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Evaluation of a dynamometer measuring torque of uni- and bilateral concentric and eccentric muscle action.

A dynamometer designed for torque measurements of uni- and bilateral concentric and eccentric muscle actions of the quadriceps and hamstring muscle groups is described. Torque reproducibility and control of lever-arm position were studied using known standards. In vivo measurements assessed angular velocity, lever-arm acceleration, variability of torque between limbs and reproducibility of torque. Torque obtained from left and right leg attachments was equal when using weights and during dynamic in vivo conditions. Static torque recorded at different lever-arm positions and known torque were equal. Likewise, lever-arm position output equated with known angles. In vivo test-retest of peak torque was found to be reliable. Acceleration of the lever arm was greater for concentric bilateral than for unilateral muscle actions but equal during eccentric muscle actions. The dynamometer is suggested to provide valid and reproducible torque measurements up to at least 700 N m at constant angular velocities up to 2.62 rad s-1. Besides being a research tool the dynamometer is useful in clinical settings for rehabilitation and evaluation of skeletal muscle function.

Adult↗

The biomechanical effect of posterior cruciate ligament reconstruction on knee joint function. Kinematic response to simulated muscle loads.

BACKGROUND: The effectiveness of posterior cruciate ligament reconstruction in restoring normal kinematics under physiologic loading is unknown. HYPOTHESIS: Posterior cruciate ligament reconstruction does not restore normal knee kinematics under muscle loading. STUDY DESIGN: In vitro biomechanical study. METHODS: Kinematics of knees with an intact, resected, and reconstructed posterior cruciate ligament were measured by a robotic testing system under simulated muscle loads. Anteroposterior tibial translation and internal-external tibial rotation were measured at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 120 degrees of flexion under posterior drawer loading, quadriceps muscle loading, and combined quadriceps and hamstring muscle loading. RESULTS: Reconstruction reduced the additional posterior tibial translation caused by ligament deficiency at all flexion angles tested under posterior drawer loading. Ligament deficiency increased external rotation and posterior translation at angles higher than 60 degrees of flexion when simulated muscle loading was applied. Posterior cruciate ligament reconstruction reduced the posterior translation and external rotation observed in posterior cruciate ligament-deficient knees at higher flexion angles, but differences were not significant. CONCLUSION: Under physiologic loading conditions, posterior cruciate ligament reconstruction does not restore six degree of freedom knee kinematics. CLINICAL RELEVANCE: Abnormal knee kinematics may lead to development of long-term knee arthrosis.

Aged↗

Irreducible congenital dislocation of the knee. Aetiology and management.

We report nine cases of irreducible congenital dislocation of the knee which were treated by early operation with good results. All were resistant to conservative measures and operation was performed at an average age of nine months. The essential abnormality was a short quadriceps muscle together with subluxation of the hamstring muscles to lie anterior to the axis of knee flexion. The quadriceps tendon was lengthened by VY-plasty and in six cases additional length was gained by proximal mobilisation of the muscle. After operation all the patients were able to walk.

Female↗

Distraction manipulation reduction of an L5-S1 disk herniation.

OBJECTIVE: A computed tomography (CT)-confirmed L5-S1 disk protrusion is reported to be reduced following chiropractic adjustment, as seen on repeat CT scanning. Correlation of the CT reports with the patient's symptoms before and after manipulation is reported. CLINICAL FEATURES: A 38-yr-old female was treated for low back pain and right lower extremity first sacral dermatome sciatica. CT confirmed disk herniations at both the L4-L5 and L5-S1 levels were found. Motor weakness of the right gluteus maximus muscle was found and extremely tight hamstring muscles accompanying positive straight leg signs were elicited. A clinical and imaging diagnosis of an L5-S1 disk herniation was made. INTERVENTION AND OUTCOME: Distraction type chiropractic manipulation, electrical stimulation, exercises, nutrition advice and low back wellness class were administered with complete relief of sciatic pain and nearly complete relief of low back pain. CONCLUSIONS: Chiropractic distraction manipulation is an effective treatment of lumbar disk herniation, if the chiropractor is observant during its administration for patient tolerance to manipulation under distraction and any signs of neurological deficit demanding other types of care.

Adult↗

The effects of progressive resistance training for children with cerebral palsy.

OBJECTIVES: To investigate the effects of progressive resistance training of quadriceps and hamstrings muscles in children with cerebral palsy (CP). DESIGN: Pilot study using a repeated measures design with measurements at baseline, immediately after six weeks training then at four-week follow-up. SETTING: The project was undertaken within the physiotherapy department of two special schools in Glasgow. SUBJECTS: A convenience sample of eight children aged between six and 12 years, with hypertonic CP. INTERVENTION: The subjects participated three times per week in a six-week, progressive, free-weight, strengthening programme. OUTCOME MEASURES: Maximum isometric muscle strength and resistance to passive stretch were measured with a hand-held myometer. The Gross Motor Function Measure and a 10-metre timed walking test, were used to assess function and gait parameters respectively. RESULTS: Muscle strength increased, with the quadriceps to hamstrings strength ratio moving towards normal. These changes were retained at follow-up. Muscle tone decreased and continued to decrease to follow-up. The standing (D) and walking, running and jumping (E) goal areas of the Gross Motor Function Measure showed improvement that continued towards follow-up. Walking speed and step rate increased. CONCLUSIONS: A future large-scale randomized controlled study would be of value to substantiate these results as the small convenience sample and lack of control group limit this study. However, the finding that no adverse effect accompanied the positive outcomes in strength and function may encourage clinicians to consider resistance training alongside standard therapeutic interventions.

Analysis of Variance↗

Bone mineral density and muscle strength in young men with mental retardation (with and without Down syndrome).

The objective of this study was to compare the bone mineral density (BMD) of men with Down syndrome (DS) to otherwise mentally retarded (MR) men and to investigate whether leg muscle strength of these patients is related to BMD. Two groups with MR (with and without DS) participated in the study, having met the following criteria: similar age, moderate to mild mental retardation, Tanner stage V of sexual development, similar age of beginning to walk, and equal motor activities. The DS group consisted of 8 men 23.9 +/- 4.2 years, and the MR group without DS consisted of 8 men 23.5 +/- 3.6 years. The two groups were compared with 10 sedentary students of the same age range (25.9 +/- 2.9 years) attending our University. The BMD of the 2(nd) to 4(th) lumbar vertebrae was measured in the PA projection and the mean density was expressed as g/cm(2). The isokinetic muscle strength of the right quadriceps femoris and hamstrings muscles was measured on a Cybex II isokinetic dynamometer. The value measured was peak torque at angular velocities at 60, 120, and 300 degrees.sec(-1). The results showed that BMD in DS individuals versus young adults (reference group of the scanner) was lower at the 26% level (T-score - 2.66 +/- 0.29) and significantly lower (P = 0.002) than that of the MR group. Significantly different muscle strength was observed between the DS and non-DS MR group (in quadriceps at 300 degrees.s(-1): P < 0.01, at 120 and 60 degrees. s(-1): P < 0.05; in hamstrings at 300 degrees.s(-1): P < 0.05). Higher differences in muscle strength were found between MR and control men, but no significant difference existed in BMD between them. Bivariate correlation showed that quadriceps strength significantly predicted the BMD in the DS patients. Active lifestyle and increased physical exercise to improve muscular strength should be instituted to avoid the development of osteoporosis in DS patients.

Adult↗

Predominant right leg dysfunction without asymmetric muscle inflammation in CD1 Swiss mice with coxsackievirus B1-induced myositis.

To establish the existence of predominant right leg involvement in Coxsackievirus B1-induced myositis (CB1 myositis) 189 neonatal CD1 Swiss mice were inoculated with 300 pfu CB1, and regularly observed for posture, mobility, and gait. After 2 and 4 weeks, quantitative comparison of motor dysfunction of right and left leg yielded an asymmetry score; on light microscopy mononuclear cell infiltration and muscle fiber necrosis were quantified in bilateral hamstring muscles, using a five-grade scale (0-4). Motor asymmetries were seen during acute viral myositis as soon as hind leg dysfunction appeared, and animals with a predominant dysfunction of one leg preserved that preference throughout the observation period. At 2 weeks, mice with predominant right leg dysfunction (n = 34) significantly outnumbered those with predominant left leg dysfunction (n = 11) (p = 0.01). At 2 and 4 weeks, infiltration and necrosis in hamstrings from legs with predominant dysfunction were not higher than in those from contralateral legs, and infiltration in right-sided hamstrings was not higher than in left-sided ones, nor was infiltration at 4 weeks. At 4 weeks right-sided muscles were more necrotic (mean +/- SD, 1.8 +/- 1.5) than left-sided muscles (1.1 +/- 1.2; p = 0.03). In the absence of predominant inflammatory disease of the right leg, we interpret the hind leg asymmetry as a preferential use of the left leg, due to left-leggedness, and suggest that in CD1 Swiss mice left-leggedness is associated with increased susceptibility to CB1 myositis.

Animals↗

Unilateral lower limb injury: its long-term effects on quadriceps, hamstring, and plantarflexor muscle strength.

OBJECTIVE: To ascertain if long-term deficits in quadriceps, hamstring, and plantarflexor muscle strength remain after unilateral lower-limb musculoskeletal injury and to quantify whether improvements in performance continue once a subject concludes rehabilitation and returns to everyday activities. The relation between the size of decrement and limb dominance, type of injury, and time since injury was also considered. DESIGN: Isometric and/or dynamic muscle strength of both legs was measured (using the KinCom 500H isokinetic dynamometer) in 48 subjects. SETTING: A physiological laboratory at Brunel University. PATIENTS: Patients were recruited locally via a district general hospital, sports injury clinic, and university. MAIN OUTCOME MEASURES: Muscle strength in the injured limb, reported as a percentage of muscle strength in the uninjured limb. It was assumed that the preinjury state of the injured limb was similar to that of the uninjured limb. RESULTS: Decrements were seen in mean isometric and peak isometric, concentric, and eccentric quadriceps activity (p < .0001) and isometric plantarflexor activity (p < .05) in the injured limb, with the type of injury influencing the size of the decrement. Minimal difference was found in the hamstring muscles. CONCLUSIONS: The decrements in performance in the quadriceps muscle imply that full recovery (as defined by the preinjury state) is frequently not achieved and stress the need for accurate, objective assessment of muscle strength and further investigation into the nature and duration of rehabilitation after musculoskeletal injury.

Adult↗

Muscle activation and torque development during maximal unilateral and bilateral isokinetic knee extensions.

BACKGROUND: The aim of this study was to investigate whether or not a bilateral strength deficit occurs during bilateral (BL) velocity controlled dynamic knee extensions and if the neural control of the knee extensors and flexors is altered during homologous muscle BL efforts. METHODS: Twenty-eight healthy and habitually active subjects, 13 female and 15 male, performed maximal unilateral (UL) and BL isokinetic leg extensions at a velocity of 60 degrees.s-1 through a 90 degrees range of motion of the knee joint (90 to 180 degrees). Knee extension torque and electromyographic activity (EMG) of the quadriceps and hamstrings muscles were recorded. RESULTS: The mean knee extensor torque produced in the BL condition (168 +/- 52 Nm) was 17% less than the sum of the two UL conditions (Sigma=202 +/- 56 Nm). During BL conditions, quadriceps EMG activity was less in both legs (left, 8.2 +/- 7.4% less and right, 13.9 +/- 9.1% less, respectively). There were no significant differences between BL and UL efforts for either left or right hamstrings activity. Eighteen subjects, who when asked to perform a maximal knee extension simultaneously activated their contralateral hamstrings, had significantly higher bilateral deficits (21%) compared to those who exhibited little or no contralateral hamstrings EMG activity (14%). CONCLUSIONS: The main findings of the study were that a bilateral strength deficit occurred when simultaneously maximally activating the homologous knee extensor muscles. This deficit was in all likelihood due to a less than maximal efferent drive to the quadriceps muscles. Hamstrings EMG activity was not greater during the BL knee extensions, which supports the notion that antagonistic muscle activity was not primarily responsible for the observed bilateral deficit.

Adult↗

Electromyographic study of the relationship between hamstring and abdominal muscles during a unilateral straight leg raise.

The purposes of this study were 1) to assess the relative participation of the hip extensor and abdominal musculature during unilateral straight leg raising in the naive subject and 2) to examine quantitatively alterations in the pattern of pelvic stabilization when the subject was instructed to relax the contralateral extremity. Surface electrodes were used to record bilaterally the electromyographic activity of the rectus abdominus, external oblique, and medial hamstring muscles. Each healthy subject performed a unilateral straight leg raise three times in each of two modes, Preferred and Relaxed. The electromyographic values for each muscle were normalized to a maximum isometric contraction and analyzed using a three-factor (2 X 2 X 2) mixed design analysis of variance. Results indicate that 9 of the 11 subjects used the tested medial hamstrings and abdominal muscles during a unilateral straight leg raise performed in the Preferred Mode. When instructed to relax the contralateral extremity for the Relaxed Mode, abdominal muscle activity increased significantly (p less than .01). The findings indicate that although most subjects normally stabilize with the contralateral extremity during a unilateral straight leg raise, they can consciously alter the pattern.

Abdominal Muscles↗

Longitudinal structure and innervation of two mammalian hindlimb muscles.

The possibility of a topographic relationship between the spinal cord and the longitudinal axis of a muscle has been explored in two mammalian hamstring muscles: the rat semitendinosus (ST) and biceps femoris (BF). In both muscles the fibers did not extend the full length of the respective muscle bellies but were arranged in longitudinal arrays. There were two such arrays in BF and three in ST; monopolar recordings revealed that each array had a transverse band of endplates extending across the middle part. By stimulating ventral nerve roots in the lumbosacral outflow, it was found that L5 made the greatest contribution to the innervation of both ST and BF, with lesser inputs coming from adjacent roots. In neither ST or BF was there any evidence of a topographic relationship between the spinal cord and the muscle belly.

Animals↗

Biomechanical analysis of stair ambulation in lower limb amputees.

Lower extremity amputees have to cope with many activities in everyday life that are substantially more difficult than walking on level ground, and such demands require a high degree of functionality from their prosthetic components. The present study is a biomechanical evaluation (kinematics, kinetics and EMG) of stair ascent and descent in a group of eight transtibial amputees (mean (standard deviation): age 51(14) years, height 176(7)cm, mass 88(19)kg); a group of 12 transfemoral amputees (age 37(8) years, height 182(7)cm, mass 83(7)kg) fitted with the electronically controlled C-LEG knee joint system; and a group of 12 able bodied persons (age 30(10) years, height 174(12)cm, mass 69(12)kg). During stair descent the transfemoral amputees presented a strong reduction of the prosthetic ankle moments (0.11Nm/kg) compared to transtibial amputees (0.93Nm/kg) and control subjects (1.26Nm/kg). Loading of the prosthetic knee joint in the transfemoral amputees more closely resembles the loading seen in the control population when compared to transtibial amputees (mean maximum flexion moment: controls 1.31Nm/kg, transfemoral amputees 1.00Nm/kg, transtibial amputees 0.50Nm/kg). Overload of the contralateral limb is more prominent in the transfemoral amputee than in the transtibial amputee. During stair ascent, the transtibial amputee presents a significant reduction of the knee flexion moment compared to the controls (mean maximum flexion moment: transtibial amputees 0.28Nm/kg, controls 1.31Nm/kg). These differences correlate with a change in the muscle activity of the knee extensor and hamstring muscles. The results also show adaptations in motor strategies during stair negotiation, for those with the partial loss of a lower limb due to the functional limits of current prosthetic components. The present data may contribute to a further enhancement of the efficiency of prosthetic feet and knee joints.

Activities of Daily Living↗

Electromyographic analysis of exercise resulting in symptoms of muscle damage.

Surface electromyographic (EMG) signals were recorded from the hamstring muscles during six sets of submaximal isokinetic (2.6 rad x s(-1)) eccentric (11 men, 9 women) or concentric (6 men, 4 women) contractions. The EMG per unit torque increased during eccentric (P < 0.01) but not during concentric exercise. Similarly, the median frequency increased during eccentric (P < 0.01) but not during concentric exercise. The EMG per unit torque was lower for submaximal eccentric than maximum isometric contractions (P < 0.001), and lower for submaximal concentric than maximum isometric contractions (P < 0.01). The EMG per unit torque was lower for eccentric than concentric contractions (P < 0.05). The median frequency was higher for submaximal eccentric than maximum isometric contractions (P < 0.001); it was similar, however, between submaximal concentric and maximum isometric contractions (P = 0.07). Eccentric exercise resulted in significant isometric strength loss (P < 0.01), pain (P < 0.01) and muscle tenderness (P < 0.05). The greatest strength loss was seen 1 day after eccentric exercise, while the most severe pain and muscle tenderness occurred 2 days after eccentric exercise. A lower EMG per unit torque is consistent with the selective recruitment of a small number of motor units during eccentric exercise. A higher median frequency during eccentric contractions may be explained by selective recruitment of fast-twitch motor units. The present results are consistent with the theory that muscle damage results from excessive stress on a small number of active fibres during eccentric contractions.

Adult↗

Ventilatory response of spinal cord-lesioned subjects to electrically induced exercise.

Seven human spinal cord-lesioned subjects (SPL) underwent electrically induced muscle contractions (EMC) of the quadriceps and hamstring muscles for 10 min: 5 min control, 2 min with venous return from the legs occluded, and 3 min postocclusion. Group mean changes in CO2 output compared with rest were +107 +/- 30.6, +21 +/- 25.7, and +192 +/- 37.0 (SE) ml/min during preocclusion, occlusion, and postocclusion EMC, respectively. Mean arterial CO2 partial pressure (PaCO2) obtained from catheterized radial arteries at 15- to 30-s intervals showed a significant (P less than 0.05) hypocapnia (36.2 Torr) during occlusion and a significant (P less than 0.05) hypercapnia (38.1 Torr) postocclusion relative to a group mean preocclusion EMC PaCO2 of 37.5 Torr. Relative to preocclusion EMC, expired ventilation (VE) decreased during occlusion and increased after release of occlusion. However, changes in VE always occurred after changes in end-tidal PCO2 (mean 41 s after occlusion and 10 s after release of occlusion). In the two subjects investigated during hyperoxia, the VE and PaCO2 responses to occlusion and release did not differ from normoxia. We conclude that the data do not support mediation of the EMC hyperpnea in SPL by humoral mechanisms that others have proposed for mediation of the exercise hyperpnea in spinal cord-intact humans.

Blood Pressure↗

Maintenance of hamstring strength following knee surgery.

Following a variety of surgical procedures on the knee, routine clinical Cybex testing demonstrated that the hamstring muscle group loses less strength than the quadriceps group, regardless of whether the hamstrings were exercised during the rehabilitation. Two groups of postsurgical patients were randomly selected to evaluate the effects of surgery on the muscle strength of the quadriceps and hamstrings. Group I (N = 15) underwent arthrotomy and medial meniscectomy. Group II (N = 20) underwent an extraarticular substitution of the anterior cruciate ligament. All subjects were tested on a Cybex II at 60 degrees/s: Group I at 5-10 wk (mean, 7.0), and Group II at 15-22 wk (mean, 18.6). Peak torque for the quadriceps and hamstrings was measured at 30, 60, and 90 degrees. The percent deficits of the quadriceps and hamstrings were analyzed by a three-way ANOVA. The hamstring deficit was significantly less (P = 0.041) than the quadriceps deficit. A significant difference (P less than 0.001) was found between the two surgery groups. No significant difference in percent strength deficit was found at the various joint angles (30, 60, and 90 degrees). Lastly, the factors examined in the ANOVA did not contribute to a significant first or second order interaction. The authors conclude that specific hamstring strengthening postsurgically is not always indicated.

Adolescent↗

Muscle strength in children treated for displaced femoral fractures by external fixation: 31 patients compared with 31 matched controls.

In a prospective study (1993-2000), we measured the isokinetic strength of the quadriceps and hamstring muscles in 31 children aged 5-17 years, on average, 3 (1.5-5) years after treatment for a displaced femoral fracture by external fixation and early mobilization. A group of age-, sex- and weight-matched children without previous injury were used as controls. The hop-index test was used to assess the patient's confidence in the injured limb and was similar in the fractured and unfractured legs as well as in the patients and controls. We measured the peak torque output at 2 angular velocities (60 degrees/s and 180 degrees/s) in the hamstring and quadriceps muscles, using Cybex testing equipment. Torque to body weight ratios were used to compare muscle strength in patients and controls. We found no differences in muscle strength between patients and controls or in the distribution of which leg was stronger, equal or weaker in the patients or controls at any test speed. External fixation and early mobilization seem to prevent residual muscle weakness, which occurs with traction or a cast for femoral fractures in children.

Adolescent↗

Topical anesthesia: modulation of the monosynaptic reflexes by desensitization of the skin.

Skin desensitization by topical anesthesia was studied for its effect on the motoneuron excitability of the soleus muscle. Skin areas overlying calf, tibial, quadriceps and hamstrings muscles and skin dermatomes (L2, L3, L4, L5, S1 and S2) were studied separately. Motoneuron excitabilities were measured by the H-reflex and Achilles tendon reflex (for alpha and gamma motoneurons). It was shown that anesthesia applied to all skin areas and dermatomes, except those overlying the antagonist muscles, resulted in significant facilitation of the soleus H-reflex. In these cases, the ATR showed either slight inhibition or no significant changes. Anesthesia to the skin overlying the anterior tibial antagonistic muscle produced varied and inconsistent modifications in the amplitude of the H-reflex. In these cases the ATR was either slightly facilitated or showed no significant changes. These results appear to indicate the existence of on-going excitatory and inhibitory effects from the skin on the alpha and gamma motoneuron pool probably via segmental and suprasegmental levels. A possible clinical application of these results to modulate the motoneuron pool excitability is proposed.

Administration, Topical↗

Foot trajectory in human gait: a precise and multifactorial motor control task.

The trajectory of the heel and toe during the swing phase of human gait were analyzed on young adults. The magnitude and variability of minimum toe clearance and heel-contact velocity were documented on 10 repeat walking trials on 11 subjects. The energetics that controlled step length resulted from a separate study of 55 walking trials conducted on subjects walking at slow, natural, and fast cadences. A sensitivity analysis of the toe clearance and heel-contact velocity measures revealed the individual changes at each joint in the link-segment chain that could be responsible for changes in those measures. Toe clearance was very small (1.29 cm) and had low variability (about 4 mm). Heel-contact velocity was negligible vertically and small (0.87 m/s) horizontally. Six joints in the link-segment chain could, with very small changes (+/- 0.86 degrees - +/- 3.3 degrees), independently account for toe clearance variability. Only one muscle group in the chain (swing-phase hamstring muscles) could be responsible for altering the heel-contact velocity prior to heel contact. Four mechanical power phases in gait (ankle push-off, hip pull-off, knee extensor eccentric power at push-off, and knee flexor eccentric power prior to heel contact) could alter step length and cadence. These analyses demonstrate that the safe trajectory of the foot during swing is a precise endpoint control task that is under the multisegment motor control of both the stance and swing limbs.

Adult↗