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PubMed2004

[Assessment of stretching techniques for neck and arms muscles in physiotherapy following total laryngectomy].

After total laryngectomy and after complete treatment (radiotherapy) there are many functional disorders in the range of head and neck. These decrease muscle strength and flexibility of muscles of cervical spine. This causes disorders of physiological range of motions of this area. The introduction of the stretching techniques (postisometric relaxation) to the physiotherapy program allows to decrease negative effects of treatment, mentioned above. The therapy of main cervical muscles was carried out during a two week rehabilitation camp. Biomechanical-kinesiological tests were used to assess the effect of the physiotherapy program. The application of postisometrical relaxation and the massage of the cervical and arm muscles increased the average motor ranges and muscle strength. Cervical muscles disbalance was decreased at the same time.

Adult↗

PubMed1998

Structural rehabilitation of the spine and posture: rationale for treatment beyond the resolution of symptoms.

OBJECTIVE: To provide a rationale for active chiropractic rehabilitative treatment that extends beyond the single goal of resolution of symptomatic complaints. DATA COLLECTION: A manual search of available reference texts and a search of MEDLINE were collected with an emphasis on tissue healing sequelae and the role of mechanical loading on this process. RESULTS: The reviewed material indicates that all tissue growth and repair is influenced by mechanical loading and body posture and is positively affected by body postures that normalize/minimize adverse mechanical stresses and strains. Altered alignment of the human frame may lead to poor healing of the body tissues and eventual pathological architectural changes may occur in muscle, ligament, bone and central nervous system. Minimization of altered postural/structural loading of the human frame may take longer than resolution, or maximal reduction, of offensive symptoms. By itself, a patient's perception of pain is not a valid indicator of health. CONCLUSION: Because mechanical loading of the neuromusculoskeletal tissues plays a vital role in influencing proper growth and repair, chiropractic rehabilitative care should focus on the normalization/minimization of aberrant stresses and strains acting on spinal tissues. Manipulation alone cannot restore body postures or improve an altered sagittal spinal curve. Therefore, postural chiropractic adjustments, active exercises and stretches, resting spinal blocking procedures, extension traction and ergonomic education are deemed necessary for maximal spinal rehabilitation. Chiropractic studies that demonstrate structural improvements are sorely lacking and needed. The use of passive treatment modalities as the sole means of chiropractic intervention for the management of patients suffering with neuromusculoskeletal dysfunction no longer has a place in modern chiropractic practice after the acute phase of healing has passed.

Biomechanical Phenomena↗

PubMed2006

P2X receptor-mediated muscle pressor reflex in myocardial infarction.

A previous report from this laboratory demonstrated that the ATP-sensitive P2X receptor-mediated muscle pressor reflex was augmented in rats with heart failure (HF). The purpose of this study was to better understand the underlying mechanisms for this greater response in HF rats. We examined 1) responsiveness of the P2X receptor to alpha,beta-methylene ATP (alpha,beta-me-ATP), a P2X receptor agonist, in control and HF rats induced by myocardial infarction (MI); 2) the relationship between P2X-induced blood pressure response and left ventricular (LV) function; and 3) the expression of P2X receptors in the dorsal root ganglion (DRG) of control rats and rats with HF. Eight to 14 wk after coronary artery ligation, the severity of the MI was determined by echocardiography. In the first group of the experiment, alpha,beta-me-ATP (0.0625, 0.125, 0.25, and 0.5 mM) was injected into the arterial blood supply of the hindlimb muscles to evoke a pressor response in 17 decerebrated rats (6 controls, 6 small MIs with infarcts of the LV between 10 and 35%, and 5 large MIs with infarcts >35%). The P2X agonist increased blood pressure, and the effect was significantly accentuated in large MI rats compared with small MI rats and control rats. A significant correlation was observed between alpha,beta-me-ATP-evoked pressor response and the LV fractional shortening, an index of LV function. In the second group of the experiment, immunocytochemistry was used to examine the immunoreactivity of P2X receptor in the DRG neurons of small diameter fibers in six healthy control rats, five small MI, and five large MI rats. The percentage of P2X immunostaining-positive neurons in the DRG was markedly greater in large MI rats (52% vs. 29% in controls and 34% in small MIs, P < 0.05). In conclusion, our findings demonstrate that 1) muscle afferent-mediated pressor response of P2X activation was exaggerated in MI animals, and the responsiveness was related to the degree of LV dysfunction; and 2) augmented reflex response was associated with upregulated P2X receptors in the DRG neurons of thin fiber afferent nerves following MI. The data suggest that P2X-mediated responsiveness in the processing of muscle afferent signals may have important implications for understanding cardiovascular responses to exercise in HF.

Adenosine Triphosphate↗

PubMed1993

The effect of epidural anaesthesia with 1% lidocaine on the pressor response to dynamic exercise in man.

1. In order to examine the sensitivity to local anaesthetics of afferent neural feedback from working muscle during dynamic exercise, sixteen subjects cycled for 12 min before and after epidural anaesthesia using 1% lidocaine. The presence of afferent neural blockade was verified by elimination of the blood pressure response to a cold pressor test, laser-induced evoked potentials and increases in pain detection and tolerance thresholds of the foot. Conversely, epidural anaesthesia had no effect on these variables in the unblocked skin areas or on electrically evoked potentials in blocked or unblocked skin. 2. During dynamic exercise, heart rate increased as did mean arterial pressure and cardiac output. Mean arterial pressure remained at the exercise level during post-exercise ischaemia, but heart rate and cardiac output decreased while total peripheral resistance increased. Epidural anaesthesia did not significantly affect these variables during rest, dynamic exercise, post-exercise ischaemia or recovery. 3. The results of this study show that, in order to affect blood pressure during dynamic exercise, epidural anaesthesia must block the pressor response to post-exercise ischaemia. The implication of these data is that complete or almost complete block of group III and/or group IV muscle afferents is necessary to inhibit the pressor response to dynamic exercise in man.

Adult↗

PubMed1998

Rapid resetting of carotid baroreceptor reflex by afferent input from skeletal muscle receptors.

Resetting of the arterial baroreflex is mediated by central (central command) or peripheral (exercise pressor reflex) mechanisms. The purpose of this study was to determine the effect of somatosensory input from skeletal muscle receptors on resetting of the carotid baroreceptor reflex. Resetting of the baroreflex was determined by measuring carotid sinus threshold pressure (Pth) during a ramp protocol that consisted of a linear increase in sinus pressure from 50 to 250 mmHg at approximately 3 mmHg/s. Experiments were performed in seven alpha-chloralose-anesthetized and vagotomized dogs. To determine the effect of skeletal muscle afferent input on resetting, electrically induced muscle contraction was used to activate mechanically and metabolically senstive afferent fibers, whereas passive stretch of the hindlimb was used to activate predominantly mechanically sensitive afferent fibers. Pth for heart rate (HR) and arterial blood pressure (BP) during the control ramp protocol was 110 +/- 4 and 118 +/- 7 mmHg, respectively. Electrically induced muscle contraction increased hindlimb tension (5.7 +/- 0.4 kg) and significantly increased Pth-HR and Pth-BP above control (135 +/- 6 and 141 +/- 5 mmHg, respectively; P < 0.05). Muscle paralysis prevented the increase in Pth-HR and Pth-BP during ventral root stimulation (104 +/- 7 and 116 +/- 5 mmHg, respectively; P = not significant). Passive muscle stretch (n = 3) increased hindlimb tension (5.9 +/- 0.9 kg) and significantly increased Pth-BP (125 +/- 21 vs. 159 +/- 16 mmHg, control vs. contraction; P < 0.05). There was no difference in the magnitude of Pth resetting between muscle contraction or stretch. The present study demonstrates that activation of skeletal muscle afferent fibers, by either muscle contraction or stretch, increases Pth of the carotid baroreflex. Therefore, neural input from skeletal muscle receptors resets the carotid baroreflex in a manner similar to that ascribed by central command.

Afferent Pathways↗

PubMed2005

[Myofascial pain syndrome].

The myofascial pain syndrome is an autonomous clinical picture with well-defined clinical and morphological features. The myofascial pain is initiated through trigger points in the musculature which induce a typical referred pain into a specific body region typical for each muscle. Untreated, the myofascial pain syndrome leads to a reduced extensibility of the involved muscle with consecutive decrease of the range of motion and development of a muscular imbalance resulting in a disturbance of complex movement and evolution of a chronic pain disease. An early started and aimed therapy can prevent effectively the chronification. It includes beside the local treatment of the trigger point (e. g. spray-and-stretch, infiltration, acupuncture), the pharmacological and psychotherapy, the physiotherapy and the different procedures of the physical therapy.

Exercise Therapy↗

PubMed2005

Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players.

OBJECTIVE: To quantify the acute effect of whole body vibration (WBV) training on arm countermovement vertical jump (ACMVJ), grip strength, and flexibility performance. METHODS: Eighteen female elite field hockey players each completed three interventions of WBV, control, and cycling in a balanced random manner. WBV was performed on a Galileo machine (26 Hz) with six different exercises being performed. For the control, the same six exercises were performed at 0 Hz, whilst cycling was performed at 50 W. Each intervention was 5 min in duration with ACMVJ, grip strength, and flexibility measurements being conducted pre and post intervention. RESULTS: There was a positive interaction effect (intervention x pre-post) of enhanced ACMVJ (p<0.001) and flexibility (p<0.05) parameters following WBV; however no changes were observed after the control and cycling interventions. There was no interaction effect for grip strength following the three interventions. CONCLUSIONS: Acute WBV causes neural potentiation of the stretch reflex loop as shown by the improved ACMVJ and flexibility performance. Additionally, muscle groups less proportionally exposed to vibration do not exhibit physiological changes that potentiate muscular performance.

Adolescent↗

PubMedDate not supplied

Warming-up and stretching for improved physical performance and prevention of sports-related injuries.

Competitive and recreational athletes typically perform warm-up and stretching activities to prepare for more strenuous exercise. These preliminary activities are used to enhance physical performance and to prevent sports-related injuries. Warm-up techniques are primarily used to increase body temperature and are classified in 3 major categories: (a) passive warm-up - increases temperature by some external means; (b) general warm-up - increases temperature by nonspecific body movements; and (c) specific warm-up - increases temperature using similar body parts that will be used in the subsequent, more strenuous activity. The best of these appears to be specific warm-up because this method provides a rehearsal of the activity or event. The intensity and duration of warm-up must be individualised according to the athlete's physical capabilities and in consideration of environmental factors which may alter the temperature response. The majority of the benefits of warm-up are related to temperature-dependent physiological processes. An elevation in body temperature produces an increase in the dissociation of oxygen from haemoglobin and myoglobin, a lowering of the activation energy rates of metabolic chemical reactions, an increase in muscle blood flow, a reduction in muscle viscosity, an increase in the sensitivity of nerve receptors, and an increase in the speed of nervous impulses. Warm-up also appears to reduce the incidence and likelihood of sports-related musculoskeletal injuries. Improving flexibility through stretching is another important preparatory activity that has been advocated to improve physical performance. Maintaining good flexibility also aids in the prevention of injuries to the musculoskeletal system. Flexibility is defined as the range of motion possible around a specific joint or a series of articulations and is usually classified as either static or dynamic. Static flexibility refers to the degree to which a joint can be passively moved to the end-points in the range of motion. Dynamic flexibility refers to the degree which a joint can be moved as a result of a muscle contraction and may therefore not be a good indicator of stiffness or looseness of a joint. There are 3 basic categories of stretching techniques: (a) ballistic--which makes use of repetitive bouncing movements; (b) static--which stretches the muscle to the point of slight muscle discomfort and is held for an extended period; and (c) proprioceptive neuromuscular facilitation - which uses alternating contractions and stretching of the muscles. Each of these stretching methods is based on the neurophysiological phenomenon involving the stretch reflex.(ABSTRACT TRUNCATED AT 400 WORDS)

Athletic Injuries↗

PubMed1992

Effects of exercise training on vasomotor reactivity of porcine coronary arteries.

The purpose of this study was to determine whether exercise training induces changes in the contractile behavior of proximal coronary arteries. Female Yucatan miniature swine were either exercise trained (ET) on a motor-driven treadmill or allowed to remain sedentary (SED) for 16-22 wk. Responses to vasoactive compounds were evaluated in vitro using coronary arterial rings (approximately 2 mm diam) isolated from ET and SED pigs. Each ring was stretched to the apex of the length-active tension relationship. Concentration-response relationships for isometric contractions evoked with KCl (5-100 mM), prostaglandin F2 alpha (PGF2 alpha; 10(-8)-3 x 10(-5) M), acetylcholine (ACh; 10(-9)-10(-4) M), and endothelin (10(-10)-10(-7) M) were similar in arteries from SED and ET pigs. In contrast, arteries from the ET group developed 50-60% less maximal tension in response to norepinephrine (NE; 10(-6)-10(-4) M) than did controls. Vasodilator responses of rings precontracted with either KCl or PGF2 alpha were evaluated with adenosine (ADO; 10(-9)-10(-4) M), isoproterenol (10(-9)-10(-4) M), forskolin (10(-9)-10(-4) M), and sodium nitroprusside (NP; 10(-10)-10(-4) M). Vasodilator responses were similar in SED and ET groups for all agents except ADO and NP; arteries from ET pigs were more sensitive to ADO and less sensitive to NP. The ET-induced alterations in vasomotor responses to NE and ADO appear to be due to changes in vascular smooth muscle because they were still present after removal of endothelium. We conclude that chronic exercise training in pigs induces selective alterations in NE and ADO receptor-second messenger coupling and/or postreceptor-related events in epicardial coronary vascular smooth muscle.

Animals↗

PubMed2005

Evidence-based treatment of hip and pelvic injuries in runners.

The runner is especially at risk for development of injury to the hip and pelvis secondary to chronic repetitive microtrauma. The key to treatment is establishing complete and accurate diagnosis, and, in particular, identifying the functional biomechanical deficits in the kinetic chain that contribute to this repetitive microtrauma. A long-term successful outcome and prevention of reinjury are more likely if the focus of rehabilitation is on the restoration of the functional kinetic chain, rather than on a specific injured tissue. For example, the typical treatment of "iliotibial band syndrome" is a stretching protocol that frequently is unsuccessful in the long-term improvement of symptoms. A functional biomechanical approach might identify that the injured runner has lack of calcaneal eversion and a structurally rigid supinated foot. These functional biomechanical deficits would lead to inadequate internal rotation of the tibia and femur and result in inhibition or decreased recruitment of the gluteal muscles, in particular the gluteus medius. Restoring pronation throughout the lower extremity would require joint play techniques or functional joint mobilizations for the foot and ankle. In addition, a running shoe with a cushioned heel may be necessary to promote pronation and to attenuate shock. Exercises that integrate foot and hip function, including balance reaches, lunges and step-downs, are prescribed to stimulate the gluteus medius and other gluteals in positions that simulate running. Activities that are done in this manner activate the entire functional kinetic chain of muscles and joints. The nonoperative sports medicine specialist, in particular the physiatrist and physical therapist, are in an excellent position to integrate treatment of the entire functional kinetic chain through a thorough biomechanical evaluation and comprehensive rehabilitation of the injured runner. Additional training in the areas of biomechanical evaluation and functional biomechanical deficits should be sought, because residency and even many fellowship-trained programs often overlook these important areas. Finally, the injured runner is best taken care of in a setting in which different sports medicine specialists are available and work well as a team. No one sports medicine specialist can provide all of the needs to the injured runner.

Abdominal Muscles↗

PubMed1993

The functional significance of the fifth metacarpus and hypothenar in two useful grips of the hand.

Two useful grips for daily living and professional life concerning the two ulnar fingers, designated the "locking grip" and the "supporting grip," are presented. Flexion of the fifth metacarpus was recorded by an electrogoniographic method together with an electromyogram of the hypothenar muscles during formation of the two grips. For the locking grip the flexed position of the fifth metacarpus was shown to be the functional basis of the hypothenar muscles, especially the abductor digiti minimi, operating on the proximal phalanges of the little finger, thus giving full strength to the grip together with the ulnar hand flexor. For the supporting grip the flexed metacarpus enables the stretched little finger to prop up an ordinary plate and hold it horizontally. After immobilization of the ulnar fingers as a result of trauma or in the after care of cases of entrapments of the ulnar nerve, there often arise difficulties in restoring the two grips, mostly because of the atrophy of the hypothenar. A simple method, based on the statements above, of reactivating an atrophic hypothenar and exercising the fingers is suggested. A functional positioning of the fifth metacarpus and ulnar fingers during immobilization to favor the rehabilitation of the two grips is also recommended.

Activities of Daily Living↗

PubMed1988

Spastic paresis: impaired spinal reflexes and intact motor programs.

Leg muscle EMG responses evoked by short treadmill acceleration impulses applied during stance were analysed in patients with spastic hemiparesis. The compensatory reactions on the unaffected side consisted of a diphasic pattern of leg muscle activation. The first response could best be described as a polysynaptic spinal stretch reflex response. This response was absent on the spastic side, except for its later, declining component. This remainder of the first response and the following activation of the antagonistic muscle was identical on both the unaffected and the spastic side. This part of the pattern is assumed to be centrally programmed (at the spinal level) and triggered by the termination of the acceleration impulse.

Adolescent↗

PubMed1987

Skeletal muscle stiffness and pain following eccentric exercise of the elbow flexors.

Stiffness and pain occurring after eccentric exercise have been studied in human elbow flexor muscles. Increased muscle stiffness and flexion deformities of the elbow developed immediately after the exercise and were greatest 1-4 days later. Muscle tenderness and pain experienced during elbow extension developed more slowly but were both maximal at the same time as the muscle stiffness. EMG recordings at times when there was pain and flexion deformity showed the biceps to be electrically silent. This demonstrates that the pain was not due to sustained electrical activity in the muscle and the flexion was a consequence of shortening of non-contractile elements, presumably the connective tissue. It is suggested that some response to damaged connective tissue may cause increased mechanical sensitivity of muscle receptors which, in turn, gives rise to pain when the muscle is stretched or pressed.

Adult↗

PubMed2005

Exercise intervention designed to improve strength and dynamic balance among community-dwelling older adults.

Loss of balance and falling are critical concerns for older adults. Physical activity can improve balance and decrease the risk of falling. The purpose of this study was to evaluate a simple, low-cost exercise program for community-dwelling older adults. Sixteen senior adults were evaluated using the Senior Fitness Test for measures of functional strength, aerobic endurance, dynamic balance and agility, and flexibility. In addition, measures of height, weight, resting blood pressure, blood lipids, and cognitive function were obtained. Participants then attended a 10-week exercise class including stretching, strengthening, and balance-training exercises. At the completion of the program, significant improvements were observed in tests measuring dynamic balance and agility, lower and upper extremity strength, and upper extremity flexibility. The results indicate that exercise programs such as this are an effective, low-cost solution to improving health and factors that affect falling risk among older adults.

Accidental Falls↗

PubMed1992

Measurement of fibre pennation using ultrasound in the human quadriceps in vivo.

Real-time ultrasound scanning was used to measure the angles of fibre pennation of vastus lateralis (VL) and vastus intermedius (VI) of the human quadriceps (n = 12) in vivo. The maximum isometric force and cross-sectional area of the quadriceps were also measured. With the knee at right-angles the mean fibre angles for VL and VI respectively were 0.133 (0.021) rad [7.6 degrees (1.2 degrees)] and 0.143 (0.028) rad [8.2 degrees (1.6 degrees)] [mean (SD)], which is within the range of angles measured on cadavers. The mean angle decreased in going from the contracted [VL, 0.244 rad (14 degrees); VI, 0.279 rad (16 degrees)] to the stretched [VL, 0.105 rad (6 degrees); VI, 0.122 rad (7 degrees)] position. There was a significant positive correlation between fibre angle and muscle cross-sectional area but no relationship between fibre angle and force per cross-sectional area. No increase in fibre angle was detected after 3 months strength training. We conclude that ultrasound can be used to measure pennation angles of superficial muscle groups but we could not demonstrate a relationship between pennation and force-generating capacity.

Exercise↗

PubMed2004

The human spinal cord interprets velocity-dependent afferent input during stepping.

We studied the motor response to modifying the rate of application of sensory input to the human spinal cord during stepping. We measured the electromyographic (EMG), kinematic and kinetic patterns of the legs during manually assisted or unassisted stepping using body weight support on a treadmill (BWST) in eight individuals with spinal cord injury (SCI). At various treadmill speeds (0.27-1.52 m/s), we measured the EMG activity of the soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), medial hamstrings (MH), vastus lateralis (VL), rectus femoris (RF) and iliopsoas (ILIO); the hip, knee and ankle joint angles; the amount of body weight support (BWS); and lower limb loading. The EMG amplitude and burst duration of the SOL, MG, TA, MH, VL, RF and ILIO were related to the step cycle duration during stepping using BWST. EMG mean amplitudes increased at faster treadmill speeds, and EMG burst durations shortened with decreased step cycle durations. Muscle stretch of an individual muscle could not account for the EMG amplitude modulation in response to stepping speed. The effects on the EMG amplitude and burst duration were similar in subjects with partial and no detectable supraspinal input. We propose that the human spinal cord can interpret complex step-related, velocity-dependent afferent information to contribute to the neural control of stepping.

Adolescent↗

PubMed2003

Cold legs: a potential indicator of negative outcome in the rehabilitation of patients with patellofemoral pain syndrome.

PURPOSE: The purpose of this paper is to explore the link between a poor outcome in response to an exercise based approach to physiotherapy, in patients with patellofemoral dysfunction and a self-report of legs feeling cold even in warm surroundings. SCOPE: The study was carried out in the physiotherapy outpatients department of Burnley General Hospital, Lancashire, UK with 87 consecutively referred patients with a diagnosis of patellofemoral pain syndrome being assessed for suitability for entry into the study. Of these 77 entered the study with 14 (18%), of these responding 'Yes' to the question 'Do your legs feel cold even in warm surroundings?' All patients were assessed using four outcome measures prior to the commencement of a standardised rehabilitation programme consisting of lower limb biarticular muscle stretching, vastus medialis training and patella taping or biofeedback. The patients were reassessed using the same outcome measures 3 months after completing their course of treatment. CONCLUSIONS: Patients who responded 'Yes' to the question 'Do your legs feel cold even in warm surroundings?' reported higher pain levels and tolerated less physical activity than non-cold sufferers at initial assessment, these differences were statistically significant. The cold sufferers showed less improvement on all of the outcome measures although the differences between the two groups only reached statistical significance for one of the outcome measures. The implications of this in relation to clinical practice are discussed.

Adolescent↗

PubMed2005

Interstitial ATP and norepinephrine concentrations in active muscle.

BACKGROUND: Sympathetic nervous system activity increases with exercise in normal subjects. Heightened peripheral sympathetic nervous activity and the resultant increased neurovascular levels of norepinephrine (NE) evoke vasoconstriction and serve to maintain blood pressure and perfusion to vital organs. Previous work demonstrated that the interstitial ATP concentrations ([ATP]i) rise in contracting skeletal muscle, and it is known that sympathetic nerves have purinergic P2X receptors. Thus, in this report we tested the hypothesis that elevated ATP would stimulate these receptors and increase interstitial NE concentrations ([NE]i). METHODS AND RESULTS: Muscle interstitial samples were collected from microdialysis probes inserted in the skeletal muscle of rats, and dialysate concentrations of ATP and NE were determined by the high-performance liquid chromatography method. Stretch (0.5 kg of tension) increased [ATP]i by 68% (P<0.05) and [NE]i by 45% (P<0.05) in active muscle. The rise in NEi was linearly linked to the elevated ATPi (r=0.878, P<0.001). [NE]i was also elevated by 76% (P<0.05) after ATP (3 micromol/L) was injected into the arterial blood supply of the hindlimb muscles. The [NE]i response to muscle stretch was blunted after the P2X receptor antagonist pyridoxal phosphate-6-azophenyl-2',4'-disulfonic acid (PPADS) was given. Finally, this response was potentiated by the nucleotidase inhibitor 6-N,N-diethyl-beta-gamma-dibromomethylene-D-adenosine-5'-triphosphate (ARL67156). CONCLUSIONS: ATPi released by skeletal muscle during stretch stimulates P2X receptors on the sympathetic nerves and increases the concentration of NEi in the muscle interstitium.

Adenosine Triphosphate↗