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PubMedDate not supplied

The management of muscular dystrophy: a clinical review.

The optimal management of muscular dystrophy is multidisciplinary and aggressive in nature. Serial assessment aids in determining the functional stage of the disease and in indicating specific therapies. Physical therapy can augment strength through exercise and relieve contracture through passive stretching. Occupational therapy is employed to help the patient manage his activities of daily living within the restrictions imposed on him by his disease. Progressive disability can be delayed through a variety of physiatric and orthopedic techniques, including surgical release of lower-extremity contracture, repair of foot and ankle deformity, and correction of scoliosis. Appropriate orthoses are available, as are a variety of special devices to facilitate ongoing care for postambulatory patients. Physicians treating the muscular dystrophies should be aware of the complications of these diseases, particularly cardiomyopathy, pulmonary failure, and psychological and social problems.

Braces↗

PubMed1999

Investigation of the side pain "stitch" induced by running after fluid ingestion.

PURPOSE: Text books attribute the side pain "stitch" during exercise to changes in blood flow to the viscera, but the little available research favors stretching of visceral ligaments. We therefore induced and modified stitch experimentally to investigate its cause and possible treatments. METHODS: Ten active healthy young men reported the intensity of stitch during sessions of intermittent exercise after drinking either no fluid (control) or a body-mass-adjusted volume (14 mL x kg(-1)) of each of four fluids: water, Exceed, decarbonated Coca-Cola, and a hypertonic solution of the nonabsorbable sugar lactulose. Each exercise session consisted of five 5-min bouts of hard running on a treadmill, with 10-min rests between each bout. In another experiment, seven subjects reported the effect of several physical maneuvers on stitch during exercise after drinking decarbonated Coca-Cola. RESULTS: Stitch developed to a similar intensity with all fluids during the first two bouts of running; thereafter, stitch declined only with Exceed, reaching the intensity with no fluid by the last two bouts. Bending forward while tightening abdominal muscles, tightening a belt around the waist, or breathing through pursed lips with increased lung volume alleviated stitch within seconds, but attempting to relax abdominal muscles or increasing the impact of foot strike had little effect. CONCLUSIONS: Our observations cannot be explained readily by mechanisms involving digestion-induced changes in blood flow but are consistent with the notion that stitch arises when the fluid-engorged gut tugs on visceral ligaments.

Adult↗

PubMed1999

Warm-up effect on active and passive arthrometric assessment of knee laxity.

OBJECTIVE: To determine the influence of a warm-up protocol suitable for use in clinical settings on tibial displacement and muscle activity during arthrometric knee laxity assessment. DESIGN: Intervention study in which the subjects served as their own controls. SETTING: The Biomechanics Research Laboratory, University of Wollongong, Wollongong, New South Wales, Australia. SUBJECTS: Ten volunteers who reported no history of knee trauma or disease. INTERVENTION: A warm-up consisting of 10 minutes of ergometer cycling (60rpm) followed by two sets of three hamstring muscle stretches. MAIN OUTCOME MEASURES: Outcome measures were: (1) anterior tibial translation and knee extension force assessed using a Dynamic Cruciate Tester for each subject's right knee during active and passive testing, and (2) intensity of quadriceps and hamstring muscle activity during knee laxity testing. RESULTS: There was significantly less quadriceps activity after warm-up (t = 2.419, p = .039). However, there was no significant difference between anterior tibial translation, knee extension force, or hamstring muscle activity results before and after warm-up in either active or passive tests. CONCLUSION: A warm-up suitable for use in a clinical setting is not required before arthrometric assessment of knee laxity.

Adult↗

PubMed2002

Does wearing a functional knee brace affect hamstring reflex time in subjects with anterior cruciate ligament deficiency during muscle fatigue?

OBJECTIVE: To evaluate the effects of wearing a functional knee brace and muscle fatigue on hamstring reflex time in subjects with anterior cruciate ligament (ACL) deficiency. DESIGN: Repeated-measures clinical trial. SETTING: Outpatient physical therapy department. PARTICIPANTS: Sixteen subjects with ACL deficiency. INTERVENTION: Subjects tested with and without a functional knee brace before and after an exercise protocol designed to fatigue the knee muscles. MAIN OUTCOME MEASURE: Latency of hamstring reflex muscle activity after sudden perturbation of the knee. RESULTS: Wearing a knee brace shortened the hamstring reflex latency regardless of fatigue (F(1,15)=20.62, P<.001). Muscle fatigue lengthened the hamstring reflex time regardless of the bracing condition (F(1,15)=7.57, P<.015). CONCLUSION: Wearing a functional knee brace facilitated hamstring muscle reflex, but muscle fatigue lengthened the hamstring reflex latency. Subjects with ACL deficiency should not rely on the knee brace to facilitate hamstring reflex for joint protection during prolonged sporting activities when muscles are fatigued.

Achilles Tendon↗

PubMed1982

Neuromuscular function and mechanical efficiency of human leg extensor muscles during jumping exercises.

The influence of prestretch amplitude on the mechanical efficiency was examined with 5 subjects, who performed 5 different series of vertical jumps, each of which differed with respect to the mechanics of the knee joint action during the prestretch (eccentric) phase of the contact on the floor. Electromyographic activity was recorded from the major extensor muscles during the entire work period of 1 min per series. In addition, expired air was collected during the test and recovery for determination of energy expenditure. Mechanical work was calculated from the vertical displacement of the body during the jumps. The results indicated that high net efficiency of 38.7% was observed in condition where amplitude of knee bending in eccentric phase was small. In large range motion the corresponding net efficiency was 30.1%. In jumps where no prestretching of extensor muscles occurred the net efficiency was 19.7%. The high efficiency of small amplitude jumps was characterized by low myoelectrical activity of the leg extensor muscles during the positive (concentric) work phase. In addition, the small amplitude jumps had shorter transition time in the stretch-shortening cycle, high average eccentric force and high stretching speed. Therefore the results suggest that the restitution of elastic energy, which was also related to the length change and stiffness of the muscles during stretch, plays an important role in regulating the mechanical efficiency of work.

Adult↗

PubMed1999

Relationship between strength qualities and performance in standing and run-up vertical jumps.

BACKGROUND: The purpose of this investigation was to determine the relationships between the strength qualities of the leg extensor musculature and performance in vertical jumps (VJ) performed from a standing position and a run-up. METHODS: Twenty-nine males with experience in jumping activities were tested for vertical jumping capacities with a standing VJ (double leg takeoff) and run-up jumps from a 1, 3, 5 and 7 stride approach (single leg takeoff). The speed-strength and maximum strength qualities of the leg extensors were assessed by tests involving concentric, stretch-shortening cycle (SSC) and isometric muscular actions. Pearson's correlations and stepwise multiple regression was performed to describe the relationships with jumping performance. RESULTS: The speed-strength tests correlated significantly with both jump types (r = 0.55-0.82), but maximum strength did not. A drop jump test considered to measure reactive strength correlated more strongly with the run-up jump than the standing VJ. The standing VJ was best predicted by a low stretch load SSC test, whereas the run-up jump was best predicted by a model that also including the test of reactive strength. CONCLUSION: The role of maximum strength in jumping performance was not clear but speed-strength qualities were considered important. It was concluded that reactive strength is relatively more important for jumping from a run-up than for the standing VJ, and this should be reflected by appropriate training methods and test protocols for the assessment of athletes who jump.

Adult↗

PubMed1998

[Effect of loading suit "Penguin" on human metabolism during movements].

Additional energy expenses due to stretching of the elastic elements of anti-loading suit (ALS) "Penguin" as a whole (shoulders-feet) or only its lower part (waist-feet) in the course of cyclic leg movements were measured in five female and five male volunteers. ALS design enabled tensometric monitoring of efforts applied to specific elastic elements, and total efforts applied to the shoulder or pelvic girdles separately. Energy spend were determined with the indirect calorimetric techniques from the data of the expired air analysis. Registered were electromyograms of m. longus spinae, femoral extensor (m. biceps femoris) and femoral flexor (m. rectus femoris), and m. gastrocnemius. On the first stage, bicycle ergometer was pedaled w/o loading with a frequency of 60 cycles/min. The next stage included testing by incremental loading in which pedaling ceased at the pulse rate of 150/min. Results of the experiments that did not require stretching elastic parts of the suit and in which the total strain effort made up 20 to 25 kg and 15 to 16 kg by males and females, respectively, were compared. It was ascertained that ALS enhanced metabolism during motion by 20 to 30%; however, there was no significant difference in energy expenses when loaded by the whole suit or only its lower part.

Adaptation, Physiological↗

PubMed2006

Effects of dynamic balance training during standing and stepping in patients with hereditary sensory motor neuropathy.

PURPOSE: To quantitatively evaluate the effects of dynamic balance training in patients with hereditary sensory motor neuropathy (HSMN). METHODS: Sixteen patients with HSMN were randomly assigned to either an experimental or control group. The intervention session consisted of passive stretching, muscle strengthening and dynamic balance training during standing and stepping, which differed in that the experimental group used commercially available balance training mechanical apparatus while the patients from the control group were physically managed by a physiotherapist. The intervention period was 12 days. Balance and mobility functions were assessed by means of Berg Balance Scale, Up&go test and 10-m walk test before and after the intervention period. RESULTS: The within-group comparison (1-way repeated measures ANOVA) for the experimental group showed statistically significant improvement (p < 0.05) in Berg Balance Scale, Up&go test and 10-m walk test, while within-group comparison for the control group showed statistically significant improvement only in Berg Balance Scale (p < 0.05). The between-group comparison (2-way ANOVA) showed larger improvement in the experimental group, however, these differences were not statistically significant. CONCLUSION: Dynamic balance training is useful training modality for patients with HSMN. When exercised in the balance training mechanical apparatus used in this study enables efficient balance and mobility training without requiring physical assistance from a physiotherapist or a caregiver, which opens new possibilities for continuing and more frequent physical exercise and mobility training of patients with HSMN also at their homes.

Adolescent↗

PubMed2001

Behavior of fascicles and tendinous structures of human gastrocnemius during vertical jumping.

Behavior of fascicles and tendinous structures of human gastrocnemius medialis (MG) was determined by use of ultrasonography in vivo during jumping. Eight male subjects jumped vertically without countermovement (squat jump, SQJ). Simultaneously, kinematics, kinetics, and electromyography from lower leg muscles were recorded during SQJ. During phase I (-350 to -100 ms before toe-off), muscle-tendon complex (MTC) length was almost constant. Fascicles, however, shortened by 26%, and tendinous structures were stretched by 6%, storing elastic energy of 4.9 J during phase I. During phase II (-100 ms to toe-off), although fascicles generated force quasi-isometrically, MTC shortened rapidly by 5.3%, releasing prestored elastic energy with a higher peak positive power than that of fascicles. Also, the compliance of tendinous structures in vivo was somewhat higher than that of external tendon used in the simulation studies. The results demonstrate that the compliance of tendinous structures, together with no yielding of muscle fibers, allows MTC to effectively generate relatively large power at a high joint angular velocity region during the last part of push-off.

Adult↗

PubMed1990

Influence of lung volume on sympathetic nerve discharge in normal humans.

The purpose of this study was to determine the influence of tidal volume, breathing pattern, and beginning lung volume on the modulation of efferent, muscle sympathetic nerve activity (MSNA) in humans. In seven supine, healthy subjects, we measured MSNA (microneurography of the right peroneal nerve) and beat to beat arterial blood pressure during 1) low-frequency breathing (fb = 12 breaths/min) at tidal volumes (VT) of 30% (control), 50%, and 70% of inspiratory capacity and with inspiratory time-to-total breath time ratios (TI/TTOT) of 0.3-0.5 (control), less than 0.3, and greater than 0.5; and 2) simulated exercise hyperpnea (fb = 40 breaths/min; VT = 60-70% inspiratory capacity; minute ventilation, approximately 90 1). To optimize our ability to discern modulatory effects, breathing was performed during three conditions of heightened MSNA: nonhypotensive (less than 20 mm Hg) lower-body negative pressure, isometric handgrip exercise, and posthandgrip vascular occlusion (ischemia). PETCO2 was maintained at normal levels by adjusting the FICO2. Within-breath modulation of MSNA was observed during control tidal breathing with approximately 65% of the burst frequency occurring during the expiratory phase. Deep, low-frequency breathing potentiated this modulatory influence (p less than 0.05 versus control) and produced near-complete sympathoinhibition from onset-mid inspiration to early-mid expiration. Increasing (slow inspiration) and decreasing (fast inspiration) TI/TTOT shifted the onset of sympathoinhibition occurring later (greater change in volume) and earlier (less change in volume) during inspiration, respectively. In two subjects who performed deep breathing from an elevated beginning lung volume, the sympathoinhibition was observed earlier in the inspiratory period and with less change in volume compared with control. These within-breath modulatory effects did not appear to be due solely to changes in arterial pressure. Sustained low- or high ("exerciselike")-frequency deep breathing did not alter total minute MSNA compared with control breathing. These results demonstrate that the depth and pattern of breathing, and possibly the starting lung volume, exert marked influences on the within-breath modulation of MSNA in humans. Our findings also suggest that these modulatory effects may be mediated, at least in part, by pulmonary stretch reflexes.

Adult↗

PubMedDate not supplied

Evaluation of warm-up for improvement in flexibility.

The purpose of this investigation was to evaluate the effects of warming the joints by jogging and then stretching on increases in joint flexibility. Subjects were 51 students enrolled in a physical conditioning class assigned to a jog and then stretch (JS), stretch and no jog (S), or a control group (C). Both the JS and S groups performed a series of stretching exercises 2 days a week for 9 weeks, with the JS group jogging for 5 minutes prior to stretching. Subjects were pretested and posttested for shoulder, hamstrings, trunk, and ankle flexibility with a Leighton flexometer. Results of t-tests indicated that significant increases in flexibility occurred for all of the joint angles evaluated for both the JS and S groups with the exception of trunk flexibility for the JS group. An analysis of variance (ANOVA) of gain scores indicated a significant gain in ankle flexibility for the JS group compared to S and C groups. The S group produced a significant gain in trunk flexibility compared to the JS group. Both JS and S groups were effective in improving flexibility, but when the gain scores were compared the results were variable. The data from this study again demonstrate that increases in flexibility can occur as a result of a static stretching training program. However, the results do not support the claim that warming the muscles prior to stretching by jogging will result in significant increases for all of the joint angles evaluated. Both methods offer possible advantages associated with improving joint flexibility.

Adult↗

PubMed1990

Thoracic outlet syndrome--a myofascial variant: Part 1. Pathology and diagnosis.

Four cases of thoracic outlet syndrome are described, with observations to support a primary myofascial etiology involving the scalene and smaller pectoral muscles. It is believed that thermography can be extremely helpful as an aid in diagnosis of thoracic outlet syndrome and, when combined with Doppler blood flow studies and photoplethysmography, can help localize the site of the pathosis. Thermography is a sensitive, non-invasive test that most clearly demonstrates pathology in the hand views. Global changes throughout the entire hand suggest vascular or reflex autonomic involvement, while a more dermatomal distribution suggests specific neurologic involvement. Vigorous stretching and a unique form of myofascial release manipulation has been successful in rapidly treating patients with thoracic outlet syndrome. Follow-up thermography (perhaps hand and forearm views only) can be used to monitor response to treatment and to objectively document improvement.

Adult↗

PubMed1993

Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention?

In this prospective study, 145 patients with lumbar spinal stenosis were evaluated for clinical signs and radiologic findings and conservative treatment results. Clinical parameters such as pain on motion, lumbar range of motion, straight leg raising test, deep tendon reflexes, dermatomal sensations, motor functions and neurogenic claudication distances were assessed at admission and were compared after a conservative treatment program was completed. A conservative treatment program consisted of physical therapy (infrared heating, ultrasonic diathermy and active lumbar exercises) and salmon calcitonin. Pain on motion (100%), restriction of extension (77%), limited straight leg raising test (23%), neurogenic claudication (100%), dermatomal sensory impairment (47%), motor deficit (29%), and reflex deficit (40%) were observed in the patients. All aforementioned disturbances except reflex deficits improved by the conservative treatment and results were statistically significant. The authors conclude that this conservative treatment should be the treatment of choice in elderly patients and in those patients without clinical surgical indications.

Calcitonin↗

PubMed1996

New perspectives on osteoarthritis.

Osteoarthritis (OA) is the most common rheumatologic disease, afflicting tens of millions of U.S. citizens. It is not an inevitable consequence of aging; rather, it is a degenerative process acquired because of metabolic, mechanical, genetic, and other influences. It is characterized by progressive loss of cartilage and bony overgrowth. Because cartilage is not innervated, the pain of OA arises from secondary effects, such as joint capsule distention, stretching of periosteal nerve endings, and, possibly, synovial inflammation. Psychologic factors, including stress and depression, may influence the perception of pain by OA patients. The risk of OA apparently is not increased by normal joint use, but persons who participate in competitive sports or who play with abnormal or injured joints are at increased risk. Obesity increases OA risk, and weight loss has been found to decrease it. Some forms of premature OA appear to be inherited. The objective diagnosis of OA is made on the basis of radiography. However, many individuals with radiographic evidence of OA are asymptomatic in the affected joint. It is essential to ensure that pain in the affected joint is attributable to OA and not another cause. The management of OA should include physical medicine measures such as heat or cold therapy and often neglected environmental measures, such as reducing chair height and using shoe orthotics. Therapeutic exercise is beneficial for many patients and includes an initial warm-up with range of motion, muscle strengthening, and aerobic activity (such as swimming). A major question in the pharmacologic management of OA is whether nonsteroidal anti-inflammatory drugs (NSAIDs) are superior to analgesics in terms of symptomatic relief; studies indicate that they are not. The question is relevant because of the adverse effects of NSAID use, particularly in the elderly population.

Age Factors↗

PubMed2001

Intermuscular coordination during pendulum rebound exercises.

In this study, we assessed coordination during pendulum rebound jumps. To gain insight into the movement coordination strategy, nine experienced male volleyball players performed maximal rebound jumps in a pendulum swing device using three different seat arrangements (90 degrees, 135 degrees and 180 degrees). Two-dimensional filming was performed in the right sagittal plane (200 Hz) synchronized with a force platform fitted to the wall (1000 Hz). The surface electromyograms of five muscles were recorded (200 Hz), in conjunction with kinematic and kinetic assessment. During the countermovement phase, the impact forces were attenuated by eccentric contractions of most muscles, which helped to reduce the energy input into the system. The wall reaction forces, net moments and joint power profiles were comparable between conditions. The small differences found between the extreme seat arrangements were attributed to differences in muscle length and the position of the feet. The strategy used during landing was similar to that observed in unconstrained vertical and drop jumps, where the neuromuscular system attenuates the impact forces. During the push-off phase, most muscles were found to contribute to positive work generation, except the semitendinosus, which was stretching throughout the propulsive phase. Despite not being able to exert a large influence over the trunk segment, this muscle was deemed to play an important role in regulating and synchronizing the onset of knee extension, enabling hip extension to occur before extension in the other more distal joints. Our findings show that the neuromuscular system is able to produce consistent movement coordination across experimental conditions and in accordance with the specific task demands and constraints imposed in the movement structure.

Adult↗

PubMed1997

Muscle performance and electromyogram activity of the lower leg muscles with different levels of cold exposure.

The purpose of this study was to evaluate the relationship between different levels of body cooling and muscle performance decrement and to study the motor co-ordination of the working agonist-antagonist muscle pair of the lower leg. Eight volunteer male subjects dropped from a 40-cm bench on to a force plate and performed a maximal rebound jump (stretch-shortening cycle). The jumps were performed after 60-min exposures to 27 degrees C, 20 degrees C, 15 degrees C and 10 degrees C. In comparison to those at 27 degrees C, all the exposures to lower temperatures decreased the flight time of the jump, average force production and take-off velocity in a dose-dependent manner. The changes in electromyogram (EMG) activity also behaved in a dose-dependent manner. During pre-activity and stretch phases the integrated EMG (iEMG) activity of the agonist muscle (triceps surae) increased due to cooling (at 10 degrees C, P < 0.05). In contrast, during the shortening phase iEMG of the agonist muscle decreased due to cooling (at 15 degrees C and 10 degrees C, P < 0.05). Moreover, the activity of the antagonist muscle (tibialis anterior) increased due to cooling (at 15 degrees C and 10 degrees C, P < 0.01). The mean power frequency of the agonist muscle during the shortening phase was shifted from 124 (SEM 12) Hz (at 27 degrees C) to 82 (SEM 7) Hz (at 10 degrees C, P < 0.01). We concluded that there was a dose-dependent response between the degree of cooling and the amount of decrease in muscle performance as well as EMG activity changes. A relatively low level of cooling was sufficient to decrease muscle performance significantly.

Adult↗

PubMed2001

The droopy shoulder syndrome.

Droopy shoulder syndrome (DSS) is characterized by a depression of the shoulders that stretches the brachial plexus, thus causing pain without any signs of neurological impairment. We describe ten patients with DSS; all had been treated for different diagnoses before. Contrary to previous reports, three patients had unilateral involvement, and five had accompanying disease of the cervical-shoulder region. All patients responded well to conservative treatment in 2-10 weeks. DSS must be kept in mind in the differential diagnosis of pain in the cervical-shoulder region, to prevent unnecessary medication.

Adolescent↗

PubMed1983

Electrical activities of the muscle layers of the canine colon.

The spontaneous electrical and mechanical activities of the circular and longitudinal muscle layers of the canine colon were studied. The smooth muscle cells of the circular muscle layer exhibited regular, omni-present myogenic slow-wave activity at a frequency ranging from 4 to 7 c/min. With intracellular micro-electrodes, the slow-wave amplitude was 21-38 mV and its duration 3-6 sec. The 'resting' membrane potential was -60 to -76 mV. Some slow waves had superimposed spike bursts on their peak depolarizations and only these were associated with phasic contractions. It is concluded that they serve a pace-maker function similar to their counterpart in the small intestine. The longitudinal muscle layer exhibited periods of electrical activity alternating with periods of electrical quiescence. During the activity periods electrical oscillations occurred at a frequency of 13-35 c/min with spikes on top of them. Each electrical activity period was associated with a prolonged 'tonic' contraction. The duration of these periods was 30-120 sec and their frequency 0.4-1.1 period/min. This activity is similar to that recorded from the longitudinal muscle of the guinea-pig caecum despite the anatomical differences. The electrical activity periods of the longitudinal muscle appeared to require an excitatory input (stretch and/or acetylcholine release). Provided the strips were not excessively stretched, atropine abolished all electrical and motor activity. Stretching prolonged the electrical activity periods until they eventually fused together and the muscle developed maintained tone. Simultaneously recording from both layers showed that, although electrotonic spread between the two layers is probably insignificant, the activity of the two layers was co-ordinated. Only those slow waves of the circular layer that occurred during the electrical activity periods of the longitudinal layer had superimposed spikes. It is suggested that this co-ordination may indicate that the two muscle layers may be commanded by a common input from periodically active, cholinergic intramural neurones. It is proposed that the complex patterns of colonic electrical and motor activities may be explained as consisting of two major components: one arising from the longitudinal (long spike bursts, high-frequency oscillations and tonic contractions) and the other from the circular layer (slow waves, short spike and phasic contractions). Simultaneous electrical records from the two muscle layers and the mucosa failed to show a consistent relationship between the mucosal record and the activity of either layer. Caution should be exercised in the interpretation of intraluminally derived electrical recordings.

Action Potentials↗