PubMed Health⌕ Search

Biomedical subjects

Lynn Snyder-Mackler

Publications and source records attributed to Lynn Snyder-Mackler.

At least 37 records · Page 2Linked to original sources
PubMed2004

Differences in normal and perturbed walking kinematics between male and female athletes.

OBJECTIVE: To identify differences in lower extremity kinematic movement patterns between genders during walking through the application of an expected perturbation. DESIGN: Randomized limb kinematics were compared between healthy active males and females. BACKGROUND: Lower extremity kinematics during jump landing and cutting have been implicated as a potential source of the discrepancy in anterior cruciate ligament injury rates between genders. Kinematic differences between genders have been identified during tasks that are not provocative of anterior cruciate ligament injury but do result in increased ligament strain. Repetition of movement patterns that increase anterior cruciate ligament strain may increase the likelihood they will be reproduced during athletic tasks that produce force loads that exceed anterior cruciate ligament tensile strength. METHODS: Twenty subjects (10 women, 10 men) classified as a level I or II athlete underwent motion analyses while performing self-paced walking trials. Five trials were undisturbed, and five each with a platform translating either laterally or anteriorly at heel contact. Sagittal, frontal, and transverse hip angles as well as sagittal and frontal knee angles were collected during stance. RESULTS: Excursions in the frontal and transverse planes were greater at the hip and knee for females compared to males in each walking condition. The rate of these excursions also occurred more rapidly for females than males. There was no difference for joint angles at initial contact between genders, and there was no difference in the amount of sagittal plane excursion for the hip and knee when comparing genders. CONCLUSIONS: Females demonstrate characteristics during both normal and perturbed gait that may potentially contribute to increased anterior cruciate ligament strain. Repetition of these potentially harmful movement patterns during provocative athletic maneuvers may lead to anterior cruciate ligament injury. RELEVANCE: Females exhibit lower extremity kinematic patterns that differ from males. Female kinematic patterns may contribute to an increased risk for anterior cruciate ligament injury.

Adaptation, Physiological↗
PubMed2004

Effect of dynamic stability on a step task in ACL deficient individuals.

Stair ascent and descent requires large knee motions and muscle forces that can be challenging for people with anterior cruciate ligament (ACL) deficiency. Movement and muscle activity patterns were compared in two groups of ACL deficient subjects and a group of uninjured subjects. The ACL deficient subjects were prospectively classified according to functional ability. "Copers" were defined as individuals with complete ACL rupture and no symptoms of knee instability and participated in high-level sports without difficulty. "Non-copers" were defined as ACL deficient individuals who had instability with low-level daily activities and were not able to participate in sports. Sagittal plane kinematic and kinetic data from the hip, knee and ankle and electromyographic data from the vastus lateralis, lateral hamstring, medial gastrocnemius, and soleus were collected as subjects stepped up and over a 26 cm high step. Both coper and non-coper subjects had altered movement patterns as they controlled the rapid movement from step ascent to descent with their involved limbs. Only non-copers used significantly different movement patterns on their involved limb compared to controls after they had descended from the step and their involved side accepted the weight of the body. Classifying subjects by functional ability resulted in more pronounced differences in movement patterns between non-copers and copers. Copers moved more like uninjured subjects.

Adult↗
PubMed2004

Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis.

OBJECTIVE: Patients with medial compartment knee osteoarthritis (OA) adopt an abnormal gait pattern, and often develop frontal plane laxity at the knee. The purpose of this study was to quantify the extent of frontal plane knee joint laxity in patients with medial knee OA and genu varum and to assess the effect of joint laxity on knee joint kinetics, kinematics and muscle activity during gait. DESIGN: Twelve subjects with genu varum and medial compartment knee osteoarthritis (OA group) and 12 age-matched uninjured subjects underwent stress radiography to determine the presence and magnitude of frontal plane laxity. All subjects also went through gait analysis with surface electromyography of the medial and lateral quadriceps, hamstrings, and gastrocnemius to calculate knee joint kinematics and kinetics and co-contraction levels during gait. RESULTS: The OA group showed significantly greater knee instability (P = 0.002), medial joint laxity (P = 0.001), greater medial quadriceps-medial gastrocnemius (VMMG) co-contraction (P = 0.043), and greater knee adduction moments (P = 0.019) than the control group. Medial joint laxity contributed significantly to the variance in both VMMG and the knee adduction moment during early stance. CONCLUSION: The presence of medial laxity in patients with knee OA is likely contributing to the altered gait patterns observed in those with medial knee OA. Greater medial co-contraction and knee adduction moments bodes poorly for the long-term integrity of the articular cartilage, suggesting that medial joint laxity should be a focus of interventions aimed at slowing the progression of disease in individuals with medial compartment knee OA.

Adult↗
PubMed2004

A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture.

BACKGROUND: Weakness of the quadriceps femoris muscle after anterior cruciate ligament injury and reconstruction has been attributed to incomplete voluntary activation of the muscle. The literature is conflicting on the incidence of incomplete voluntary quadriceps activation after anterior cruciate ligament injury because of differences in testing methods and population biases. The purpose of this study was to systematically examine the incidence and severity of quadriceps voluntary activation failure in both lower extremities after acute anterior cruciate ligament injury. We hypothesized that the incidence of quadriceps inhibition would be higher in the anterior cruciate ligament injured limbs than the uninvolved limbs, that the incidence of inhibition in the anterior cruciate ligament deficient limbs would be larger than in our historical sample of healthy young individuals tested in the same manner and that there would be no difference in inhibition by gender. STUDY DESIGN: Prospective, descriptive. METHODS: One hundred consecutive patients with acute anterior cruciate ligament rupture (39 women and 61 men) were tested when range of motion was restored and effusion resolved, an average of 6 weeks after injury. A burst superimposition technique was used to assess quadriceps muscle activation and strength in all patients. Dependent t-tests were used to compare side-to-side differences in quadriceps strength. Independent t-tests were used to compare incidence of activation failure by gender and make comparisons to historical data on young, active individuals. RESULTS: The average involved side quadriceps activation was 0.92, and ranged from 0.60 to 1.00. The incidence of incomplete activation in the involved side quadriceps was 33 per cent and uninvolved side quadriceps was 31 per cent after acute anterior cruciate ligament rupture. The incidence of incomplete activation bilaterally was 21 per cent. There was no difference in incidence of quadriceps inhibition by gender. CONCLUSION: The incidence of voluntary quadriceps inhibition on the involved side was three times that of uninjured, active young subjects, but the magnitude was not large. The incidence of quadriceps inhibition on the uninjured side was similar to the injured side. CLINICAL RELEVANCE: Both the incidence and magnitude of quadriceps inhibition after ACL rupture are lower than have previously been reported. The conventional wisdom, therefore, that quadriceps inhibition is a significant problem in this population is challenged by the results of this study. Differences between this study and others include sufficient practice to ensure a maximal effort contraction and rigorous inclusion criteria. The findings have implications for strength testing as well as rehabilitation. The quadriceps index, an assessment of the injured side quadriceps strength deficit may be affected by the presence of voluntary activation failure in the uninvolved side.

Adolescent↗
PubMed2004

Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis.

PURPOSE: Quadriceps weakness is common in patients with knee osteoarthritis (OA), and has been attributed to failure of voluntary activation. Methodological differences may have contributed to previous reports of extensive failure of voluntary activation in patients with osteoarthritis. The purpose of this study was to determine the extent of quadriceps muscle weakness and activation failure in middle aged patients with symptomatic medial knee osteoarthritis using maximum voluntary isometric contractions (MVIC) and a burst superimposition technique. METHODS: Measurements of quadriceps MVIC and extent of voluntary activation were made in 12 subjects with knee OA and 12 similarly aged uninjured subjects. Voluntary activation was tested by superimposing a train of electrical stimulation on a maximal effort volitional contraction of the quadriceps muscle. RESULTS: The group of subjects with knee OA had significantly less quadriceps strength relative to body mass index (BMI) than the group of control subjects (p=0.010). No difference in voluntary activation was observed (p=0.233), however, 50% of the OA group, and only 25% of the control group failed to fully activate the quadriceps. DISCUSSION: The finding of quadriceps weakness is consistent with past literature. Providing adequate instruction, feedback, and several attempts to maximally contract the muscle likely yielded greater volitional activation (thus less activation failure) than had been reported previously. This finding has implications for the rehabilitation of weakened quadriceps in patients with knee osteoarthritis.

Adult↗
PubMed2004

Altered quadriceps control in people with anterior cruciate ligament deficiency.

PURPOSE: The purpose of this study was to determine whether similar patterns of quadriceps dysfunction are observed when people with anterior cruciate ligament (ACL) deficiency perform static and dynamic tasks. METHODS: EMG data were collected from 15 subjects with an ACL deficient knee and 15 uninjured subjects as they performed static and dynamic tasks that were isolated to the knee and presented no threat to joint stability. The dynamic task was cyclic flexion and extension in the terminal 30 degrees of knee extension; the static task was an established isometric target-matching protocol. The muscle activity patterns observed during the tasks were evaluated and compared. RESULTS: The subjects with ACL deficiency exhibited quadriceps muscle control strategies that were significantly different from those of the uninjured subjects. This was true in both the dynamic and the static tasks. The findings were most noteworthy in the vastus lateralis muscle. Good agreement (r = -0.73 to -0.75) was observed in subjects' static and dynamic VL results; more moderate agreement was observed in results of the other quadriceps muscles. CONCLUSION: Diminished quadriceps control was observed when people with ACL deficiency performed static and dynamic tasks. The most striking feature of this impaired control was failure to turn the quadriceps "off" when performing flexion tasks in which the knee extensors are usually "silent." Our findings suggest that quadriceps dyskinesia after ACL injury is relatively global. Changes in neural function and muscle physiology after ACL injury are put forth as the most likely source of the observed dyskinesia.

Adolescent↗
PubMed2004

Muscle and tendon morphology after reconstruction of the anterior cruciate ligament with autologous semitendinosus-gracilis graft.

BACKGROUND: The autologous semitendinosus-gracilis graft is the first choice of many orthopaedic surgeons when reconstructing the anterior cruciate ligament. The effect that graft harvest has on muscle and tendon morphology remains unclear. The purpose of this study was to describe these effects more completely. METHODS: Magnetic resonance images were acquired from eight patients before the anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft and then again postoperatively after they had returned to sports. Muscle and tendon morphology was described by determining the volume and peak cross-sectional area of each structure on digitally reconstructed images. The effects that the procedure had on muscle and tendon length were evaluated separately and then together as a muscle-tendon complex. RESULTS: Anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft resulted in a marked decrease in volume, cross-sectional area, and length of the semitendinosus and gracilis muscles. Tendon regeneration occurred in varying degrees in nearly all subjects. The morphology of the biceps femoris and semimembranosus muscles suggested that they had been compensating for the reduced semitendinosus and gracilis muscle function. Although semitendinosus and gracilis muscle retraction occurred following tendon stripping, nearly all of the subjects displayed evidence of at least partial tendon regeneration. CONCLUSIONS: Anterior cruciate ligament reconstruction with semitendinosus-gracilis autograft had a marked impact on semitendinosus and gracilis muscle morphology. However, this altered muscle morphology did not appear to have a clinically important impact on short-term outcomes. The biceps femoris and semimembranosus muscles appear to compensate for reduced semitendinosus and gracilis function. Tendon regeneration is observed in most people, but it is often incomplete at six months.

Adult↗
PubMed2004

Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series.

STUDY DESIGN: A case series. OBJECTIVES: The purpose of this case series was to assess the effect of high-intensity neuromuscular electrical stimulation (NMES) on quadriceps strength and voluntary activation following total knee arthroplasty (TKA). BACKGROUND: Following TKA, patients exhibit long-term weakness of the quadriceps and diminished functional capacity compared to age-matched healthy controls. The pain and swelling that results from surgery may contribute to quadriceps weakness. The use of high-intensity NMES has previously been shown to be effective in quickly restoring quadriceps strength in patients with weakness after surgery. METHODS AND MEASURES: All patients were treated for 6 weeks, 2 to 3 visits per week, in outpatient rehabilitation. Five patients (NMES group) participated in a voluntary exercise program for both knees and NMES for the weaker knee. Three patients (exercise group) participated in a voluntary exercise program for both knees without NMES. For each treatment session, 10 isometric electrically elicited muscle contractions were administered at maximally tolerated doses to the initially weaker leg of the NMES group. Quadriceps strength and muscle activation were repeatedly assessed up to 6 months after surgery using burst superimposition techniques. RESULTS: At 6 months, the weak NMES-treated legs of 4 of 5 patients in the NMES group had surpassed the strength of the contralateral leg. In contrast, none of the weak legs in the exercise group were stronger than the contralateral leg at 6 months. Changes in quadriceps muscle activation mirrored the changes exhibited in strength. CONCLUSION: When NMES was added to a voluntary exercise program, deficits in quadriceps muscle strength and activation resolved quickly after TKA.

Aged↗
PubMed2003

Predictability of maximum voluntary isometric knee extension force from submaximal contractions in older adults.

The purposes of this study were to develop and test a model describing the relationship between the central activation ratio (CAR; a measure of voluntary muscle activation) and percent maximum voluntary contraction (%MVC) force for old adults and to provide a method for more accurate determination of voluntary muscle activation failure. Twenty-one adults (ages 64-81) performed isometric testing of the quadriceps at 25%, 50%, 75%, and 100% MVC. During each contraction, a 100-HZ, 120-ms train of electrical pulses was delivered to the quadriceps muscle to quantify voluntary muscle activation. Similar to a young, healthy population (ages 20-35), a curvilinear relationship existed between the CAR and %MVC force for older adults. Predictions of subjects' MVCs using the linear model of CAR-%MVC force relationship generally demonstrated poor agreement with actual MVCs. Predictions of MVC from submaximal contractions (25%, 50%, and 75%) using a previously identified curvilinear young adult CAR-%MVC relationship were good [ICC (2,1): 0.81, 0.96, and 0.82, respectively]. Similar agreement was obtained from the curvilinear older adult CAR-%MVC relationship. These data suggest that the CAR-%MVC relationship is similar in young and older adult subjects and that curvilinear models of this relationship can predict MVC forces in older adults more accurately. Reexamination of the relationship between the CAR and %MVC force may allow a more accurate determination of how failure of voluntary muscle activation contributes to weakness in old adults.

Adult↗
PubMed2003

Are voluntary muscle activation deficits in older adults meaningful?

The relationship between the central activation ratio (CAR) and contraction force is curvilinear, not linear as was previously believed. Voluntary quadriceps femoris muscle activation from previously collected data sets in 46 older adults (64-84 years) and 46 young adults (18-32 years) were therefore reexamined using a curvilinear model of the voluntary muscle activation-percent maximum voluntary force relationship. This method revealed lower voluntary muscle activation in older adults (0.868 +/- 0.018) than younger subjects (0.978 +/- 0.005). The mean difference between older and younger adults was 11%, which may be more meaningful than previous reports of 2-4% because it could explain the greater rate of strength loss as compared to loss of muscle mass as humans age.

Adolescent↗
PubMed2003

Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis.

INTRODUCTION: Patients with osteoarthritis (OA) of the knee have quadriceps weakness and arthrogenous muscle inhibition (AMI). While total knee arthroplasty (TKA) reliably reduces pain and improves function in patients with knee OA, quadriceps weakness persists after surgery. The purpose of this investigation was to assess contributions of AMI to quadriceps weakness before and after TKA and to assess the effect of pain on AMI. METHODS: Twenty-eight patients with unilateral, end-stage, primary knee OA were tested an average of 10 days before and 26 days after TKA. The mean age at time of operation was 63 years (range 49-82 years). Measurements on the involved and uninvolved knees were performed using the burst-superimposition technique, where supramaximal electrical stimulation is superimposed on a voluntary contraction. Knee pain during contraction was measured using a numeric rating scale. RESULTS: The involved quadriceps were significantly weaker than the uninvolved prior to TKA (p<0.05). Quadriceps strength decreased by 60% (p<0.001) and activation decreased 17% (p<0.001) after TKA. Changes in muscle activation accounted for 65% of the variability in the change in quadriceps strength (r(2)=0.65) (p<0.001). Knee pain during muscle contraction accounted for a small, but significant portion of the change in voluntary activation (r(2)=0.22) (p=0.006). DISCUSSION: Exercise regimens that emphasize strong muscle contraction and clinical tools that facilitate muscle activation like biofeedback and neuromuscular electrical stimulation may be necessary to reverse the quadriceps activation failure and weakness in the patients with knee OA that worsens after TKA. The failure of current rehabilitation regimens to directly address activation deficits within the first months after surgery may explain the persistent quadriceps weakness in patients after TKA.

Aged↗
PubMed2003

Specificity of muscle action after anterior cruciate ligament injury.

Neuromuscular control is believed to be a critical factor in dynamic knee stability. The purpose of this study was to evaluate voluntary muscle control in anterior cruciate ligament deficient (ACL-D) and uninjured people. Twenty athletes of similar age participated in this study. Subjects performed a target-matching protocol that required them to produce isometric moments about the knee with fine control in flexion, extension, varus, and valgus (i.e., loads were generated in the plane perpendicular to the long axis of the shank). Electromyographic data were collected from 10 muscles that span the knee. A specificity index was calculated for each muscle to describe how fine-tuned (specific) its muscle activity pattern was with respect to its principal direction of action in the load plane. Diminished specificity of muscle action was observed in 8 of 10 muscles in the ACL-D subjects' involved knees when compared with the activity patterns from their uninvolved knees and those from the uninjured subjects' knees. The vastus lateralis muscle was especially affected. Increased and more global co-contraction was also observed in the ACL-D limbs. The alterations in muscle firing patterns observed in this study are consistent with diminished neuromuscular control.

Adult↗
PubMed2003

Dynamic knee stability after anterior cruciate ligament rupture.

A functional classification scheme has been devised to study knee stabilization strategies after anterior cruciate ligament rupture. A screening examination can determine which patients may be candidates for nonsurgical treatment (potential copers). A rehabilitation program that includes support surface perturbations can improve the potential coper's ability to stabilize the knee. Biomechanical, electromyographic, and clinical data support the classification scheme and perturbation training for improving dynamic knee stability.

Adaptation, Physiological↗
PubMed2003

Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport.

Muscles operate eccentrically to either dissipate energy for decelerating the body or to store elastic recoil energy in preparation for a shortening (concentric) contraction. The muscle forces produced during this lengthening behavior can be extremely high, despite the requisite low energetic cost. Traditionally, these high-force eccentric contractions have been associated with a muscle damage response. This clinical commentary explores the ability of the muscle-tendon system to adapt to progressively increasing eccentric muscle forces and the resultant structural and functional outcomes. Damage to the muscle-tendon is not an obligatory response. Rather, the muscle can hypertrophy and a change in the spring characteristics of muscle can enhance power; the tendon also adapts so as to tolerate higher tensions. Both basic and clinical findings are discussed. Specifically, we explore the nature of the structural changes and how these adaptations may help prevent musculoskeletal injury, improve sport performance, and overcome musculoskeletal impairments.

Accidental Falls↗
PubMed2003

Voluntary activation and decreased force production of the quadriceps femoris muscle after total knee arthroplasty.

BACKGROUND AND PURPOSE: Quadriceps femoris muscle weakness as manifested by a decrease in force-generating capability is a persistent problem after total knee arthroplasty (TKA). The authors hypothesized that (1) patients with a TKA would have decreased quadriceps femoris muscle performance (weakness) and impaired volitional activation when compared with a group of older adults without knee pathology, (2) pain and age would account for a large portion of the variability in volitional activation after surgery, and (3) volitional activation in the TKA group would account for a large portion of the variability in force production. SUBJECTS: Comparison subjects were 52 volunteers (mean age=72.2 years, SD=5.34, range=64-85). The TKA group comprised 52 patients (mean age=64.9 years, SD=7.72, range=49-78) with a diagnosis of osteoarthritis who had undergone a tricompartmental, cemented TKA. METHODS: Knee extension force was measured using a burst superimposition technique, where a supramaximal burst of electrical stimulation was superimposed on a maximal voluntary isometric contraction (MVIC). The amount of failure of volitional activation is determined by the amount of electrical augmentation of force beyond a person's MVIC at the instant of the application of the electrical burst. RESULTS: The average normalized knee extension force of the TKA group was 64% lower than that of the comparison group. The average volitional activation deficit in the TKA group (26%) was 4 times as great as the comparison group's deficit (6%). Age did not correlate with quadriceps femoris muscle activation, and knee pain explained only a small portion of the variance in knee extension force (r2=.17). Volitional activation was highly correlated with knee extension force production (r2=.65). DISCUSSION AND CONCLUSION: Considerable quadriceps femoris muscle inhibition after surgery has several implications for recovery. Rehabilitation programs that focus on volitional exercise alone are unlikely to overcome this pronounced failure of activation. Early interventions focused at improving quadriceps femoris muscle voluntary activation may improve efforts to restore muscle force.

Age Factors↗
PubMed2002

The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction.

OBJECTIVE: To determine the effect of quadriceps strength and joint stability on gait patterns after anterior cruciate ligament injury and reconstruction. DESIGN: Cross-sectional comparative study in which four groups underwent motion analysis with surface electromyography. BACKGROUND: Individuals following anterior cruciate ligament rupture often demonstrate reduced knee angles and moments during the early stance phase of gait. Alterations in gait can neither be ascribed to instability nor to quadriceps weakness alone when both are present. METHODS: Twenty-eight individuals with complete anterior cruciate ligament rupture (10 patients with acute rupture, 8 patients following reconstruction with quadriceps strength >90% of the uninvolved side [strong-anterior cruciate ligament reconstructed group], and 10 patients after reconstruction with quadriceps strength <80% of the uninvolved side [weak-anterior cruciate ligament reconstructed group]), and 10 uninjured subjects underwent an examination of their lower extremity to collect kinematics, kinetics, and electromyography during walking and jogging. Anterior cruciate ligament reconstruction was arthroscopically assisted and a double loop semitendinosis-gracilis autograft or allograft was used as a graft source. All reconstructed subjects had stable knees, full range of motion, and no effusion or pain at the time of testing (more than three months after surgery). RESULTS: Knee angles and moments of the strong group were indistinguishable from the uninjured group during early stance of both walking and jogging. The weak subjects had reduced knee angles and moments during walking, and jogged similarly to the deficient subjects. Regression analysis revealed a significant effect between early stance phase knee angles and moments and quadriceps strength during both walking and jogging. CONCLUSION: Inadequate quadriceps strength contributes to altered gait patterns following anterior cruciate ligament reconstruction. RELEVANCE: Rapid strengthening following anterior cruciate ligament injury or reconstruction may contribute to a safe return to high-level activities.

Adolescent↗
PubMed2002

Changes in weight-bearing following injury or surgical reconstruction of the ACL: relationship to quadriceps strength and function.

PURPOSE: Changes in weight-bearing an average of 1.5 months after ACL injury (ACLD) and up to 3 months after surgical reconstruction (ACLR) were investigated using a force platform. Correlations between force platform test variables, quadriceps strength and functional self-report scores were also examined. RESULTS: Each force platform test revealed impaired weight-bearing by either ACLD and/or ACLR subjects. Many variables were correlated to quadriceps strength; therefore, improved strength in ACLR subjects by 6 weeks post-operative negated any weight-bearing impairment. No single force platform variable correlated with the subjects' perception of function. CONCLUSION: Only the step up/over test provided insight into disability in these patients. Modification of force platform analysis programs may allow for other clinical questions to be answered.

Adult↗