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PubMed2000

Cardiovascular responses to static exercise in patients with Brown-Séquard syndrome.

1. The purpose of this study was to determine the contributions of central command and the exercise pressor reflex in regulating the cardiovascular response to static exercise in patients with Brown-Sequard syndrome. In this rare condition, a hemisection of the spinal cord typically leaves one side of the body with diminished sensation and normal motor function and the other side with diminished motor function and normal sensation. 2. Four, otherwise healthy, patients with Brown-Sequard syndrome and varying degrees of motor and sensory dysfunction were studied during four isometric knee extension protocols involving both voluntary contraction and electrically stimulated contractions of each leg. Heart rate, blood pressure, force production and ratings of perceived exertion were measured during all conditions. Measurements were also made during post-contraction thigh cuff occlusion and during a cold pressor test. 3. With the exception of electrical stimulation of the leg with a sensory deficit, protocols yielded increases in heart rate and blood pressure. Cuff occlusion sustained blood pressure above resting levels only when the leg had intact sensation. 4. While voluntary contraction (or attempted contraction) of the leg with a motor deficit produced the lowest force, it produced the highest ratings of perceived exertion coupled with the greatest elevations in heart rate and blood pressure. 5. These data show that the magnitude of the heart rate and blood pressure responses in these patients was greatly affected by an increased central command; however, there were marked cardiovascular responses due to activation of the exercise pressor reflex in the absence of central command.

Adult↗

PubMed1994

A rippling muscle disease gene is localized to 1q41: evidence for multiple genes.

Rippling muscle disease (RMD) is an inherited disorder of skeletal muscle in which mechanical stimuli provoke electrically silent contractions. Patient symptoms are muscle cramps, pain, and stiffness, particularly during or following exercise. Clinical signs are balling of muscle following percussion and a characteristic lateral rolling movement of muscle occurring after contraction followed by stretching. We report a new 44-member pedigree segregating RMD as an autosomal dominant trait. A genetic linkage study in this family, using a novel approach of testing closely spaced highly polymorphic markers in affected individuals, localized the responsible gene to the distal end of the long arm of chromosome 1 with a maximum multipoint lod score of 3.56 (theta = 0). In this family, RMD is localized to a 12-cM region near D1S235. We studied two previously reported German families for linkage to the same locus, and this same area did not cosegregate with the disease, a finding that shows that different genetic defects can cause a similar clinical phenotype (genetic heterogeneity). An understanding of the defect in contraction control within the muscle fibers in this disease may lead to a better understanding of muscle force transduction, intracellular calcium homeostasis, or both.

Adolescent↗

PubMed1998

Excision of subcutaneous tissue and deep muscle fascia for advanced lymphedema.

In advanced peripheral lymphedema particularly involving the legs, complex physical therapy (massage/bandage-wrapping compression, remedial exercises, and maintenance use of a low stretch elastic compression garment), is not uniformly successful. In six patients with morbid lymphedema of the legs, we described our positive experience using a modified Auchincloss/Homans excisional operation.

Adipose Tissue↗

PubMed2005

Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up.

OBJECTIVE: To assess the adherence to and effects of a 12-month combined strength and stretching home exercise regimen versus stretching alone, on patient outcome after lumbar disk surgery. DESIGN: Randomized controlled trial. SETTING: Departments of physical medicine and rehabilitation and orthopedics at a Finnish hospital. PARTICIPANTS: Patients (N=126) were randomized into either a combined strength training and stretching group (STG, n=65) or a control group (CG, n=61). INTERVENTION: The STG was instructed to perform strength training and both the STG and CG were instructed in the same stretching and stabilization exercises for 12 months. MAIN OUTCOME MEASURES: Pain on the visual analog scale (VAS), the Oswestry and the Million disability indexes, isometric and dynamic trunk muscle strength, mobility in the lumbar spine, and straight-leg raising were measured. RESULTS: The trial was completed by 71% and 77% of the patients from the STG and the CG, respectively. The mean strength training frequency decreased from 1.5 to 0.6 times a week in the STG during the intervention. The mean stretching frequency decreased from 3.7 to 1.6 times a week in both groups. Median back and leg pain varied between 17 and 23 mm (VAS), and the Million and Oswestry indices varied between 14 and 23 points 2 months postoperatively. No statistically significant changes took place in these outcome measures during the 12-month follow-up in both groups. The changes in isometric trunk extension favored the STG ( P =.016) during the first 2 months. However, during the whole 12-month training period, both dynamic and isometric back extension and flexion strength, as well as mobility of the spine and repetitive squat-test results, improved significantly in both groups, and no differences were found in any of the physical function parameters between the STG and CG. CONCLUSIONS: At the 12-month follow-up, no statistically significant changes were found in the physical function, pain, or disability measures between the groups. In the STG, training adherence with regard to training frequency and intensity remained too low to lead to specific training-induced adaptations in the neuromuscular system. Progressive loading, supervision of training, and psychosocial support is needed in long-term rehabilitation programs to maintain patient motivation.

Adult↗

PubMed1987

Neural compensation for muscular fatigue: evidence for significant force regulation in man.

We have investigated the role of reflex regulation of muscle force in normal human subjects by comparing changes in the stretch-evoked increments in elbow joint flexor electromyogram (EMG) and elbow joint torque before and after fatigue. Elbow flexor muscle fatigue was induced by repetitive voluntary isometric contractions. To assess the appropriateness of the EMG signal as an index of neural excitation of muscle under fatiguing conditions, we examined the time course of recovery of joint torque and EMG power spectrum following fatigue. Fatigue-related changes in the EMG power spectra recovered within 5-10 min after fatiguing exercise was terminated, yet the muscle weakness induced by the exercise lasted greater than 7 h and was substantial in magnitude. The decoupling of torque and EMG recovery allowed us to compare pre- and postfatigue EMG stretch responses without adjusting for differences in EMG spectral content. Torque and EMG responses to stretch were quantified by time-averaging over 250-ms "isometric" and "steady-state" periods, just before and just after a ramp angular stretch of the elbow joint, respectively. The torque increment elicited by stretch was lower following fatigue in seven of eight experiments. However, the average decrease of 20.13 +/- 14.42% in these seven subjects was somewhat smaller than the corresponding average shift in the slope of the isometric EMG-torque relationship of 85.84 +/- 90.29% (n = 8). Furthermore, the stretch-induced EMG increment was larger following fatigue in all eight sessions (average of 56.14 +/- 28.96%, n = 8), with six of the shifts reaching statistical significance for alpha = 0.05. Because the pattern of torque and EMG responses before and after fatigue suggested the presence of an active force regulator, we used a simple model of the neuromuscular system to estimate a loop gain value for each session. When pre- and postfatigue responses were matched by isometric background torque level, an average loop gain value of 7.9 was computed, whereas for responses matched by average prestretch EMG level, the loop gain estimates averaged 2.1. Although our assessment of force regulation was essentially static and derived from the responses to a single type of perturbation, the change in the incremental torque and EMG stretch responses indicates that meaningful neural compensation for fatigue occurred. Moreover, the loop gain estimates derived from these responses are an order of magnitude larger than those previously reported in animal models, suggesting that force regulation may be important in the control of human muscle contraction.

Adaptation, Physiological↗

PubMed1988

Light resistance and stretching exercise in elderly women: effect upon flexibility.

Decreased range of motion (ROM) due to disuse limits the older adult's ability to perform daily activities. The flexibility of five joints of 46 women (aged 65 to 89 years) was measured by goniometer before and after a 25-week exercise program. Three groups were formed: a control group who did no exercise (C) (n = 13), a group who exercised with light weights (EW) (n = 17), and a group who exercised with no weights (EN) (n = 16). Subjects who exercised (EN and EW) gained significantly greater ROM in ankle plantar flexion, shoulder flexion, shoulder abduction, and left neck rotation than C subjects. No significant differences were found between groups in hip flexion, right neck rotation, wrist flexion or extension, or ankle dorsiflexion. The only difference between exercise treatments was that the EN group gained significantly more ROM in shoulder abduction than the EW. The use of arm weights may have limited shoulder ROM during exercise, resulting in less improvement for shoulder abduction. Comparison with data from other studies suggests age-related loss in flexibility at the shoulder joint. Exercise generally increased shoulder ROM and may be capable of reversing loss in flexibility due to disuse.

Aged↗

PubMed1998

Reflex excitability and isometric force production in cerebral palsy: the effect of serial casting.

During passive dorsiflexion, the angle of stretch-reflex onset was earlier in the dorsiflexion range for children with spastic cerebral palsy (CP) (N=10) compared with controls (P<0.001) at comparable velocities of stretch. Isometric plantar-flexor force was lower in children with CP (P<0.0001) and a leftward shift in the length-tension curve reflected that peak forces were produced in greater plantar flexion in children with CP than in controls (P<0.0001). Seven children with CP underwent 3 weeks of serial casting resulting in increased dorsiflexion at postcasting and at 6 weeks follow-up (P<0.002). There was no associated loss in plantar-flexor strength (P>0.32), but increased reflex threshold (P<0.03) and a decline in restraint to imposed stretch (P<0.002) were evident. A rightward shift in the length-tension curve illustrated that peak tension was generated in dorsiflexion rather than plantar flexion following casting (P<0.001). The gains were still evident at follow-up although generally to a lesser extent.

Adolescent↗

PubMed2004

Effect of static stretch training on neural and mechanical properties of the human plantar-flexor muscles.

To determine the contributions of neural and mechanical mechanisms to the limits in the range of motion (ROM) about a joint, we studied the effects of 30 sessions of static stretch training on the characteristics of the plantar-flexor muscles in 12 subjects. Changes in the maximal ankle dorsiflexion and the torque produced during passive stretching at various ankle angles, as well as maximal voluntary contraction (MVC) and electrically induced contractions, were recorded after 10, 20, and 30 sessions, and 1 month after the end of the training program. Reflex activities were tested by recording the Hoffmann reflex (H reflex) and tendon reflex (T reflex) in the soleus muscle. Training caused a 30.8% (P < 0.01) increase in the maximal ankle dorsiflexion. This improved flexibility was associated (r(2) = 0.88; P < 0.001) with a decrease in muscle passive stiffness and, after the first 10 sessions only, with a small increase in passive torque at maximal dorsiflexion. Furthermore, both the H- and T-reflex amplitudes were reduced after training, especially the latter (-36% vs. -14%; P < 0.05). The MVC torque and the maximal rate of torque development were not affected by training. Although the changes in flexibility and passive stiffness were partially maintained 1 month after the end of the training program, reflex activities had already returned to control levels. It is concluded that the increased flexibility results mainly from reduced passive stiffness of the muscle-tendon unit and tonic reflex activity. The underlying neural and mechanical adaptation mechanisms, however, showed different time courses.

Adult↗

PubMed2000

[Sternocleidomastroid inflammatory pseudotumors of muscle in children].

PATIENTS AND METHODS: The files of 12 children presenting with a sternocleidomastoid tumor of infancy at the Timone Children's Hospital in Marseille between 1990 and 1999 were retrospectively studied. All of them underwent physical and ultrasonographic examination. RESULTS: The mass was firm, within the lower two-thirds of the sternocleidomastoid muscle. Ultrasonographic examination showed a soft tissue mass independent of the great vessels. Biopsy revealed a benign fibrous lesion. Eleven children were treated with stretching exercises and a surgical therapy was performed for one in whom physical therapy was unsuccessful. CONCLUSION: The sternocleidomastoid tumor of infancy is a lateral neck mass affecting children between the ages of two and four weeks. Most of the time it spontaneously resolves in four to eight months. It may be associated with congenital muscular torticollis and requires physical therapy. Surgery should be reserved for children who have failed with this treatment.

Female↗

PubMed1992

Effect of spinal microinjections of an antagonist to substance P or somatostatin on the exercise pressor reflex.

The purpose of this study was to determine the heart rate and arterial blood pressure changes to isometric skeletal muscle contraction and muscle stretch before and after microinjecting an antagonist to substance P (SP) or somatostatin (SOM) into the L-7 dorsal horn region of the spinal cord of anesthetized cats. Anesthesia was induced by administering an anesthetic gas mixture and was subsequently maintained with alpha-chloralose. Triceps surae contraction was induced by electrically stimulating the L-7 ventral root. Three muscle manipulations (all 1 minute in duration) were performed: 1) continuous tetanic contraction, 2) intermittent tetanic contractions (1 second of contraction, 1 second of relaxation), and 3) passive muscle stretch. Saline microinjections had no effect on the cardiovascular responses to these muscle manipulations. However, both peptide antagonists blunted the pressor response to a continuous tetanic contraction as mean arterial pressure increased 47 +/- 4 and 44 +/- 4 mm Hg before and 28 +/- 3 and 28 +/- 4 mm Hg after microinjecting the SP or SOM antagonist, respectively. In contrast, neither antagonist influenced the increase in mean arterial pressure produced by passive stretch; values were 43 +/- 6 versus 41 +/- 6 mm Hg (SP antagonist) and 39 +/- 7 versus 42 +/- 7 mm Hg (SOM antagonist) before and after injections, respectively. Microinjecting the SOM antagonist attenuated the pressor response to intermittent tetanic contractions (44 +/- 4 mm Hg before SOM antagonist versus 26 +/- 4 mm Hg after SOM antagonist), whereas the SP antagonist had no effect (35 +/- 3 mm Hg before SP antagonist versus 32 +/- 4 mm Hg after SP antagonist).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2002

Estrogen attenuates the cardiovascular and ventilatory responses to central command in cats.

Static exercise is well known to increase heart rate, arterial blood pressure, and ventilation. These increases appear to be less in women than in men, a difference that has been attributed to an effect of estrogen on neuronal function. In decerebrate male cats, we examined the effect of estrogen (17beta-estradiol; 0.001, 0.01, 0.1, and 1.0 microg/kg iv) on the cardiovascular and ventilatory responses to central command and the exercise pressor reflex, the two neural mechanisms responsible for evoking the autonomic and ventilatory responses to exercise. We found that 17beta-estradiol, in each of the three doses tested, attenuated the pressor, cardioaccelerator, and phrenic nerve responses to electrical stimulation of the mesencephalic locomotor region (i.e., central command). In contrast, none of the doses of 17beta-estradiol had any effect on the pressor, cardioaccelerator, and ventilatory responses to static contraction or stretch of the triceps surae muscles. We conclude that, in decerebrate male cats, estrogen injected intravenously attenuates cardiovascular and ventilatory responses to central command but has no effect on responses to the exercise pressor reflex.

Animals↗

PubMedDate not supplied

Physical fitness in the elderly.

Through disuse and aging, many muscles and joints in the elderly lose their flexibility and range of motion. A flexibility testing bench and a stretch bench were designed for measuring flexibility and supporting a variety of exercises to combat inelasticity. Flexibility is an essential component of physical fitness, regardless of age, and fitness programs must be adapted to meet the needs of the elderly.

Aging↗

PubMed2000

Passive tensile stress and energy of the human hamstring muscles in vivo.

The present study measured passive resistance to stretch in the hamstring muscles during a standardized stretch maneuver to estimate tensile forces and energy of the individual hamstring muscles in 7 flexible and 6 inflexible persons defined according to joint range of motion. Using a dynamometer, knee joint moment was measured during slow passive knee extension to a maximal angle (dynamic phase) followed by a 90-s static phase. Cross-sectional areas (CSA) of the separate hamstring muscles were obtained with magnetic resonance (MR) imaging. Mathematical modeling was used to calculate instantaneous muscle length and joint moment arm for each muscle. Subsequently, passive muscle tension (N/cm2) was calculated based on moment arm lengths, knee joint moments, and CSA. Maximal tolerated joint angle was greater in flexible (delta1.30+/-0.06 rad) than inflexible (delta0.84+/-0.06 rad) subjects, P<0.01. The peak tension at maximal angle was greater in flexible (81.8+/-12.5 N/cm2) than inflexible subjects (29.3+/-4.1 N/ cm2), P<0.001. For the separate muscles the overall change in muscle length (delta cm) and moment arm (delta cm) differed between groups, P<0.01. Similarly, muscle stiffness (delta tension/delta muscle length) was greater in flexible than inflexible subjects in the final 3 cm, P<0.01, and in the final 20% of length change, P<0.01. Absorbed energy (mJ/cm2) was greater in flexible than inflexible subjects in the final 40% of length change, P<0.05. These data show that flexible persons can attain a greater angle of stretch with an accompanying greater tensile stress and energy than inflexible persons due to an apparent greater tolerance to the externally applied load, and larger change in moment arm. The obtained stress data appear to be in the toe region of a 'classical' stress-strain curve, and energy rather than stiffness may therefore be more appropriate to analyze during the stretch procedure.

Adult↗

PubMed1999

Quantitative evaluation of the stretch reflex before and after hydro kinesy therapy in patients affected by spastic paresis.

The aim of this study was the quantitative evaluation of the myotatic reflex in a group of 26 patients affected by stationary spastic paresis (6: hemiparesis; 5: paraparesis; 8: tetraparesis; 7: multiple sclerosis) before and after a treatment of hydro-kinesy therapy. The treatment was carried out in an indoor pool containing warm (32 degrees C) sea water and consisted of active and passive motion exercises, coordination exercises and immersion walking. The measured parameters were: (i) the peak input force (FpH) measured by means of an instrumented hammer with which the patellar tendon was hit; and (ii) the peak value of the corresponding reflex force of the quadriceps femoris (FpQ) measured by means of a load cell connected to the subject's ankle. The peak values of the reflex response (FpQ) were found to increase as a function of the intensity of the imposed stimulus and to reach a plateau between 15 and 30 N of FpH. A Student's t test applied to the paired values of FpQ (as measured at plateau conditions) on both the lower limbs, before and after therapy, showed no significant changes due to the treatment in the four groups of subjects. However, if all subjects were grouped regardless the type of illness: 1) the average reflex response of the affected limb (the one characterized before therapy by the higher FpQ values) was found to decrease following the treatment (75.1+/-26.7 N pre therapy and 69.1+/-29.3 N post therapy, p = 0.07, n = 26); and 2) the effect of the treatment was found to be significantly larger (p = 0.04, n = 26) on the affected limb (delta FpQ = 6.07+/-16.5 N) as respect with the contra lateral one (delta FpQ = -0.16+/-12.1 N).

Adult↗

PubMed1987

Muscle activation during proprioceptive neuromuscular facilitation (PNF) stretching techniques.

Proprioceptive neuromuscular facilitation (PNF) techniques are often used to induce muscle relaxation and increase joint range of motion (ROM). However, the relationship between muscle activation and ROM with PNF is not well understood. The purpose of this study was to investigate the effect of three common PNF stretching techniques on hamstring muscle activation and knee extension. Three PNF techniques: stretch-relax (SR), contract-relax (CR) and agonist contract-relax (ACR) were applied to ten male and female subjects aged 23-36 years who were stabilized to isolate knee extension measurements. Knee joint position and EMG activity from quadriceps and hamstring muscles were computer processed throughout technique application. The results revealed mean hamstring EMG activity increased 8-43% within a given trial of ACR and CR respectively, and did not diminish across trials. SR produced a 11% decrease in mean hamstring EMG activity. ACR produced 3-6% greater knee extension values than CR and SR respectively, in spite of 71-155% greater hamstring EMG activity during ACR. The data suggest that CR and ACR do not evoke sufficient relaxation in muscles opposing knee extension to overcome tension facilitation generated by stretch. Thus, increases in ROM are achieved while the hamstrings are under considerable tension. Such tension increases muscle vulnerability to soreness and strain if stretching continues. The degree of knee extension produced via SR, although 3-6% less than CR and ACR, was achieved during simultaneous reduction in hamstring activity and may be the safer stretching technique.

Adult↗

PubMedDate not supplied

Strains of the posterior calf musculature ("tennis leg").

Strains of the posterior calf musculature frequently relate to overuse of the gastrocnemius muscle. The principal sports involved are the slower side-to-side sports. Treatment routine is composed of pain relief, passive stretching, exercises for the antagonists and later the agonists, and quadriceps exercises. In a series of 720 patients, over a 12-year period, this routine has been effective as evidenced by a recurrence of the condition in only 0.7% of the patients. Prevention of the injury is best obtained by regular stretching and strength development routines.

Adolescent↗

PubMed1997

Establishment of behavioral parameters for the evaluation of osteopathic treatment principles in a rat model of arthritis.

Unilateral arthritis was produced in rats by use of methylated bovine serum albumin in a model of antigen-induced arthritis. The progression of arthritis was measured by computerized motion analysis, bilateral joint circumference, voluntary extension force of the hindlegs, and length of ankle extension. Animals with induced arthritis were assigned to treated and untreated groups on the basis of approximately equal deficits by the parameters measured. A third group of rats, which did not have arthritis induced and received no treatment, served to establish mean normal parameters. Modified techniques of muscle energy, passive movement of the ankle and knee, and passive myofascial stretch were applied to the animals, and the animals were exercised in a mechanized exercise wheel. Parameters associated with gait were examined by computerized motion analysis of walking. Animals treated with manipulation and exercise improved significantly relative to untreated animals with antigen-induced arthritis in vertical ankle lift, ankle-based and foot-based stride lengths, knee circumference, and normalized extension of the ankle. The results demonstrate that the parameters identified can be used to detect functional deficits and significant improvement from those deficits can be derived from a nonpharmacologic treatment paradigm that includes osteopathic manipulation and exercise in an animal model of arthritis. These parameters may be useful in the identification of the relative benefits of independent treatment variables including frequency of osteopathic manipulation and exercise and the relative benefits of each in this model. Also, they may elucidate how these treatments produce their beneficial effects clinically.

Animals↗

PubMed2004

Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program.

BACKGROUND AND PURPOSE: Shoulder impingement syndrome is a common condition and is often managed with an exercise program. The purpose of this study was to examine an exercise program in patients with shoulder impingement syndrome. Specifically, the purpose was to identify changes that might occur in 3-dimensional scapular kinematics, physical impairments, and functional limitations. SUBJECTS: Fifty-nine patients with impingement syndrome were recruited, and 39 patients successfully completed the 6-week rehabilitation program and follow-up testing. Impingement was defined as having at least 3 of 6 predefined clinical signs or symptoms. METHODS: Subjects were assessed before and after a 6-week rehabilitation program and again at 6 months. Pain, satisfaction, and function were measured using the University of Pennsylvania Shoulder Scale. Range of motion, isometric muscle force, and 3-dimensional scapular kinematic data also were collected. Subjects were given a progressive exercise program that included resistive strengthening, stretching, and postural exercises that were done daily at home. Subjects also were given shoulder education related to anatomy, the basic mechanics of impingement, and strategies for reducing load on the shoulder. Each subject attended one physical therapy session per week for a 6-week period, primarily for monitoring and upgrading the exercise program. Pretest and posttest scores were compared using paired t tests and repeated-measures analysis of variance. RESULTS: Passive range of motion increased for both external and internal rotation but not for elevation. Abduction external and internal rotation force all increased. There were no differences in scapular kinematics. Improvements were found for pain, satisfaction, and shoulder function and for Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scores related to physical function. At 6-month follow-up, improvements made in pain, satisfaction, and function were maintained. DISCUSSION AND CONCLUSION: The use of this exercise protocol in the management of shoulder impingement syndrome may have a positive impact on patients' impairments and functional limitations. Our findings suggest a relatively simple exercise program combined with patient education may be effective and, therefore, merits study in a larger trial using a control group. Changes in scapular kinematics did not appear to be a primary mechanism underlying improvement in symptoms and function.

Adult↗