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PubMed2003

Exercise and coronary vascular remodelling in the healthy heart.

In this review the evidence for structural adaptations of the coronary circulation in the healthy adult heart in response to exercise and training is examined. Previously, it was thought that expansion of the coronary arteries and resistance vasculature occurred without angiogenesis. Detailed studies of the time course of coronary vascular remodelling now reveal that capillary proliferation is an integral response to exercise training, but is disguised by concurrent transformation of capillaries into arterioles by 'arteriolarization'. Increases in numbers of small arterioles < 30 micro m in diameter are accompanied by expansion in calibre of resistance and large coronary arteries. Stimuli related to increases in blood flow--shear stress and wall tension--and to mechanical deformation of the myocardium--stretch and compression--provide the main impetus for coronary vascular remodelling. Despite the technical difficulties of measuring such parameters in the heart in vivo, intervention studies using specific exercise components such as vasodilator, inotropic and chronotropic manipulations have allowed some insight into the differential regional effects of haemodynamic factors throughout the vascular tree. It remains to establish more clearly the involvement of mediators such as nitric oxide and growth factors in the temporal relationship to endothelial and smooth muscle growth and proliferation so that the endogenous attributes of exercise can be exploited for therapeutic purposes.

Adaptation, Physiological↗

PubMed2003

Muscle mechanoreflex induces the pressor response by resetting the arterial baroreflex neural arc.

The effects of the muscle mechanoreflex on the arterial baroreflex neural control have not previously been analyzed over the entire operating range of the arterial baroreflex. In anesthetized, vagotomized, and aortic-denervated rabbits (n = 8), we isolated carotid sinuses and changed intracarotid sinus pressure (CSP) from 40 to 160 mmHg in increments of 20 mmHg every minute while recording renal sympathetic nerve activity (SNA) and arterial pressure (AP). Muscle mechanoreflex was induced by passive muscle stretch (5 kg of tension) of the hindlimb. Muscle stretch shifted the CSP-SNA relationship (neural arc) to a higher SNA, whereas it did not affect the SNA-AP relationship (peripheral arc). SNA was almost doubled [from 63 +/- 15 to 118 +/- 14 arbitrary units (au), P < 0.05] at the CSP level of 93 +/- 8 mmHg, and AP was increased approximately 50% by muscle stretch. When the baroreflex negative feedback loop was closed, muscle stretch increased SNA from 63 +/- 15 to 81 +/- 21 au (P < 0.05) and AP from 93 +/- 8 to 109 +/- 12 mmHg (P < 0.05). In conclusion, the muscle mechanoreflex resets the neural arc to a higher SNA, which moves the operating point towards a higher SNA and AP under baroreflex closed-loop conditions. Analysis of the baroreflex equilibrium diagram indicated that changes in the neural arc induced by the muscle mechanoreflex might compensate for pressure falls resulting from exercise-induced vasodilatation.

Action Potentials↗

PubMed1984

The ventilatory pump in exercise.

The response of the ventilatory pump during exercise in health and in patients with COPD is reviewed. The authors' hope is that the pump's response to the stress of exercise will be seen to be efficiently matched to the demands placed on it, even though in disease or under some extreme circumstances in normal subjects it may be stretched to (or beyond) its capacity. From a review of the literature, suggestions are made for directions for future research.

Abdominal Muscles↗

PubMed1986

Exercise therapy for Parkinson's disease.

The outcomes of two different 12-week exercise programs were assessed by machine measurements of motor signs, tests of grip strength, motor coordination and speed, and neurophysiologic determinations of long-latency stretch responses in two groups of Parkinson patients matched for age, sex and stage of disease. The programs tested included an exercise program developed by the United Parkinson Foundation and a program of upper body karate training. Outcomes of these programs were similar. The majority of patients in both groups showed improvements in gait, tremor, grip strength and motor coordination on tasks requiring fine control. In one task involving whole body coordination there was a decline in function, while muscle rigidity was unchanged. The findings suggest that exercise is a useful adjunct to pharmacologic therapy.

Exercise Therapy↗

PubMed2003

A clinical guide to surface-EMG-assisted stretching as an adjunct to chronic musculoskeletal pain rehabilitation.

Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.

Accidents↗

PubMed1986

Muscle economy of isometric contractions as a function of stimulation time and relative muscle length.

For rat medial gastrocnemius muscle economy (i.e. the ratio of time integral of force and total energy-rich phosphate consumption) was calculated. Muscles in situ at 35 degrees C were stimulated to perform either one continuous or several repetitive isometric contractions at one muscle length in the range from 70% to 130% of optimum muscle length for force generation. Whereas during one continuous contraction economy increased, no differences in economy were found between 6, 12 or 18 successive contractions. Economy during intermittent exercise was always lower than during continuous exercise. The difference in economy is a result of different rates of metabolism, whereas no difference was found for force generation. Economy was highest at optimum muscle length for force generation and decreased at muscle lengths smaller as well as greater than optimum muscle length. Force-dependent energy consumption was calculated by subtracting the force-independent part (obtained by extrapolation) from total energy consumption. The calculated force produced per mumol force-dependent energy-rich phosphate consumption was similar in muscles stretched beyond optimum length. In contrast, a decreasing amount of force per mumol force-dependent energy-rich phosphate consumption was observed at lengths smaller than optimum length.

Animals↗

PubMed1998

Cellular and molecular aspects of muscle growth, adaptation and ageing.

Although major advances have been made over the past few decades in prosthetic dentistry, deterioration in oral function and altered facial appearance are still common accompaniments of ageing. Molecular biology methods now allow us to understand these age-related changes at the level of gene expression. Muscle loss as well as bone loss still present major problems, the magnitude of which increases as the age profile of our society changes. Both muscle and bone tissue respond to mechanical signals for which bone depends on muscle and for muscle, stretch has been shown to be important as it induces protein synthesis and an increase in girth as well as length of the muscle fibres. The latter involves the production of more sarcomeres in series so that the jaw muscles adapt to a new functional length following changes in vertical dimension of occlusion. It also determines the postural position of the lower jaw. In our investigations into the control of muscle mass we have recently cloned a growth factor which is expressed in exercised and/or overloaded muscles. This comes in two forms: an autocrine or local form and a paracrine or systemic form. Both growth factors influence muscle growth markedly and it is probable that the systemic type is also involved in maintenance of bone. The discovery of these growth factors provides the mechanisms by which mechanical signals are transduced into chemical signals that in turn regulate gene expression and protein synthesis.

Adaptation, Physiological↗

PubMed2000

Adaptation of respiratory muscle perfusion during exercise to chronically elevated ventilatory work.

Pneumonectomy (PNX) leads to chronic asymmetric ventilatory loading of respiratory muscles (RM). We measured RM energy requirements during exercise from RM blood flow (Q) using a fluorescent microsphere technique in dogs that had undergone right PNX as adults (adult R-PNX) or as puppies (puppy R-PNX), compared with dogs subjected to right thoracotomy without PNX as puppies (Sham) and to left PNX as adults (adult L-PNX). Ventilatory work (W) was measured during exercise. RM weight was determined post mortem. After adult and puppy R-PNX, the right hemidiaphragm becomes grossly distorted, but W and right costal muscle mass increased only after adult R-PNX. After adult L-PNX, the diaphragm was undistorted; W and left hemidiaphragm RM Q were elevated, but muscle mass did not increase. Mass of parasternal muscle did not increase after adult R-PNX, despite increased Q. Thus muscle mass increased only in response to the combination of chronic stretch and dynamic loading. There was a dorsal-to-ventral gradient of increasing Q within the diaphragm, but the distribution was unaffected by anatomic distortion, hypertrophy, or workload, suggesting a fixed pattern of neural activation. The diaphragm and parasternals were the primary muscles compensating for the asymmetric loading from PNX.

Adaptation, Physiological↗

PubMed2006

Using recovery modalities between training sessions in elite athletes: does it help?

Achieving an appropriate balance between training and competition stresses and recovery is important in maximising the performance of athletes. A wide range of recovery modalities are now used as integral parts of the training programmes of elite athletes to help attain this balance. This review examined the evidence available as to the efficacy of these recovery modalities in enhancing between-training session recovery in elite athletes. Recovery modalities have largely been investigated with regard to their ability to enhance the rate of blood lactate removal following high-intensity exercise or to reduce the severity and duration of exercise-induced muscle injury and delayed onset muscle soreness (DOMS). Neither of these reflects the circumstances of between-training session recovery in elite athletes. After high-intensity exercise, rest alone will return blood lactate to baseline levels well within the normal time period between the training sessions of athletes. The majority of studies examining exercise-induced muscle injury and DOMS have used untrained subjects undertaking large amounts of unfamiliar eccentric exercise. This model is unlikely to closely reflect the circumstances of elite athletes. Even without considering the above limitations, there is no substantial scientific evidence to support the use of the recovery modalities reviewed to enhance the between-training session recovery of elite athletes. Modalities reviewed were massage, active recovery, cryotherapy, contrast temperature water immersion therapy, hyperbaric oxygen therapy, nonsteroidal anti-inflammatory drugs, compression garments, stretching, electromyostimulation and combination modalities. Experimental models designed to reflect the circumstances of elite athletes are needed to further investigate the efficacy of various recovery modalities for elite athletes. Other potentially important factors associated with recovery, such as the rate of post-exercise glycogen synthesis and the role of inflammation in the recovery and adaptation process, also need to be considered in this future assessment.

Athletic Injuries↗

PubMed2002

Examination of and intervention for a patient with chronic lateral elbow pain with signs of nerve entrapment.

BACKGROUND AND PURPOSE: Lateral elbow pain has several causes, which can make diagnosis difficult. The purpose of this case report is to describe the examination of and the intervention for a patient with chronic lateral elbow pain who had signs of nerve entrapment. CASE DESCRIPTION: The patient was a 43-year-old woman who had right lateral elbow pain for about 4 months, which she attributed to extensive keyboard work on a computer. She had a reduction in joint passive range of motion during "neural tension testing," an examination procedure to detect nerve entrapment. This sign, in combination with other findings, suggested that the patient had a mild entrapment of the deep radial nerve (radial tunnel syndrome). The patient was treated 14 times over a 10-week period with "neural mobilization techniques," which are designed to free nerves for movement; ultrasound; strengthening exercises; and stretching. OUTCOMES: The patient had minimal symptoms at discharge, was pain-free, and had resumed all activities at a 4-month follow-up visit. DISCUSSION: Neural tension testing may be a useful examination procedure and mobilization may be useful for intervention for patients who have lateral elbow pain.

Adult↗

PubMed2006

Effects of Type II diabetes on capillary hemodynamics in skeletal muscle.

Microcirculatory red blood cell (RBC) hemodynamics are impaired within skeletal muscle of Type I diabetic rats (Kindig CA, Sexton WL, Fedde MR, and Poole DC. Respir Physiol 111: 163-175, 1998). Whether muscle microcirculatory dysfunction occurs in Type II diabetes, the more prevalent form of the disease, is unknown. We hypothesized that Type II diabetes would reduce the proportion of capillaries supporting continuous RBC flow and RBC hemodynamics within the spinotrapezius muscle of the Goto-Kakizaki Type II diabetic rat (GK). With the use of intravital microscopy, muscle capillary diameter (d(c)), capillary lineal density, capillary tube hematocrit (Hct(cap)), RBC flux (F(RBC)), and velocity (V(RBC)) were measured in healthy male Wistar (control: n = 5, blood glucose, 105 +/- 5 mg/dl) and male GK (n = 7, blood glucose, 263 +/- 34 mg/dl) rats under resting conditions. Mean arterial pressure did not differ between groups (P > 0.05). Sarcomere length was set to a physiological length ( approximately 2.7 mum) to ensure that muscle stretching did not alter capillary hemodynamics; d(c) was not different between control and GK rats (P > 0.05), but the percentage of RBC-perfused capillaries (control: 93 +/- 3; GK: 66 +/- 5 %), Hct(cap), V(RBC), F(RBC), and O(2) delivery per unit of muscle were all decreased in GK rats (P < 0.05). This study indicates that Type II diabetes reduces both convective O(2) delivery and diffusive O(2) transport properties within muscle microcirculation. If these microcirculatory deficits are present during exercise, it may provide a basis for the reduced O(2) exchange characteristic of Type II diabetic patients.

Animals↗

PubMed1980

Review of physical therapy alternatives for reducing muscle contracture.

Passive stretching is a technique frequently used to treat muscle contractures; however, because it can activate the stretch reflex and has little carry-over, it may not be as effective as other modes. Four approaches to treating muscle contracture are described: 1) activation or strengthening of the weak oppnent, 2) local inhibiton of the contractdd muscle, 3) general inhibition of hypertonus, and 4) passive lengthening. Specific examples of techniques, their rationales, and suggestions for use of each are discussed.

Contracture↗

PubMed2000

Lumbar segmental rigidity: can its identification with facet injections and stretching exercises be useful?

OBJECTIVES: To describe a method for observing lumbar segmental rigidity and to show how motion measurements and pain/disability questionnaires can be used to evaluate outcomes of combined facet injections and stretching exercises. DESIGN: Preliminary 2-part study: (1) presentation of a technique for, identifying lumbar segmental rigidity based on physical observation of the spine's lateral bending; and (2) repeated measures of motion and pain/disability self-report in a chronic lumbar spinal disorder cohort, performed before and after treatment with combined facet injections and stretching exercises. SETTING: An outpatient tertiary rehabilitation facility providing interdisciplinary functional restoration for chronic disabling work-related spinal disorders. PATIENTS: Chronically disabled patients with lumbar spinal disorder (n = 39; mean age, 41yr; 82% male) with segmental rigidity at 1 or more levels on physical examination. Subjects averaged 20 months of disability, and 51% had preinjection spine surgery (average, 1.7 procedures involving up to 3 spinal segments). Thirty-nine percent of the cohort had a fusion at levels 1 or 2. INTERVENTIONS: Bilateral facet injections were administered under fluoroscopy to all patients, and 2 or 3 levels were performed in 93% of cases (range, levels 1-4). Patients were instructed in an unsupervised stretching program and were reassessed 2 to 4 weeks later. After an intensive supervised resistance exercise training program as part of interdisciplinary functional restoration, a third set of motion, pain, and disability measures were collected. MAIN OUTCOME MEASURES: Changes in true lumbar sagittal and coronal motion (T12-S1), measured with inclinometers, and pain/disability self-report were compared statistically. RESULTS: Patients' mobility improved significantly (p < .01-.0001) across all 4 motions. A large majority (71%-97%) of individuals improved on motion. According to self-reports made over the postinjection period, most patients improved their disability (83%) and pain intensity (63%) ratings. CONCLUSIONS: A simple physical examination technique for assessing lumbar spine segmental rigidity was used in this preliminary study to select patients and levels for combined facet injection and stretching exercise, with resultant improvements in mobility and self-reported pain/disability that may extend beyond the pharmacologic duration of the corticosteroid. The efficacy of either the facet injection or stretching components alone in achieving objective mobility improvements cannot be determined from the present study, but warrants future investigation.

Adult↗

PubMed2006

Effects of physical training and detraining, immobilisation, growth and aging on human fascicle geometry.

In addition to its size and the extent of its neural activation, a muscle's geometry (the angles and lengths of its fibres or fascicles) strongly influences its force production characteristics. As with many other tissues within the body, muscle displays significant plasticity in its geometry. This review summarises geometric differences between various athlete populations and describes research examining the plasticity of muscle geometry with physical training, immobilisation/detraining, growth and aging. Typically, heavy resistance training in young adults has been shown to cause significant increases in fascicle angle of vastus lateralis and triceps brachii as measured by ultrasonography, while high-speed/plyometrics training in the absence of weight training has been associated with increases in fascicle length and a reduction in angles of vastus lateralis fascicles. These changes indicate that differences in geometry between various athletic populations might be at least partly attributable to their differing training regimes. Despite some inter-muscular differences, detraining/unloading is associated with decreases in fascicle angle, although little change was shown in muscles such as vastus lateralis and triceps brachii in studies examining the effects of prolonged bed rest. No research has examined the effects of other interventions such as endurance or chronic stretching training. Few data exist describing geometric adaptation during growth and maturation, although increases in gastrocnemius fascicle angle and length seem to occur until maturation in late adolescence. Although some evidence suggests that a decrease in both fascicle angle and length accompanies the normal aging process, there is a paucity of data examining the issue; heavy weight training might attenuate the decline, at least in fascicle length. A significant research effort is required to more fully understand geometric adaptation in response to physical training, immobilisation/detraining, growth and aging.

Aging↗

PubMed1998

The Vodder School: the Vodder method.

BACKGROUND: The history and development of manual lymphatic drainage (MLD) from Winiwarter to Vodder and the Vodder School of today are discussed. METHODS: The Vodder technique differs in the use of adapted pressure and its application. The constant change in pressure optimizes results, moving fluid in the skin, increasing lymphomotoricity, and softening fibrosis, with the positive side effects of reducing pain and relaxing tense muscles. Another difference from other methods is the technique of stretching skin, not sliding it. Because of the fluid content in lymphedema, which is different from all other edemas, the combination of MLD with compression treatment is the only solution for this pathology. Depending of it severity, each case requires individualized treatment. Phase 1 (intensive treatment) consists of daily treatment with up to two sessions per day for up to 2 hours. This phase is combined with special, individual skin care and remedial exercise. In phase 2, the goal of treatment is to maintain the results achieved in phase 1. The frequency of treatment is changed, but there is still the need for permanent, continued therapy. RESULTS: In phase 1, an average reduction of more than 40% of edema volume is achieved. In phase 2, the results are maintained and, with repetitions of phase 1, further improvement is possible. Thus, long term results with permanent improvement are possible. CONCLUSIONS: Because of the complexity of the technique, no one can learn MLD in 1 week. Students require a great deal of correction, and the technique must be checked constantly. To become a certified Vodder therapy, a 4-week education program must be completed, and reviews must be attended every 2 years to maintain certification. The best education produces the best results for patients as long as patients are compliant. Therefore, the Vodder School also includes a patient education program as part of its curriculum.

Austria↗

PubMed2000

Patellofemoral pain syndrome in the female athlete.

Although PFS will continue to be a therapeutic challenge, the prognosis for most female athletes is good, especially if they are motivated and compliant with their treatment program. Particularly in women, care should be taken to avoid placing too much emphasis on biomechanical variants that may not be clinically significant or correctable because such findings can reinforce a feeling that "nothing can be done." In many cases, muscle dysfunction and repetitive loading of the patellofemoral joint rather than fixed biomechanical factors contribute to the development of PFS. Nonetheless, the importance of a detailed biomechanical assessment on physical examination must not be neglected, particularly in athletes who are not improving with conservative treatment and who may become surgical candidates. A practical initial treatment program for most athletes with nontraumatic PFS begins with relative rest, quadriceps strengthening, and stretching of tight myotendinous units. The introduction of NSAIDs, orthoses, taping, knee sleeves, and more specific rehabilitative exercises should be an individualized decision based on physical findings, past treatment results, and athletic expectations. Surgical referral should be considered in cases of PFS or patellar instability refractory to prolonged maximal nonoperative treatment.

Biomechanical Phenomena↗

PubMed1982

Managing spasticity.

Spasticity, a common symptom of upper motor neuron lesions, may actually aid the patient and should be treated only if it interferes with function, comfort or nursing care. Stretching exercises and elimination of nociceptive stimuli are the first steps in management. If problems persist, medication should be considered. Tenotomies are useful. Motor-point blocks and peripheral nerve blocks are temporary aids, while neurectomies usually provide permanent relief. More drastic neurosurgical procedures are reserved for uncontrolled, incapacitating cases.

Adult↗

PubMed2004

[Exertional compartment syndrome].

OBJECTIVES: To review the literature on chronic exertional compartment syndrome. METHODS: We searched the Medline database with use of the keys words compartment syndrome, exertional, chronic, pressure, and fasciotomy. RESULTS: Exertional compartment syndrome is characterized by pain on exertion, which recedes at rest, and by excessive increase in compartment intramuscular pressure. Intramuscular pressure measurement is the reference diagnostic tool, but it has not been standardized or evaluated. Pressure observed during the first 5 min after exertion stops is more often used in diagnosis. The first studies of noninvasive investigations (magnetic resonance imaging, thallium single-photon emission tomographic imaging, near infrared spectroscopy) revealed their inadequate diagnostic value. The pathophysiological features of exertional compartment syndrome remain unclear: increased muscle bulk, fascia thickness and stiffness, stimulation of fascial sensory stretch-receptors, poor venous return, micromuscular injuries, and small clinical myopathic abnormalities. Treatment includes decreased sport activity or fasciotomy with partial fasciectomy. Several authors have used endoscopically assisted fasciotomy, which retrospective studies have shown to be successful. Long-term outcome studies could investigate the persistence of exertional minor pain and recurrence of the compartment syndrome with this treatment. CONCLUSION: Further studies are required to understand the physiopathology, standardize the intramuscular pressure test and evaluate the pressure threshold values, evaluate noninvasive investigations and specify the long-term outcome of fasciotomy.

Chronic Disease↗