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PubMed1990

[Clinical and pathological studies on two patients with adult-onset nemaline myopathy].

Clinical and pathological findings of two patients, a 44-year-old male and a 54-year-old female, with adult-onset nemaline myopathy were described. Both patients showed normal motor development through their childhood; Patient 1 ran fast and was involved in powerful heavy labor until the age of 40, and Patient 2 was in good health until 49, when they began to have progressive muscle weakness. They had no family history of neuromuscular diseases. On neurological examination, they had moderate muscle weakness and atrophy in their limb-girdle and paravertebral muscles. Because paravertebral and neck muscles were preferentially involved, they had difficulty in holding the head straight up. They stood in a lordotic posture. They had neither high-arched palate nor facio-skeletal abnormalities which were common findings in congenital nemaline myopathy. Serum enzymes derived from muscle were normal and needle electromyography showed myogenic and neurogenic changes in both patients. On CT scan of the skeletal muscles, the paravertebral muscles were markedly decreased in density suggesting advanced fat tissue replacement in large areas. In patient 2 who was in more advanced stage, the quadriceps femoris, hamstrings and soleus muscles also showed the similar CT findings. Light microscopic examination of biopsied biceps brachii (Patient 1) and quadriceps femoris (Patient 2) demonstrated abundant rod-like structures in the majority of type 1 fibers. In both patients, there was a marked variation in fiber size. Type 1 fibers were atrophic and type 2C fibers increased in number.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Resistance exercise-induced fluid shifts: change in active muscle size and plasma volume.

The purpose of this study was to test the hypothesis that the reduction in plasma volume (PV) induced by resistance exercise reflects fluid loss to the extravascular space and subsequently selective increase in cross-sectional area (CSA) of active but not inactive skeletal muscle. We compared changes in active and inactive muscle CSA and PV after barbell squat exercise. Magnetic resonance imaging (MRI) was used to quantify muscle involvement in exercise and to determine CSA of muscle groups or individual muscles [vasti (VS), adductor (Add), hamstring (Ham), and rectus femoris (RF)]. Muscle involvement in exercise was determined using exercise-induced contrast shift in spin-spin relaxation time (T2)-weighted MR images immediately postexercise. Alterations in muscle size were based on the mean CSA of individual slices. Hematocrit, hemoglobin, and Evans blue dye were used to estimate changes in PV. Muscle CSA and PV data were obtained preexercise and immediately postexercise and 15 and 45 min thereafter. A hierarchy of muscle involvement in exercise was found such that VS > Add > Ham > RF, with the Ham and RF showing essentially no involvement. CSA of the VS and Add muscle groups were increased 10 and 5%, respectively, immediately after exercise in each thigh with no changes in Ham and RF CSA. PV was decreased 22% immediately following exercise. The absolute loss of PV was correlated (r2 = 0.75) with absolute increase in muscle CSA immediately postexercise, supporting the notion that increased muscle size after resistance exercise reflects primarily fluid movement from the vascular space into active but not inactive muscle.

Adult↗

PubMedDate not supplied

Radiographic imaging of muscle strain injury.

We reviewed our experience with computed tomography and magnetic resonance imaging of acute muscle strain injury. We imaged 50 athletes (average age, 28 years; range, 17 to 42) who had an acute muscle strain involving either the adductor, hamstring, quadriceps, or triceps surae muscles. Computed tomography (axial imaging) was used from 1982 to 1987 for 27 athletes. Spin-echo magnetic resonance imaging (axial, coronal, sagittal imaging) was used from 1987 to 1991 for 23 athletes. Computed tomography and magnetic resonance imaging localize the strain injury to a single muscle within a group of synergists; the adductor longus, rectus femoris, and medial head of gastrocnemius muscles are most prone to strain injury. A disruption occurs predictably at the myotendinous junction; fluid collects at the disruption site and dissects along the epimysium and subcutis. Muscle tissue remote from the myotendinous junction clearly demonstrates extensive injury with abundant magnetic resonance imaging signal changes consistent with edema and inflammation. Follow-up computed tomographic and magnetic resonance imaging studies can clearly demonstrate atrophy, fibrosis, and calcium deposition.

Acute Disease↗

PubMed2002

Relationship between mechanical factors and incidence of low back pain.

STUDY DESIGN: A multifactorial cross-sectional nonexperimental design. OBJECTIVES: To collectively investigate the association among 17 mechanical factors and occurrence of low back pain (LBP). BACKGROUND: Several physical characteristics, based on assumptions, clinical findings, and scientific experiments, have been associated with the development of LBP Controversy exists regarding the degree of association between some of these physical characteristics and LBP. Information regarding the degree of association of each factor to LBP is needed for effective prevention and appropriate treatment strategies. METHODS AND MEASURES: A total of 600 subjects participated in this study. Subjects were categorized into 4 groups: asymptomatic men (n = 150, age [mean +/- SD] = 43 +/- 15 years), asymptomatic women (n = 150, age [mean +/- SD] = 43 +/- 13 years), men with LBP (n = 150, age [mean +/- SD] = 43 +/- 14 years), and women with LBP (n = 150, age [mean +/- SD] = 43 +/- 13 years). Seventeen physical characteristics were measured in each group and the relative association of each characteristic with LBP was assessed. RESULTS: Among all the factors tested, endurance of the back extensor muscles had the highest association with LBP Other factors such as the length of the back extensor muscles, and the strength of the hip flexor, hip adductor, and abdominal muscles also had a significant association with LBP. CONCLUSION: It appears that muscle endurance and weakness are associated with LBP and that structural factors such as the size of the lumbar lordosis, pelvic tilt, leg length discrepancy, and the length of abdominal, hamstring, and iliopsoas muscles are not associated with the occurrence of LBP.

Adult↗

PubMed2003

Sex-Related and Age-Related Differences in Knee Strength of Basketball Players Ages 11-17 Years.

OBJECTIVE: To assess hamstrings and quadriceps strength of basketball players ages 11-13 and 15-17 years. DESIGN AND SETTING: This cross-sectional study occurred during the 2000 American Youth Basketball Tour National Tournament. We investigated whether sex- or age-related strength differences existed among study participants. SUBJECTS: Forty-one tournament participants (22 girls, 19 boys; 11-13 or 15-17 years old) who reported no history of knee sprain or surgery were recruited. MEASUREMENTS: We used a Cybex II dynamometer to obtain isokinetic concentric peak torques relative to body mass (Nm/kg) at 60 degrees /s for hamstrings and quadriceps bilaterally. From average peak torques, we determined ipsilateral hamstrings:quadriceps and homologous muscle-group ratios. RESULTS: Correlations between hamstrings and quadriceps strength measures ranged from 0.78 to 0.97. Players 15-17 years old had greater relative hamstrings and quadriceps strength than 11- to 13-year-old athletes. Age and sex interacted significantly for quadriceps strength. The quadriceps strength of 15- to 17-year-old girls did not differ from that of 11- to 13-year-old girls, whereas 15- to 17-year-old boys had stronger quadriceps than 11- to 13-year-old boys. Boys 15-17 years old had greater quadriceps strength than girls 15-17 years old. CONCLUSIONS: This study is unique in providing normative data for the hamstrings and quadriceps strength of basketball players 11-13 and 15-17 years old. Age-related strength differences did not occur consistently between the sexes, as girls 11-13 and 15-17 years old had similar relative quadriceps strength.

Journal Article↗

PubMed1992

Normality, variability and predictability of work, power and torque acceleration energy with respect to peak torque in isokinetic muscle testing.

This study evaluated at two different test sessions the normality and variability of the isokinetic peak torque (PT), peak work (PW), peak power (PP) and peak torque acceleration energy (PTAE) data outputs in healthy adult males (n = 10) and females (n = 10). The hamstring and quadriceps muscles were tested at the angular velocities of 60 deg/s (a slow speed test) and 240 deg/s (a high speed test). The predictability of the PW, PP and PTAE from the PT was also assessed. The results showed that the consistency of the PW and PP measurements were equal with that of the PT. This was due to equal (almost normal) data distribution, equal variability of the outputs (the coefficient of variation (cv) ranged from 14 to 29% in the PWs and PPs versus 16 to 29% in the PTs), and excellent predictability of the PW and PP from the PT (PTs accounted on an average 85% for the variation seen in the PWs and PPs). In addition, in the regression analyses the standard errors of the estimates (SEEs) were low (less than 10%) and the residuals were distributed nonsystematically. In the PTAE measurements, the results were much more inconsistent, especially during the slow speed of the dynamometer. Compared with PT, PW and PP, the PTAE data distribution differed more frequently from normal distribution and the PTAE outputs showed higher variability. In addition, the PTAE outputs could not be acceptably predicted from the PT. In conclusion, the isokinetic PW and PP measurements can be recommended for clinical use, while the PTAE measurements should not be used routinely.

Adult↗

PubMed2000

Long-term residual musculoskeletal deficits after femoral shaft fractures treated with intramedullary nailing.

BACKGROUND: Locked intramedullary (IM) nailing has been recognized as one of the most reliable methods for treatment of femoral shaft fractures. Although IM nails are routinely used in the treatment of these fractures, the long-term effects of retained IM nails are unknown. METHODS: Seventeen patients with radiographically documented healed fracture of femoral diaphysis after locked IM nailing technique were evaluated at a follow-up of at least 18 months postoperatively. All patients had returned to their preinjury level of function and activity before the study. The bone mineral densities (BMD) of the injured and contralateral femora were measured using dual energy x-ray absorptiometry (DEXA). BMD of symmetrical regions in the femoral neck and medial and lateral femoral cortex of the implanted and contralateral femora were compared. Postinjury muscle function was assessed from measurement of the isometric strength of six separate muscle groups (quadriceps, hamstrings, hip extensors, hip flexors, hip abductors, and hip adductors) in treated and control extremities. RESULTS: The average BMD of the femoral neck region of instrumented femora was 9% less than in contralateral control. Within the medial cortex, BMD of the control femora was an average of 20% greater than in the implanted side. In the lateral cortex, the difference averaged 13%. The isometric dynamometric data demonstrated a statistically significant reduction in the strength of the quadriceps of the instrumented extremities as compared with the contralateral ones. There was no significant difference in the strength of the hamstrings, hip extensors, hip flexors, abductors, or adductors. In the control extremities, the average torque generated by isometric contraction of the quadriceps was 3.45+/-1.35 times greater than by the hamstrings. Torque in extension/flexion and abduction/adduction was also observed. CONCLUSION: Our data suggest that limbs with long-term retained IM nails experience a significant reduction in the femur BMD and quadriceps muscle strength. These findings may not be simply related to the implant, and further study is warranted to determine the causes of these changes.

Adolescent↗

PubMed2000

Nerve rootlets to be sectioned for spasticity resolution in selective dorsal rhizotomy.

BACKGROUND: The goal of this study is to confirm the efficacy of the protocol for selective dorsal rhizotomy (SDR). In this protocol, rootlets to be sectioned are selected by palpable responses elicited by intraoperative electrical stimulation, without detailed electromyographic classifications. METHODS: Thirty-six children with spasticity due to cerebral palsy underwent SDR according to our protocol. Priority was given to sectioning rootlets that showed palpable clonic or bilateral responses, which were considered abnormal, over sectioning rootlets that merely had hyperactive responses to intraoperative stimulation. The results of intraoperative monitoring and sectioning amount were analyzed by physical evaluation. RESULTS: Significant improvements were obtained in passive range of motion and muscle tone of the lower extremities. The total percentages of rootlets with abnormal and hyperactive responses at L3 and S1 were bilaterally correlated with preoperative spasticity of the hip adductors and the plantar flexors, respectively. When rootlets with hyperactive responses were excluded from the correlation analysis, no bilateral correlation was observed. From the correlation analyses between the improvement in the physical evaluation and the amount of nerve sectioned, it was concluded that a greater improvement in muscle tone in all examined muscles, except the hamstrings, could be obtained if larger amounts of nerve roots were sectioned. CONCLUSION: The number of rootlets with palpable abnormal and hyperactive responses elicited by intraoperative stimulation reflects the preoperative spasticity of multiple muscles. This implies that only selecting rootlets with palpable responses can be reliable. Because more sectioning leads to better spasticity resolution, our protocol should be reviewed to increase the percentage of rootlets sectioned with hyperactive responses, especially for innervated levels of severely affected muscles.

Adolescent↗

PubMedDate not supplied

Knee joint effusion and cryotherapy alter lower chain kinetics and muscle activity.

CONTEXT: Cryotherapy has been shown to disinhibit the quadriceps muscle after joint effusion by a resting measure (Hoffmann reflex) of motor recruitment. I sought to determine whether cryotherapy-induced motor recruitment changes resulted in subsequent changes in functional movement. OBJECTIVE: To quantify muscle recruitment changes and knee joint function after joint effusion and subsequent joint cryotherapy. DESIGN: A 3 x 4 multivariate mixed-model design was used to compare groups (normative, effusion/control, effusion/cryotherapy) across time (preinjection, postinjection, 30 minutes postinjection, and 60 minutes postinjection). SETTING: Human performance laboratory. PATIENTS OR OTHER PARTICIPANTS: Forty-five volunteers (26 males, 19 females; age = 21 +/- 2 years, height = 174.8 +/- 10.2 cm, mass = 78.1 +/- 15.4 kg). INTERVENTION(S): Experimental joint effusion was used to elicit inhibition of the quadriceps muscle. Cryotherapy was a treatment intervention. MAIN OUTCOME MEASURE(S): Lower chain peak joint torque, peak and average power, knee anterior joint reaction force, and average and peak vastus medialis, vastus lateralis, medial hamstrings, and gastrocnemius muscle normalized electromyographic activity were collected during the extension phase of a seated, recumbent stepping motion with a resistance of 36% of 1-repetition maximum and a controlled cadence of 1.5 Hz. RESULTS: Decreases in peak torque and peak power were observed after effusion, whereas no decrease was observed over time in the cryotherapy or normative groups. A decrease in peak vastus lateralis activity was also noted after effusion relative to other groups. Also, the effusion/cryotherapy group had a greater knee anterior joint reaction force relative to the effusion/control and normative groups after effusion. CONCLUSIONS: Joint cryotherapy negated movement deficiencies represented by knee peak torque and power decreases. This could be due to facilitated vastus lateralis activation relative to other groups.

Journal Article↗

PubMed2003

The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours.

STUDY DESIGN: Experimental pretest-posttest control design. OBJECTIVES: The purpose of the study was twofold: (1) to determine the lasting effect of static stretch on hamstring length for up to 24 hours and (2) to compare the efficacy of static stretch with and without warm-up exercise on hamstring length. BACKGROUND: Research is limited on the lasting effects of static stretching and is controversial on the combined effects of warm-up activities and static stretching on muscle lengthening. METHODS AND MEASURES: Fifty-six volunteer subjects (ages 18-42 years) with limited bilateral hamstring length were assigned to 1 of 4 groups: (1) warm-up and static stretch, (2) static stretch only, (3) warm-up only, and (4) control. The warm-up was 10 minutes of stair climbing at 70% of maximum heart rate. Static stretch consisted of a single session of three 30-second passive stretches of the hamstring. Hamstring length was measured preintervention and at several intervals postintervention (immediately and then at 15 minutes, 60 minutes, 4 hours, and 24 hours) using the active knee extension (AKE) test. Data were analyzed using a mixed-model analysis of variance. RESULTS: The warm-up-and-static-stretch group and the static-stretch-only group showed a significant increase in hamstring length between preintervention and all postintervention measurements. At 24 hours poststretch, the warm-up-and-static-stretch group had a mean increase of 10.3 degrees (95% confidence interval, 7.7-12.9) and the static-stretch-only group had a mean increase of 7.7 degrees (95% confidence interval, 4.7-10.7) in AKE range of motion (ROM). Both of these groups did show significant decrease (2.9 degrees and 4.0 degrees, respectively) in hamstring muscle length (AKE ROM) at 15 minutes poststretch when compared to immediate poststretch values. The static-stretch-only and the warm-up-and-static-stretch groups did not differ significantly from each other. Control and warm-up-only groups showed no significant increase in hamstring length between preintervention and any of the postintervention measurements. CONCLUSIONS: A significant increase in hamstring length can be maintained for up to 24 hours when using static stretching. Muscle length gains are greatest immediately after stretching and decline within 15 minutes. The addition of a warm-up exercise prior to stretching does not appear to significantly increase the effectiveness of static hamstring stretching.

Adolescent↗

PubMed1992

Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries.

In sports medicine, neuromuscular electrical stimulation (NMES) has been used for muscle strengthening, maintenance of muscle mass and strength during prolonged periods of immobilisation, selective muscle retraining, and the control of oedema. A wide variety of stimulators, including the burst-modulated alternating current ('Russian stimulator'), twin-spiked monophasic pulsed current and biphasic pulsed current stimulators, have been used to produce these effects. Several investigators have reported increased isometric muscle strength in both NMES-stimulated and exercise-trained healthy, young adults when compared to unexercised controls, and also no significant differences between the NMES and voluntary exercise groups. It appears that when NMES and voluntary exercise are combined there is no significant difference in muscle strength after training when compared to either NMES or voluntary exercise alone. There is also evidence that NMES can improve functional performance in a variety of strength tasks. Two mechanisms have been suggested to explain the training effects seen with NMES. The first mechanism proposes that augmentation of muscle strength with NMES occurs in a similar manner to augmentation of muscle strength with voluntary exercise. This mechanism would require NMES strengthening protocols to follow standard strengthening protocols which call for a low number of repetitions with high external loads and a high intensity of muscle contraction. The second mechanism proposes that the muscle strengthening seen following NMES training results from a reversal of voluntary recruitment order with a selective augmentation of type II muscle fibres. Because type II fibres have a higher specific force than type I fibres, selective augmentation of type II muscle fibres will increase the overall strength of the muscle. The use of neuromuscular electrical stimulation to prevent muscle atrophy associated with prolonged knee immobilisation following ligament reconstruction surgery or injury has been extensively studied. NMES has been shown to be effective in preventing the decreases in muscle strength, muscle mass and the oxidative capacity of thigh muscles following knee immobilisation. In all but one of the studies, NMES was shown to be superior in preventing the atrophic changes of knee immobilisation when compared to no exercise, isometric exercise of the quadriceps femoris muscle group, isometric co-contraction of both the hamstrings and quadriceps femoris muscle groups, and combined NMES-isometric exercise. It has also been reported that NMES applied to the thigh musculature during knee immobilisation improves the performance on functional tasks.(ABSTRACT TRUNCATED AT 400 WORDS)

Athletic Injuries↗

PubMedDate not supplied

Prediction of walking possibility in crawling children in poliomyelitis.

Crawling is one of the most common modes of ambulating in children with severe paralysis and deformities in poliomyelitis. Restoring upright posture and bipedal gait, although desirable, has its own limitations due to various factors. Fifty-three children below the age of 12 years (29 boys and 24 girls) crawling due to post-poliomyelitis residual paralysis were assessed for the genesis of crawling as a mode of ambulating. The patterns of crawling were classified according to Cross's classification. Paralyzed muscles and deformities in definite combinations were found responsible for each type of crawling. Trunk muscles, gluteus maximus, quadriceps, hamstrings, tibialis anterior, and triceps surae were identified as muscles crucial for walking in order of priority. At least antigravity power in these muscles was necessary for an upright posture and walking with support. Various combinations of treatment modalities were used to correct the deformities before fitting an orthosis and instituting gait training. Thirty-four children became outdoor walkers, 14 indoor walkers, and five remained nonwalkers. The most favorable patterns of crawling for restoration of upright posture were true quadruped progression (30 cases) and infant-like crawl (14 cases). Average follow-up was 17 months (range, 6 months to 5 years).

Child↗

PubMed1988

Clinical evaluation of computerized functional electrical stimulation after spinal cord injury: a multicenter pilot study.

This study investigated the safety and effects of computerized functional electrical stimulation (FES) on spinal cord injured individuals. Nineteen subjects two to ten years postinjury, with clinically complete motor and sensory lesions between C4 and T10, participated. All subjects met the specific selection criteria. None had received lower extremity electrical stimulation before. In phase I, subjects received surface electrical stimulation to the quadriceps muscle bilaterally for resistive knee extension 3 times a week for four weeks. The resistance and number of completed lifts was recorded daily. In phase II, 36 sessions provided sequential surface electrical stimulation to the quadriceps, hamstrings, and gluteus muscles bilaterally in order for subjects to pedal a lower extremity ergometer with resistance varied depending on completed run time. For each session, heart rate, blood pressure, temperature, and work performance were recorded. Tests done before and after the training program included fasting blood chemistries, 24-hour urinalysis, arm-crank ergometer stress testing, and midthigh girth measurement. Results indicate that this form of FES is safe, that quadriceps strength and endurance is increased, that endurance for ergometer pedaling is increased, and that there may be a training effect as more work is done at a similar heart rate and systolic blood pressure and as muscle bulk is increased. The FES effect on cardiovascular conditioning and general health requires further research to precisely determine its benefits.

Adult↗

PubMed2004

Factors associated with recurrent hamstring injuries.

A history of muscle injury represents a predominant risk factor for future insult in that muscle group. The high frequency of re-injury and persistent complaints after a hamstring strain comprise major difficulties for the athlete on return to athletic activities. Some of the risk factors associated with the possible recurrence of the injury are, in all probability, already implicated in the initial injury. One can distinguish between those events peculiar to the sport activity modalities (extrinsic factors) and other contributing factors based on the athletes individual features (intrinsic factors). For both categories, the persistence of mistakes or abnormalities in action represent an irrefutable component contributing to the re-injury cycle. Additional factors leading to chronicity can come from the first injury per se through modifications in the muscle tissue and possible adaptive changes in biomechanics and motor patterns of sporting movements. We emphasise the role of questionable approaches to the diagnosis process, drug treatment or rehabilitation design. To date, the risk factors examined in the literature have either been scientifically associated with injury and/or speculated to be associated with injury. In this context, quantifying the real role of each factor remains hypothetical, the most likely ones corresponding to inadequate warm-up, invalid structure and the content of training, muscle tightness and/or weakness, agonist/antagonist imbalances, underestimation of an extensive injury, use of inappropriate drugs, presence of an extensive scar tissue and, above all, incomplete or aggressive rehabilitation. Such a list highlights the unavoidable necessity of developing valid assessment methods, the use of specific measurement tools and more rigorous guidelines in the treatment and rehabilitation. This also implies a scientific understanding as well as specifically qualified medical doctors, physiotherapists and trainers acting in partnership.

Athletic Injuries↗

PubMed1994

Age-related differences in temporal scaling of postural EMG activity.

Electromyographical (EMG) burst onset times for postural muscles were compared in young and elderly male and female subjects performing a forceful abrupt pull with the right arm against a load cell apparatus while standing. EMG activity was collected via surface electrodes from the posterior deltoid, and right and left hamstring and quadriceps muscles. Pulls were performed at varying force levels from 100% to approximately 50% of a maximum effort. Regression equations were developed for each postural muscle for each group, using force production values as the independent variable, and postural muscle onset latencies (relative to deltoid onset) as the dependent variable. Regression slopes for postural muscles of elderly subjects ranged from 0.59 to 0.33, while slopes for the young subjects ranged from 0.72 to 0.63. Less elevated slopes for the elderly may indicate a reduced ability to temporally scale postural muscle onset latencies to variations in the force of the upper-limb task; a reduction in this ability may constitute a possible contributing factor to instability in the elderly.

Adult↗

PubMed2001

[The groin pain syndrome].

Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphises in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphises which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman's hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause.

Athletic Injuries↗

PubMed1975

Electromyographic study of two-joint muscles.

To determine the nervous control of two-joint muscles and their coordination with other muscles in monoarticular and biarticular motions, action patterns of important two-joint muscles (rectus femoris and the medial hamstrings) and related one-joint muscles were observed. The EMG analysis of ten subjects led to the conclusion that the effect of contraction of two-joint muscles is never limited to one joint; whenever a two-joint muscle participates in a monoarticular motion its role shifts in close coordination with the other muscles. In biarticular concurrent motion the activity of the rectus femoris and the medial hamstrings is inhibited when they are antagonists, especially when motion of the knee is concerned.

Adult↗

PubMed2006

Predicting the loss of knee flexion during limb lengthening using inherent muscle length.

Limb lengthening procedures can be associated with loss of range of knee movement, although the amount of knee flexion lost varies markedly between patients. The exact aetiology of this problem is not fully understood. This study investigates whether the amount of joint range that is lost during limb lengthening might be affected by the inherent passive compliance and length of the patients' soft tissues determined preoperatively. A simple mathematical model has been developed to calculate the inherent length and 'spare' length of the hamstring and quadriceps muscle groups in 28 patients undergoing limb lengthening procedures. The range of knee motion was recorded preoperatively and loss of movement recorded during follow-up. The results show a strong correlation between predicted 'spare' length of quadriceps and loss of knee flexion. An association was noted between loss of knee extension and the straight leg raise and correlation of knee extension and the spare length of the hamstrings. The straight leg raise test, and calculation of spare quadriceps length using our formula, as part of the preoperative assessment, can help predict which patient is at risk of a reduced range of motion of the knee.

Adolescent↗