Twohey, Eric

Objective: Percutaneous needle tenotomy (PNT) and ultrasonic debridement (UD) are minimally invasive interventions for the management of chronic tendinopathy. Despite their increasing use, no standardized, evidence-based rehabilitation guidelines currently exist to direct clinicians in post-procedural management. This systematic review aimed to characterize and synthesize reported rehabilitation protocols following PNT and UD for patellar, proximal hamstring, and gluteal tendinopathies. Design: Systematic Review Results: Twenty-seven studies met inclusion criteria, with patellar tendon procedures (n=13) being the most common, followed by gluteal (n=6), proximal hamstring (n=3), and multi-tendon protocols (n=5). Of the included studies, 21 (78%) utilized percutaneous needle tenotomy (PNT) and six (22%) used ultrasound debridement or Tenex. Exercise restrictions were mandated in 19 studies (70%), while 12 (44%) provided a detailed, structured rehabilitation program, frequently emphasizing eccentric loading for patellar and hamstring tendons. Weight-bearing limitations were uncommon, appearing in only three studies (11%). Fifteen studies (56%) combined the procedure with platelet-rich plasma (PRP). Pharmacological protocols also showed high variance, with NSAID restrictions ranging from 1 to 28 days and corticosteroid avoidance lasting between 10 days and one year. Overall, substantial variability remains regarding recommended activity progression, exercise initiation, and mechanical loading strategies across current research. Conclusion: PNT and UD appear effective for managing refractory tendinopathy, yet post-procedure rehabilitation guidelines remain inconsistent and supported by limited high-quality evidence. Future research should aim to identify key variables that guide individualized rehabilitation progressions, optimizing recovery timelines, and facilitating safe and efficient return to activity following PNT and UD procedures.

Abstract Jagim, AR, Dobbs, WC, Horswill, CA, Twohey, E, Fields, JB, and Jones, MT. Prevalence and magnitude weight loss among collegiate wrestlers. J Strength Cond Res 40(1): 90–97, 2026—The purpose of this study was to examine the percentage of wrestlers who compete in their minimal weight class (MWC), and the magnitude of weight loss. Data from the 2023–2024 collegiate season were retrospectively analyzed resulting in a sample of 9,638 collegiate male wrestlers from the National Association of Intercollegiate Athletics ( n = 1,904) and all 3 divisions of the National Collegiate Athletics Association ( n = 7,734). All wrestlers completed skinfold assessments for weight certification at the start of the competition season. The lowest recorded weight class (LRW) achieved by each wrestler during the season was also recorded and used to determine magnitude of weight loss. Out of the 4,605 (53.2%) of wrestlers who competed in their MWC, their average amount of weight loss was significantly higher than those who did not compete in their MWC (3.9 ± 2.5 vs. 3.2 ± 2.9 kg.; p < 0.001), yet they had an initial lower body fat percentage (12.7 ± 2.9 vs. 17.5 ± 4.8%; p < 0.001). At the time of weight certification, wrestlers weighed 8.1 ± 4.5 (95% confidence interval (CI): 8.0–8.2; effect size (ES) = 1.8) kg more than their minimal wrestling weight. The LRW was 3.6 ± 2.9 (95% CI: 3.6–3.7; ES = 1.2) kg lower than their weight at the time of weight certification. Given that slightly more than half of the male wrestlers competed in their MWC, coaches and sports practitioners should recognize that not all athletes follow the traditional assumption of cutting to the lowest possible weight class. Importantly, those who did achieve their MWC had lower initial body fat percentages, limiting the amount of weight they could safely lose. This underscores the need for individualized weight management strategies that consider body composition and health implications.

Objective We examined the weight management practices of successful high school wrestlers to contribute meaningful data to the conversations that weight-certifying clinicians and athletic trainers have with athletes at the start of the wrestling season. Understanding how elite athletes navigate weight management can inform safer and more individualized guidance during preseason assessments. Specifically, we sought to determine the proportion of state-qualifying wrestlers who competed at or above their certified minimum weight class. We also quantified the magnitude of weight change from certification to state competition and analyzed seasonal trends in both body weight and body fat percentage over a 20-year period. Design Longitudinal retrospective review. Setting Four Minnesota high schools. Patients or Other Participants State-qualifying wrestlers from 2003 to 2023. Independent Variable State-qualifying weight class. Main Outcome Measure(s) Dependent variables are certification weight, measured body fat percent, and calculated minimum weight class. Results Only 48 wrestlers (52.7%; CI = 42.5%, 63.0%) competed at state in their minimum weight class, while the other 43 competed 1 to 2 weight classes above. Thirty-six wrestlers (39.6%) gained weight over the season. Conclusions Nearly half the successful wrestlers competed in weight classes above their minimum weight, while 5% lost 9% to 18% of their body mass over the wrestling season. This suggests factors other than maximizing individual athletic potential, such as team needs to fill a weight class, influence weight management decisions. Over the 20-year span of the study, trends toward lower measured body fat percentage and lower weight fluctuations suggest influences from sports specialization and year-round training and less emphasis on extreme leanness for competitive advantage. Athletes, in consultation with their coaches and clinicians, should select a competition weight class where they can adequately fuel, train, and recover. This may not be their minimum certified weight class.

Abstract Twohey, E, Dobbs, WC, Malone, CM, Fields, JB, Jones, MT, and Jagim, AR. The use of a consumer-grade bioelectrical impedance analysis device for weight certification in collegiate wrestling: Implications for minimal wrestling weight determination. J Strength Cond Res 39(12): 1321–1326, 2025—Wrestlers are required to complete a preseason weight certification assessment, which includes a weigh-in, a hydration test, and a body fat percentage (BF%) measurement. This information is then used to establish their minimal wrestling weight (MWW) and minimal weight class. Skinfold (SKF) is the primary method used for determining body fat for collegiate wrestling, yet impedance devices are being considered for use in the future. The purpose of this study was to examine differences in body fat and the resulting MWW values derived from SKF and a consumer-grade multifrequency bioelectrical impedance analysis (MFBIA) device. Thirty-one collegiate male wrestlers produced a urine sample for urine specific gravity assessment to ensure adequate hydration status. Subjects then completed a weigh-in, followed by 2 body composition assessments using a (a) MFBIA device and (b) skinfold calipers to determine body density and BF%. No significant differences were observed for estimates of BF% (SKF: 13.4 ± 2.8% vs. MFBIA: 14.0 ± 3.3%; p = 0.198) or computed MWW values (SKF: 69.8 ± 8.7 kg vs. MFBIA: 69.4 ± 9.7 kg; p = 0.348) between devices. When determining the minimal weight class for each device, there were discrepancies in 11 of the 31 wrestlers (35%). Although the current MFBIA device can provide an acceptable estimate of BF% and similar resulting MWW value at the group level, the methods cannot be used interchangeably.

Abstract Jagim, AR, Horswill, CA, Dobbs, WC, Twohey, EE, Tinsley, GM, Fields, JB, and Jones, MT. Minimum wrestling weight for high school girls wrestling: Time to revisit minimal body fat percent. J Strength Cond Res 39(3): 332–339, 2025—The purpose of this study was to determine whether an alternative body fat percentage (BF%) could be established as a safer margin for minimal wrestling weight (MWW) determination by evaluating the distribution of BF% and MWW values naturally occurring for high school girls wrestling. Data from the 2022–2023 high school season were retrospectively analyzed. In total, 33,321 female wrestlers completed skinfold (SKF) assessments or bioelectrical impedance analysis (BIA) in accordance with sport governing body mandates for weight certification. Frequency statistics and descriptive analysis were performed to compute normative MWW and BF% profiles. Body fat percentage thresholds of 12% (12MWW) and the BF% value defining the lowest fifth percentile were used to determine the resulting MWW and minimum weight class for each method. The median ± interquartile range for BF% was 28.3 ± 9.2%. There was a difference ( p < 0.001) in BF% values between BIA (28.4 ± 6.8%) and SKF (29.4 ± 7.6%), but a trivial effect size (ES = 0.14). The fifth percentile for BF% was 19%, which was used for alternative MWW determination (19MWW). 12MWW and 19MWW were 11.2 ± 6.4 kg ( p < 0.001; ES = 1.8) and 8.6 ± 7.7 kg ( p < 0.001; ES = 1.1) lower than the body mass of the wrestlers at the time of weight certification. Nearly all BF% values were above the 12% threshold currently used to determine MWW. Current body weights were more than 9.1 kg above MWW values for both 12MWW and 19MWW. Increasing the minimum BF% threshold from 12 to 19% would affect a small percentage of wrestlers and improve the margin of safety for those intent on achieving a lower weight class.