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Clonus after human spinal cord injury cannot be attributed solely to recurrent muscle-tendon stretch.

Clonus, presented behaviorally as rhythmic distal joint oscillation, is a common pathology that occurs secondary to spinal cord injury (SCI) and other neurological disabilities. There are two predominant theories as to the underlying mechanism of clonus. The prevailing one is that clonus results from recurrent activation of stretch reflexes. An alternative hypothesis is that clonus results from the action of a central oscillator. We present evidence that the mechanism underlying clonus in individuals with SCI is not solely related to muscle stretch. We studied electromyography (EMG) of the soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), medial and lateral hamstrings, vastus medialis, vastus lateralis, and rectus femoris from subjects with clinically complete and clinically incomplete SCI during stretch-induced ankle clonus, stepping, and non-weight-bearing standing. Clonic EMG of the SOL, MG, and TA occurred synchronously and were not consistently related to muscle-tendon stretch in any of the conditions studied. Further, EMG activity during stretch-induced ankle clonus, stepping, and non-weight-bearing standing had similar burst frequency, burst duration, silent period duration, and coactivation among muscles, indicating that clonic EMG patterns occurred over a wide range of kinematic and kinetic conditions, and thus proprioceptive inputs. These results suggest that the repetitive clonic bursts could not be attributable solely to immediate afferent feedback such as recurrent muscle stretch. However, these results support the theory that the interaction of central mechanisms and peripheral events may be responsible for clonus.

Adult↗

A preliminary study of dynamic muscle function in hereditary ataxia.

Dynamic muscle function was evaluated in nine patients with Friedreich's ataxia (FA) and eight with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). The measurement of torque throughout maximum voluntary isokinetic knee movements was used to quantitatively describe muscle weakness in the ataxic patients. Both FA and ARSACS patients were shown to have decreased dynamic strength in comparison to normal values during knee extension and flexion movements at 30 degrees/s. In the FA patients a lower torque-producing capacity was seen in the older patients. The electromyographic (EMG) activity was recorded in lower extremity muscles during the movements. In the vastus lateralis (VL), deviations from the normal EMG activation pattern were described in both groups of patients. A reduced amplitude in the EMG activity in the medial hamstrings (MH) was seen in the majority of the patients. An index of coactivation was defined by comparing the EMG activity when a muscle lengthened (antagonistic) to the EMG activity when the same muscle shortened (agonistic) during the isokinetic contractions. In comparison to normal values increased coactivation indexes were present in the VL and MH in patients of both groups. The characteristics of dynamic muscle strength and the activation of agonistic and antagonistic muscles described in the present study will provide the basis of evaluation for the effects of therapy in these patients.

Adolescent↗

Dependence of cruciate-ligament loading on muscle forces and external load.

A sagittal-plane model of the knee is used to predict and explain the relationships between the forces developed by the muscles, the external loads applied to the leg, and the forces induced in the cruciate ligaments during isometric exercises. The geometry of the model bones is adapted from cadaver data. Eleven elastic elements describe the geometric and mechanical properties of the cruciate ligaments, the collateral ligaments, and the posterior capsule. The model is actuated by 11 musculotendinous units, each unit represented as a three-element muscle in series with tendon. For isolated contractions of the quadriceps, ACL force increases as quadriceps force increases for all flexion angles between 0 and 80 degrees; the ACL is unloaded at flexion angles greater than 80 degrees. When quadriceps force is held constant, ACL force decreases monotonically as knee-flexion angle increases. The relationship between ACL force, quadriceps force, and knee-flexion angle is explained by the geometry of the knee-extensor mechanism and by the changing orientation of the ACL in the sagittal plane. For isolated contractions of the hamstrings, PCL force increases as hamstrings force increases for all flexion angles greater than 10 degrees; the PCL is unloaded at flexion angles less than 10 degrees. When hamstrings force is held constant, PCL force increases monotonically with increasing knee flexion. The relationship between PCL force, hamstrings force, and knee-flexion angle is explained by the geometry of the hamstrings and by the changing orientation of the PCL in the sagittal plane. At nearly all knee-flexion angles, hamstrings co-contraction is an effective means of reducing ACL force. Hamstrings co-contraction cannot protect the ACL near full extension of the knee because these muscles meet the tibia at small angles near full extension, and so cannot apply a sufficiently large posterior shear force to the leg. Moving the restraining force closer to the knee-flexion axis decreases ACL force; varying the orientation of the restraining force has only a small effect on cruciate-ligament loading.

Anterior Cruciate Ligament↗

Effects of joint pathology on muscle.

The muscle wasting associated with joint damage may be highly selective; knee disorders produce quadriceps wasting but little change in the size of the hamstrings. This causes isolated quadriceps weakness, so predisposing to a position of knee flexion. Nociceptors and other receptors in and around the joint can have flexor excitatory and extensor inhibitory actions. At the knee, these receptors are likely to excite hamstrings and inhibit quadriceps. Although other actions could occur, quadriceps inhibition may be favored by a position of knee extension. Quadriceps inhibition will weaken voluntary contraction, reduce tone, and contribute to wasting of the muscle, further predisposing to a position of knee flexion. The potency of quadriceps inhibition may be considerable, even in the absence of perceived pain. A small, apparently trivial effusion (or even a clinically undetectable effusion) may cause important inhibition. In order to improve the orthopedist's ability to prevent flexion contracture of the injured or operated joint, he must look not only for ways of reducing joint pain, but also for ways of preventing activity in other joint afferents. For example, he must consider the possible effects of joint position, intraarticular pressure, suture-line tension, and afferent blockade.

Animals↗

Muscle rehabilitation after arthroscopic meniscectomy with or without tourniquet control. A preliminary randomized study.

Nineteen patients with isolated meniscus lesions were randomly assigned to operation with or without tourniquet. All patients underwent arthroscopic meniscectomy. Measurements of CK (creatinin-kinase), CK-B (isoenzymes MB of creatinin-kinase), LD (lactate dehydrogenase), ASAT (aspartate aminotransferase), and ALAT (alanine aminotransferase) were performed preoperatively and postoperatively over 6 days. The muscle torque was measured on a Cybex II isokinetic dynamometer preoperatively, 1 week and 4 weeks postoperatively. The mean CK level rose significantly in both groups, but did not pass the upper normal serum level. There was no effect on the other muscle enzymes. Quadriceps torque was significantly lowered in both groups 1 week after operation. Four weeks postoperatively, it was still lowered in the nontourniquet group, which also had a slower increase in torque between weeks 1 and 4 than the tourniquet groups. There was no effect from the operation on isometric or hamstrings torque. The slight rise in CK was similar to that seen after hard physical exercise. The decrease in muscle torque was, therefore, mostly due to pain inhibition. The slightly slower rehabilitation in the nontourniquet group may be caused by the technique of raising saline flow and pressure during the arthroscopy to control bleeding. This causes extravasation of fluid which may increase postoperative pain and stiffness.

Adult↗

Study on three-dimensional kinematics and electromyography of ACL deficient knee participants wearing a functional knee brace during running.

This investigation examined the muscular activity and 3D knee joint kinematic changes of anterior cruciate ligament-deficient (ACLD) participants in the involved leg under bracing condition during running. Different adaptation strategies have been found between patients who can cope with the injury and patients who cannot. One of the expected changes can be the muscle activation characteristic of the injured knee during strenuous activity with and without a functional knee brace. Three-dimensional kinematic and electromyographical (EMG) data were collected from 11 participants for 10 consecutive gait cycles during running on a treadmill under both braced and unbraced conditions. Participants were administered the "Knee Outcome Survey Activities of Daily Living Scale" to distinguish functional and non-functional candidates. No significant differences on 3D kinematics and EMG data were noted between functional and non-functional participants, thus data analysis focused on comparisons of bracing conditions for one combined group. Bracing significantly reduced total range of motion in the frontal and transverse planes (P<0.05). Muscle activity at heel-strike showed a consistent trend to increase for the hamstrings and decrease for the quadriceps under the braced condition when compared to the unbraced condition. Our findings indicate that bracing the ACLD knee alters the kinematics of the injured leg while running. Tendencies toward reductions in quadriceps and increases in hamstrings activity at heel-strike indicate that bracing might have resulted in added stability of the injured knee. The adaptations to bracing found in this preliminary study further support the potential mechanical and proprioceptive contributions of the functional knee brace to protect the ACLD knee.

Adolescent↗

Areas of operation of interneurons mediating presynaptic inhibition in sacral spinal segments.

Sources of primary afferent depolarization (PAD) of skin afferents in the sural (Sur) nerve and of group-II muscle afferents in the posterior biceps and semitendinosus (PBST) nerve were compared at several sites, about 2 mm apart, within the L7-S2 segments in order to define areas of projection of sacral interneurons mediating PAD of these afferents. Just rostral to the pudendal nucleus, strong PAD of Sur afferents was evoked by stimulation of skin nerves, while stimulation of muscle nerves had only marginal effects. This indicates that sacral PAD interneurons co-excited by skin and muscle afferents operate primarily within the regions overlying the pudendal nucleus. Furthermore, PAD evoked by muscle afferents was weaker over the rostral part of the pudendal nucleus than over the caudal part of this nucleus, where hamstring afferents became its main source, both in Sur and in PBST group-II afferents. By correlating the relative strength of PAD at the levels of the rostral and caudal parts of the pudendal nucleus with the previously established input from muscle and cutaneous afferents to interneurons at these levels, it is therefore proposed that sacral PAD interneurons operate over shorter distances than indicated by previous experiments: over either rostral or caudal parts of the pudendal nucleus, i.e., about 2 mm, rather than over the whole length of this nucleus, i.e., 4-5 mm. Sacral PAD interneurons may, thus, modulate synaptic transmission to even more spatially restricted neuronal populations than previously proposed.

Action Potentials↗

Comparison of stoop versus prone postures for a simulated agricultural harvesting task.

Physical and psychophysical differences between working in the stooped and prone postures were compared while performing a simulated agricultural harvesting task for 30 min. Fifteen male subjects participated. The measures used to compare the two postures included perceived discomfort, electromyography (EMG), and heart rate (HR). Average hamstrings localized discomfort (0-10 scale) was 6.17 (SD=2.9) for the stoop posture and 0.67 (SD=1.29) for the prone posture. Erector spinae and hamstring EMG RMS increased 68% and 18%, respectively, while mean power frequency for the hamstrings decreased 13% for the stoop task. Mean power frequency for the middle trapezius muscle decreased in both postures (stoop 4.13%, prone 3.79%). Average heart rate during the last work cycle was 35% greater than the resting heart rate for the stoop posture while average heart rate was 17% greater for the prone posture. Subjects worked on the prone workstation without rest during the 15 min work simulations with less discomfort, no localized fatigue in the back or leg muscles tested, and lower working heart rates than subjects working in the stoop posture.

Adult↗

Congenital caudal spinal atrophy: a case report.

An infant presented at birth with symmetrical flaccid paraparesis limited to lower legs and feet, and involving the proximal and distal muscle group. Limitation of the ankle joints was noticed. There were no sensory deficits to painful stimuli and no evidence of loss of sphincter control. Muscle CT revealed severe muscle atrophy in the pelvis and lower limbs, and electromyographic study of the bilateral hamstrings showed polyphasic giant potentials. Motor and sensory nerve conduction velocities were within normal limits, and the spinal MRI showed no structural abnormalities in the cord and the lower spine. These features suggest a congenital segmental abnormality at the anterior horn cell level in the lumbosacral spinal cord, which we propose to call "congenital caudal spinal atrophy".

Arthrogryposis↗

Muscular function during ergometer cycling.

Quantified EMG and calculated mechanical muscular power output data were combined to provide further analysis of muscular function during ergometer cycling. The single-joint muscles; gluteus maximus, gluteus medius, vastus medialis, vastus lateralis and soleus all showed a more predictable function with approximately linear relationship between calculated power output and recorded EMG. The function for the two-joint muscles was found to be more complex. Biceps femoris seemed to act mainly as a hip extensor and medial hamstring mainly as a knee flexor. Gastrocnemius medialis was proposed to act more as a plantar flexor and gastrocnemius lateralis as a knee flexor.

Adult↗

Improved hemiparetic muscle activation in treadmill versus overground walking.

OBJECTIVE: Treadmill training is a promising tool for retraining gait after stroke. The treadmill induces an immediate shift toward symmetry and longer paretic stance times due to altered muscle activation (active) or the motorized belt (passive). The authors investigated vastus lateralis and medial hamstrings activation differences between treadmill and overground walking in participants with stroke. METHODS: Vastus lateralis and medial hamstrings surface electromyography was recorded during velocity-matched overground and treadmill walking in 19 chronically hemiparetic subjects. Variables from ensemble averages of electromyography included burst onset and offset times (% cycle), duration (% cycle), integrated amplitude (mV.% cycle), and onset relative to foot strike (% cycle). Conditions were compared using paired t-tests (alpha = 0.05). RESULTS: Paretic vastus lateralis onset occurred earlier in the treadmill condition (overground: 47.1%, treadmill: 41.9%, P = 0.01). For nonparetic vastus lateralis in the treadmill condition, onset occurred later (overground: 85.2%, treadmill: 87.6%, P = 0.09), offset occurred earlier (overground: 54.7%, treadmill: 47.8%, P = 0.03), duration was shorter (overground: 69.1%, treadmill: 61.2%, P = 0.01), and integrated amplitude was lower (overground: 14.1, treadmill: 10.6, P = 0.05). Within limbs, paretic vastus lateralis onset occurred earlier relative to paretic foot strike. Nonparetic vastus lateralis onset occurred later relative to nonparetic foot strike. CONCLUSIONS: Treadmill walking induces immediate changes in vastus lateralis, but not medial ham-strings, activation patterns. These alterations (earlier paretic vastus lateralis onset and later nonparetic vastus lateralis onset) during treadmill versus overground walking parallel the increased symmetry in gait patterning.

Electromyography↗

Electromyographic comparison of standard and modified closed-chain isometric knee extension exercises.

The purpose of this study was to compare electromyographic (EMG) activity during open kinetic chain (OKC) and a modified closed kinetic chain (MCKC) knee extension exercises. Both OKC and closed kinetic chain (CKC) exercises provide benefits when devising conditioning programs; however, there are no exercises that combine the benefits of both exercises. Subjects performed maximum isometric knee extensions for both traditional OKC and MCKC knee extension exercises. Surface electrodes were placed on 8 lower-extremity muscles. One second of integrated EMG activity followed 95% maximal knee extension force. The following muscles demonstrated greater EMG activity during the MCKC vs. the OKC knee extension exercises: vastus medialis, medial hamstring, lateral hamstrings, and gluteus maximus. There was no difference between force output between the 2 conditions. This study demonstrates that modifications to traditional OKC exercises demonstrate some characteristics of CKC exercises, and therefore provide another avenue of rehabilitation or strengthening.

Adolescent↗

Comparison of three methods of assessing muscle strength and imbalance ratios of the knee.

Three strength measurement methods for determining muscle strength and imbalance ratios of the knee were compared in 41 (23 female, 18 male) NCAA Division I track and field athletes. Peak quadriceps extensions and hamstring flexions were measured isotonically, isometrically, and isokinetically. Isokinetic measurements were performed on a Cybex II at 60 degrees /s. Isometric extension and flexion measurements were performed using the Nicholas Manual Muscle Tester (Lafayette Instruments; Lafayette, Ind). Isotonic measurements were done on both Universal and Nautilus apparatuses. Testing order was randomized to avoid a treatment order effect. A repeated measures ANOVA and a post hoc Tukey test were used to compare the three methods of assessing strength and imbalance ratios of the knee. Absolute strength values were significantly different according to gender and mode of testing. Bilateral strength imbalance ratios for knee flexion were significantly lower for the Nautilus leg curl machine. Ipsilateral strength imbalance ratios were significantly greater for the Cybex II. Our results indicated that absolute strength values cannot be interchanged between testing modes. Except for Cybex II (ipsilateral) and Nautilus (bilateral knee flexion), strength imbalance ratios could be interchanged.

Journal Article↗

An in vitro study of anterior cruciate ligament strain induced by quadriceps and hamstrings forces.

Strain in the anteromedial fibers of the anterior cruciate ligament [ACL(am)] was studied in six cadaver knees. ACL(am) strain was measured in five knees during the application of isometric quadriceps forces alone and simultaneously applied isometric quadriceps and hamstrings forces at 10 degrees increments from 0 degrees to 90 degrees of knee flexion. ACL(am) strain during muscle loading was measured with respect to the ACL(am) strain measured with the knee in its resting position (neutral or near neutral position). A sixth knee was used to investigate the reproducibility of the resting position and quadriceps-induced ACL(am) strains. The strains induced in the ACL(am) by the quadriceps were significantly greater than 0 at knee flexion angles from 0 to 40 degrees and not significantly different from 0 for 50 to 90 degrees. The ACL(am) strains induced by simultaneously applied hamstrings and quadriceps forces were not significantly different from 0 at any of the knee flexion angles tested. Simultaneously applied hamstrings and quadriceps forces significantly reduced ACL(am) strain at 10, 20, and 90 degrees of knee flexion compared to the ACL(am) strain induced by quadriceps forces alone. The hamstrings are potentially capable of both significantly reducing and negating quadriceps-induced ACL(am) strain at 10 and 20 degrees of knee flexion.

Adult↗

Sports injuries in school gaelic football: a study over one season.

School football injuries were studied over the seven months of one season on 150 males aged 16.94 +/- 0.82 years. Training averaged 4.13 +/- 1.47 hours per week and matches 1.84 +/- 0.60 hours per week. Mean time injured was: 0.51 +/- 1.7 days in hospital, 34.27 +/- 37.08 days off sport and 13.98 +/- 5.22 days of restricted activity. There were 136 match and 63 training injuries giving 175.98 injuries per 10000 hours of matches and 31.06 injuries per 10000 hours of training. Injuries were treated as follows: hospital 83, general practitioners 51, physiotherapists 28, no treatment 38. The most common injuries were: ankle sprain (11.6% of the total), hamstring strain (6.5%), contusion (6.5%) back strain (6%) knee sprain (5.0%), finger sprain (5.0%), other muscle strains (5.0%), fracture of the wrist (5.0%), dislocation of the finger (4.5%), overuse injury of the back (4.0%), tenosynovitis (3.5%), fracture of the ankle (3.0%). Thirteen injuries were to goal-keepers, 85 to backs, 31 to mid-field players and 70 to forwards. In 34.83% of the injuries foul play was given as the major cause. This was followed by "Lack of fitness", "Poor kit or boots" and "Previous injury" (all 11.24%). The most common minor cause was "Poor state of the pitch" (17.42% of injuries).

Adolescent↗

Hamstrings stretch reflex in human spasticity.

In 16 patients with spastic paralysis the hamstrings stretch reflex was found to increase as the velocity of stretch increased, and generally to subside after movement ceased. These effects are attributable to the dynamic property of the primary spindle ending. The stretch reflex commonly appeared in only the last third of the stretching movement and was maximal as the knee became fully extended. This is consistent with the static properties of the primary and secondary spindle endings, and accounts for the absence of the clasp-knife phenomenon in the spastic hamstrings. The difference in the nature of the stretch reflex in spastic flexor and extensor muscles is best explained by the differential reflex effects of group II afferent fibres which facilitate flexor motoneurones and inhibit extensor motoneurones.

Electromyography↗