement (CMJ) jump height were assessed before and following each 4-week mesocycle. Significant strength and power improvements were observed after the 4-week hypertrophy training block (1RM bench press = Δ3.82 kg, ES [95% CI] = 1.34 [0.76, 1.93], p < 0.001; 1RM squat = Δ4.71 kg, ES = 0.52 [0.07, 0.96], p = 0.024; CMJ height = Δ0.54 cm, ES = 0.62 [0.16, 1.07], p = 0.008) and after the 4-week maximal strength training block (1RM bench press = Δ1.5 kg, ES = 0.68 [0.21, 1.41], p = 0.004; 1RM squat = Δ5.47 kg, ES = 0.61 [0.15, 1.06], p = 0.010; CMJ height = Δ0.45 cm, ES = 0.71 [0.23, 1.17], p = 0.003). However, no time × group differences were observed between the TS and CL groups following the 4-week power training block. Though traditional periodized resistance training improved neuromuscular qualities of elite junior Judokas, no between-group neuromuscular differences using either TS or CL suggests that both methods may be used as part of periodized training programs.

Objectives: Strength assessment and comparison to normative values are an important benchmarking tool in human health and performance. However, population specific normative data are several decades old, lack information about adolescent and adult strength levels and are not representative of the strength levels of strength trained individuals. The purpose of this study was to develop contemporary strength norms for the squat, bench press, and deadlift using powerlifters competing in un-equipped, drug-tested competitions. Design: Retrospective cross-sectional analysis. Methods: Retrospective data from global drug-tested, unequipped powerlifting competitions were collated with 809,986 samples (571,650 males, 238,336 females) included. Strength was assessed according to sex, United Nations age classifications, and competitive powerlifting weight class. Strength was expressed relatively (ratio of weight lifted/bodyweight) and computed for the 10th-90th percentile for each of the above categories. Results: Relative strength was greatest for young adults (18-35 years; 90th percentile for squat [male: 2.83 x bodyweight, female: 2.26], bench press [male: 1.95, female: 1.35], deadlift [male: 3.25, female: 2.66]) before declining thereafter for all three exercises. Although lower than their younger counterparts, very old adults (>80 years) had 90th percentile data for the squat of male: 1.72 and female: 1.01, bench press: male: 1.31 and female: 0.92, and deadlift: male: 2.30 and female: 1.68. Conclusions: These findings provide a comprehensive, accurate and precise representation of strength for drugtested, unequipped powerlifters in each category and serve as a point of reference for other trained population groups. To facilitate uptake and ease of comparison, we have developed a freely available online tool (www. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article

Studies have shown that neural responses following concentric (CON) and eccentric (ECC) muscle contractions are different, which suggests differences in motor control associated with CON and ECC contractions. This study aims to determine brain activation of the left primary motor cortex (M1) and left and right dorsolateral prefrontal cortices (DLPFCs) during ECC and CON of the right bicep brachii (BB) muscle at low-and high-contraction intensities. Eighteen young adults (13M/5F, 21-35 years) were recruited to participate in one familiarization and two testing sessions in a randomized crossover design. During each testing session, participants performed either ECC or CON contractions of the BB (3 sets x 8 reps) at low-(25% of maximum ECC/CON, 45 degrees/s) and high-intensity (75% of maximum ECC/CON, 45 degrees/s) on an isokinetic dynamometer. Eleven-channel functional near-infrared spectroscopy was used to measure changes in oxyhemoglobin (O(2)Hb) from the left M1, and left and right DLPFC during ECC and CON contractions. Maximum torque for ECC was higher than CON (43.3 +/- 14.1 vs. 46.2 +/- 15.7 N m, p = 0.025); however, no differences in O(2)Hb were observed between contraction types at low or high intensities in measured brain regions. High-intensity ECC and CON contractions resulted in greater increases in O(2)Hb of M1 and bilateral DLPFC compared to low-intensity ECC and CON contractions (p = 0.014). Our findings suggest no differences in O(2)Hb responses between contraction types at high and low intensities. High-contraction intensities resulted in greater brain activation of the M1 and bilateral DLPFC, which may have implications for neurorehabilitation to increase central adaptations from exercise.

BACKGROUND:Parkinson's disease (PD) is a progressive neurodegenerative disorder that predominantly affects movement and currently has no cure. Alongside medication, non-invasive brain stimulation (NIBS) may be used as an adjunct therapy to attenuate the motor symptoms experienced by people with PD. However, there is considerable heterogeneity in the evidence exploring the effects of NIBS for improving aspects of physical function in people with PD. Therefore, this protocol paper will outline the objectives, structure and procedure of a proposed umbrella review which will comprehensively summarise and map the current body evidence on the effectiveness of NIBS for improving physical function in people with PD.METHODS AND ANALYSIS:This study will adhere to the Joanna Briggs Institute (JBI) reviewer's manual and the PRISMA guidelines for conducting an umbrella review. The protocol is registered in PROSPERO (CRD42022380544). The population, intervention, comparison, and outcomes (PICO) method will be used to guide the search strategies and inclusion/exclusion criteria. Systematic reviews, with or without meta-analyses, based on quantitative or mixed-methods studies, will be searched for, and then critically evaluated by two authors using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool. If the data allows, we will run a random effects pooled meta-analysis using standardized mean differences (SMDs), with heterogeneity and publication bias reported using the I2 statistic. We will determine the level of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) tool. Overlap in studies across reviews will be assessed using citation matrices and corrected covered areas (CCAs). Lastly, visual bubble plots will display the effects and strength of evidence from each review.DISCUSSION:This umbrella review will be the first to examine the collective evidence on the effectiveness of NIBS in improving physical outcomes for individuals with PD. It aims to provide an overall understanding of the relationship between NIBS and motor function changes, discuss underlying physiological mechanisms, and identify future therapeutic strategies.TRIAL REGISTRATION:PROSPERO registration number: CRD42022380544.

Rehabilitative practice is often criticised for being non-individualised, monotonous and not well aligned with foundational principles that drive continued physiological adaptation(s). However, our understanding of neuromuscular physiology is rapidly increasing and the way we programme rehabilitation is improving. This viewpoint highlights some of the potential considerations around why the adaptations achieved during rehabilitation programmes may be suboptimal. We provide basic, clinician-focused discussion about potential confounding physiological factors, and put forward several exercise-based programming recommendations and novel approaches to consider in contemporary rehabilitative practice. Specifically, we outline several potential mechanisms contributing to poor muscle activation and function that might be present following musculoskeletal injury. However, clinicians require strategies capable of attenuating these impairments to restore proper function. Therefore, we also provide an overview of recommended strength and conditioning guidelines, and novel strategies (such as external pacing and electrical stimulation techniques) that clinicians can consider to potentially improve the efficacy of musculoskeletal rehabilitation.