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Force-time measurements of knee muscle functions of subjects with multiple sclerosis.

The purpose of this study was to determine whether the time-rate of muscle tension development, the muscle tension-maintaining capacity, and the reciprocal inhibition time of muscles in subjects with multiple sclerosis were significantly different from those of healthy subjects. An isokinetic dynamometer was used to evaluate the quadriceps femoris and hamstring muscles of 15 Experimental Group subjects with multiple sclerosis and 17 healthy Control Group subjects. The muscles were tested isometrically at 45 degrees of knee flexion and isokinetically at speeds of 30 degrees/sec and 90 degrees/sec. The subjects with multiple sclerosis demonstrated a significant (p less than .001) slowing of the time-rate of muscle tension development and a significant (p less than .005) decrease in muscle tension-maintaining capacity when compared with healthy subjects. The difference in the reciprocal inhibition time of muscles of the Experimental and Control Groups was not significant. When the reciprocal inhibition time of muscles was expressed as a percentage of the total torque curve, however, a significant prolongation (p less than .001) was observed in the subjects with multiple sclerosis.

Adolescent

Dynamic EMG analysis of anterior cruciate deficient legs with and without bracing during cutting.

The purpose of this research was to determine if bracing altered muscle firing amplitude, duration, or timing, creating improved dynamic stability. We hypothesized that a derotational knee brace improved the stability of an ACL deficient knee by augmenting limb proprioception, causing hamstring muscles to increase in activity and/or to contract earlier during a side-step cut. Ten subjects with documented unilateral isolated ACL deficient knees and five normal controls participated. A strap dominant brace (Lenox Hill, Lenox Hill Brace, Inc., Long Island City, NY) and a shell dominant brace (CTi, Innovation Sports, Irvine, CA) were selected for study. Using footswitches and dynamic EMG, we tested each subject during performance of a side-step cutting maneuver. Subjects completed 15 trials: 5 without bracing, 5 with the strap dominant brace, and 5 with the shell dominant brace. Normals cut 10 times each on their dominant limb. In swing phase, subjects had 38% more and 32% higher lateral hamstring EMG activity than normals; in stance phase, subjects had less quadriceps and gastrocnemius activity but more medial hamstring activity. When braced during stance phase, the ACL deficient legs demonstrated a further reduction of 18% in quadriceps total activity and 14% in peak activity compared to the unbraced situation. The hamstrings showed a concomitant decrease of 18% in total activity. No timing differences were noted between the braced and unbraced conditions during swing or stance phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Thigh muscle activity during maximum-height jumps by cats.

Cats were trained to jump from a force plate and touch a cotton ball suspended as high as 1.6 m. Force-plate reaction forces and double-joint hamstring muscle activity observed early in propulsion varied from one maximal jump to another. This variability is consistent with theory (31, 32, 42); that is, different coordination strategies can be implemented prior to the heels losing contact with the force plate (heel-off). Single-joint hip extensor and double-joint posterior thigh (hip extensor-knee flexor) muscles were coactivated prior to heel-off. This coactivation is probably partially responsible for the observed backward rotation of the trunk. Forepaws, observed to contact the force plate prior to heel-off, probably assist the hindlimbs in generating trunk rotation. Both single-joint knee extensor and hip extensor muscles exhibited greatest activation between heel-off and body lift-off. Single-joint flexor muscles were inactive throughout propulsion. Double-joint posterior thigh muscles were deactivated at heel-off and remained inactivated until lift-off. These observations agree with the theoretical notion that muscles should be either fully activated, inactivated, or switched from one extreme to the other (i.e., bang-bang control) between heel-off and body lift-off (31, 32, 42, 44). All seven muscles studied shortened while activated. Using computations based on muscle geometry, fiber architecture, and joint angle trajectories, I propose that sarcomeres shorten along the flat and ascending regions of the force-length curve. De- and inactivation of double-joint posterior thigh muscles between heel-off and lift-off coincided with muscle stretch. The reason for inactivation of these muscles is that the negative work that would have been generated had these muscles stayed activated would have hindered propulsion. Contractions preceded by active stretch were not observed. Enhancement of positive work by previous storage of energy in elastic musculotendinous structures is thus not used by cat thigh musculature in jumps starting from the squat. Adductor femoris, semimembranosus anterior, and biceps femoris anterior muscles were activated synergistically as one group yet differently from the synergistic activation of gracilis, semitendinosus, and biceps femoris posterior muscles. The separation of these muscles into two groups based on their activation patterns during jumping is compatible with the classification of these muscles into hip extensor and knee flexor muscle groups, respectively, based on their reflex patterns (37), spinal cord reflex connectivity (18, 30), and firing patterns during locomotion (20).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals

Mechanics of the knee. A study of joint and muscle load with clinical applications.

The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg box was quantified using a computerized static sagittal plane body model. Surface electromyography of quadriceps and hamstrings muscles was normalized and expressed as a percentage of an isometric maximum voluntary test contraction. Working with straight knees and the trunk flexed forwards induced extending knee load moments of maximum 55 Nm. Lifting the box with flexed knees gave flexing moments of 50 Nm at the beginning of the lift, irrespective of whether the burden was between or in front of the feet. During machine milking, a level difference between operator and cow of 0.70 m - 1.0 m significantly lowered the knee extending moments. To quantify the force magnitudes acting in the tibio-femoral and patello-femoral joints, a local biomechanical model of the knee was developed using a combination of cadaver knee dissections and lateral knee radiographs of healthy subjects. The moment arm of the knee extensor was significantly shorter for women than for men, which resulted in higher knee joint forces in women if the same moment was produced. A diagram for quantifying patellar forces was worked out. The force magnitudes given by the knee joint biomechanical model correlated well with experimentally forces measured by others. During the parallel squat in powerlifting, the maximum flexing knee load moment was estimated to 335-550 Nm when carrying a 382.5 kg burden and the in vivo force of a complete quadriceps tendon-muscle rupture to between 10,900 and 18,300 N. During isokinetic knee extension, the tibio-femoral compressive force reached peak magnitudes of 9 times body weight and the anteroposterior shear force was close to 1 body weight at knee angles straighter than 60 degrees, indicating that high forces stress the anterior cruciate ligament. A proximal resistance pad position decreased the shear force considerably, and this position is recommended in early rehabilitation after anterior cruciate ligament repairs or reconstructions. The methods presented quantify muscle activity, sagittal knee joint moments and forces, enabling assessments to be made of different work postures, training exercises and joint derangements.

Adult

Knee muscle strength in elite male gymnasts.

This study was launched to establish the profile of knee dynamic concentric strength in elite male gymnasts after it was found that three of the 10-member Canadian men's gymnastics team had incurred anterior cruciate ligament (ACL) rupture. The dynamic concentric force characteristics of the quadriceps and hamstring muscles of 84 male gymnasts were studied at the Canadian National Championships using a Kin-Com isokinetic dynamometer. These tests were performed at 90 degrees/sec and 230 degrees/sec and revealed that the hamstrings to quadriceps peak torque ratio was not only unusually low (0.5) when compared with data collected in previous research, but that this ratio was consistent across all ages, from 12 to 27 years. The torque ratios were also reported at 30 degrees, 45 degrees, and 60 degrees and it was found that the ratios decreased as the joint angle increased and again was consistent across the four age groups. It was also found that the hamstrings to quadriceps peak torque ratio did not increase (hamstrings becoming stronger relative to quadriceps) as velocity of movement increased as has been reported in other studies. It was hypothesized that the large shear forces that are generated about the knee in gymnastics (extrinsically from backward landing and intrinsically from the quadriceps eccentrically contracting), combined with the relatively weak hamstrings, could be one cause for the increasing incidence of ACL injuries in that sport. The results of this study indicate that it would be prudent for clinicians involved with gymnasts to test for knee strength imbalance and to prescribe exercises to correct it when necessary.

Adolescent

The influence of ankle sprain injury on muscle activation during hip extension.

The likely influence of a localised injury in a distal joint on the function of proximal muscles is an important consideration in assessment and treatment of musculoskeletal injuries. However, little experimental evidence in humans exists in this area. Accordingly, a controlled study was carried out, in which the function of muscles at the hip was compared between subjects who had suffered previous severe unilateral ankle sprain and matched control subjects. The pattern of activation of the gluteus maximus, the hamstring muscles and the ipsilateral and contralateral erector spinae muscles was monitored through the use of surface electromyography during hip extension from prone lying. Analyses revealed that the pattern of muscle activation in subjects with previous injury differed markedly from normal control subjects, and that changes appeared to occur on both the uninjured and the injured sides of the body. A significant difference between the two groups was the delay in onset of activation of the gluteus maximus in previously injured subjects. The existence of remote changes in muscle function following injury found in this study emphasise the importance of extending assessment beyond the side and site of injury.

Adolescent

Isokinetic hamstring/quadriceps strength ratio: influence from joint angular velocity, gravity correction and contraction mode.

This study investigated isokinetic peak- and angle-specific hamstring/quadriceps strength ratios (conventional H/Q ratio) obtained during concentric and eccentric muscle contraction and examined the influence of joint angular velocity and the effect of gravity correction on these ratios. Also, a 'functional' H/Q ratio was defined by calculating eccentric hamstring strength relative to concentric quadriceps strength (Hecc/Qcon' representative for knee extension) and calculating concentric hamstring strength relative to eccentric quadriceps strength (Hcon/Qecc' representative for knee flexion). The H/Q ratio was calculated based on isokinetic peak moment and 50 degree-moment (0 degree = full extension) obtained at joint angular velocities 30, 120 and 240 degrees s-1. Gravity corrected conventional H/Q ratio remained constant across speeds and contraction mode, ranging from 0.47 to 0.54 and from 0.49 to 0.56 based on peak and 50 degree moment, respectively. In contrast, non-corrected H/Q ratio increased during concentric contraction from 0.58 at 30 degrees s-1 to 0.74 at 240 degree s-1 (P < 0.01). For knee extension at 240 degrees s-1 an Hecc/Qcon of 1.05 (peak) and 0.89 (50 degrees) was observed while for flexion at 240 degrees s-1 an Hcon/Qecc of 0.27 (peak) and 0.28 (50 degrees) was observed. In conclusion, gravity correction had high influence on the change in H/Q ratio with variation in extension velocity. A potential 1:1 hamstring/quadriceps strength relationship was demonstrated for fast knee extension, indicating a significant functional capacity of the hamstring muscles for providing muscular stability at the knee joint in such situations.

Adult

Differential responses to proprioceptive neuromuscular facilitation (PNF) stretch techniques.

The purpose of this study was to investigate the effects of sustained stretch and two common proprioceptive neuromuscular facilitation (PNF) stretch techniques on hamstring muscle activation and knee extension range of motion (ROM) in different athletic populations. Three stretch techniques: stretch-relax (SR), contract-relax (CR), and agonist contract-relax (ACR) were applied to 10 endurance athletes (EN), 10 high intensity athletes (HI), and 10 control subjects (C). The results revealed that ACR produced 89-110% greater hamstring EMG activity (P less than 0.05) and 9-13% more knee joint ROM than CR and SR, respectively. This same pattern was evident for the individual subject groups. Comparisons of mean data among the three subject groups revealed that the EN athletes generated 58-113% more hamstring EMG activity (P less than 0.05) than the HI and C groups, respectively, across all stretch conditions, whereas the EN group attained significantly less ROM than the HI and C groups for CR and ACR conditions. It was postulated that high intensity-short term activity training necessitates less hamstring resistance to knee extension than long term endurance training. The findings suggest that decreases in muscle activity may not be strongly related to increases in joint range of motion and that factors other than muscle relaxation are important in achieving increased ROM. Also, the differential effects of various stretch techniques between dissimilar athletic populations should be considered if stretch-induced injury is to be avoided.

Adult

Ankle muscle activity during gait in children with cerebral palsy and equinovarus deformity.

Temporal electromyographic (EMG) characteristics of lower limb muscles during gait of spastic hemiplegic and diplegic children with cerebral palsy are described. All subjects were referred for presurgical evaluation of equinovarus deformity. The data indicated both similar and discriminating phasic EMG characteristics between groups of patients. All children displayed premature triceps surae activity beginning in swing phase of gait and continuing through stance. Tibialis posterior, normally active during stance, was also active during swing phase of gait. However, some patients displayed cocontraction of triceps surae and tibialis anterior during stance, together with hamstring muscle activity within normal limits. The remainder of the patients displayed a prolonged duration of hamstring activity. How this gait analysis contributed to presurgical decisions for equinovarus gait is discussed and compared with data from postsurgical gait analysis.

Ankle

Serial isokinetic evaluations used for a patient with scapuloperoneal muscular dystrophy. A case report.

This article reports the reversal of an atypical rapid decline in muscle strength experienced by a patient with scapuloperoneal muscular dystrophy by modulating his excessive daily physical activity. This process was aided by our monitoring the strength of the quadriceps femoris and hamstring muscles using an isokinetic dynamometer. Serial torque values for muscle strength were compared as the total daily physical activity was decreased systematically. The torque values for thigh muscle strength increased as the subject's total work load was decreased. A complete management program for neuromuscular patients should include specified amounts of daily physical activity, rest, and therapeutic exercise.

Adult

Effect of knee joint laxity on long-loop postural reflexes: evidence for a human capsular-hamstring reflex.

The onset latency and discharge amplitude of preprogrammed postural responses were evaluated in order to determine if the structure of synergistic activation could be altered by ligamentous laxity at the knee joint. Twelve subjects with unilateral and one subject with bilateral anterior cruciate ligament (ACL) insufficiency were tested while standing on a moveable platform. External balance perturbations (6 cm anterior or posterior horizontal displacements of the platform) were presented at velocities ranging from 15 to 35 cm/s. Perturbations were presented under the following experimental conditions: unilateral and bilateral stance, knees fully straight or flexed, and with ankle motion restricted or free. These stance, knee position, and ankle motion conditions were introduced to alter the stress transmitted to the knee joint during movement of the support surface. The automatic postural response was recorded from the tibialis anterior (T), quadriceps (Q), and medial hamstrings muscles (H) bilaterally. The normal response to an externally induced backward sway involved the automatic activation of T and Q at latencies of 80 ms and 90 ms respectively. Activation of the hamstrings in the non-injured extremity was not coupled with the postural response. Hamstrings are not typically involved in the correction posterior sway because H activation would tend to pull the center of mass further backwards. However, when the response in the ACL-deficient extremity was compared to the non-injured limb: (1) the automatic postural response in the ACL-deficient extremity was restructured to include hamstrings activation (100 ms latency), (2) H activation time was faster and less variable in the ACL-deficient limb, and (3) the ratio of H/Q discharge amplitude integrated over 100 ms and 200 ms from the onset of EMG activation showed a dominance of hamstring activity during unilateral stance on the lax limb. In addition, H/Q ratios integrated over 200 ms showed dominant hamstring activity in the ACL-deficient limb during bilateral stance. (4) Cross-limb comparisons showed greater normalized IEMG amplitudes for T, H, and Q during unilateral stance on the lax limb. These results suggest that a capsular-hamstring reflex is integrated into the existing structure of a preprogrammed postural synergy in order to compensate for ligamentous laxity. Furthermore, the generalized increase of response gain observed during perturbations of unilateral stance on the lax limb indicates that joint afference can modulate central programming to control localized joint hypermobility. A concept of postural control is discussed with respect to the capsular reflex, joint loading and displacement of the center of gravity.

Adolescent

Non-surgical management of overuse knee injuries in runners.

Seventy-three injured runners (45 men, 28 women) who presented with 83 running-induced overuse knee injuries were managed conservatively. The regimens utilized focused on quadriceps and hamstring muscle retraining and the control of functional overpronation. Patello-femoral pain syndrome (42 cases) was by far the most common problem. The next most common problems were iliotibial band friction syndrome (10), patellar tendonitis (9) and popliteal tendonitis (5). The most frequent etiological factor was a sudden increase in training mileage. Following the initial visit and at regular intervals throughout the recovery phase, quadriceps and hamstring capacities were determined on a Cybex II isokinetic unit at 60 degrees/second and 180 degrees/second. Significant differences (p less than 0.01) in Cybex scores were observed between strong and weak extremities in males and females for both muscle groups at both velocities. The mean Cybex scores and the differences with muscle groups between strong and weak legs for the subjects were similar to those reported for healthy non-athletes. The treatment protocol followed four basic principles: control of pain; rebuilding of muscle strength and endurance; improvement of bio-mechanical efficiency and gradual reintroduction of training. No significant changes in the differences between strong and weak leg Cybex scores occurred between the initial and final evaluations, except in the male group when the hamstrings were evaluated at 60 degrees/second (p less than 0.01). In the 82 cases managed non-surgically, 1 poor, 8 fair, 36 good and 37 excellent results were obtained. The authors believe that the significance of disturbance in quadriceps and hamstring function to the etiology of overuse knee injuries may be increased in runners who over-pronate.

Adolescent

Serum creatine kinase activity and its changes after a muscle biopsy.

The significance of the absolute elevations of serum creatine kinase (CK) levels after intense exercise and injuries was studied by measuring CK activities from seven healthy active males during a 2-week period, with a muscle biopsy taken between the first and second week. Most of the subjects (three lifters and two runners) carried on their normal exercise activities, while two lifters stopped training during the 2 weeks. The weight of the biopsy, number of fibres, percentage of fibre types, and cross-sectional areas of the muscle fibres were measured. The CK levels of the non-active subjects and runners remained consistently low during the control week, whereas those of the lifters were usually 500% greater than those of the other two groups, and fluctuated with the intensity of their workouts. A muscle biopsy, having a mean weight of 71.3 mg and containing 1800 fibres, increased the CK values by approximately 100 units litre-1 (U l-1) in most of the subjects. One runner injured his right hamstring muscles 2 days prior to the biopsy, and his CK values rose from 50 to 4400 U l-1. The increases in CK after the biopsy were not related to fibre type, activity, weight of the biopsy, or number or size of fibres removed. These results indicate that: (1) CK values are consistently lower in normal subjects and runners than in lifters. (2) Weight training results in chronic elevations of CK. (3) Compared to a muscle biopsy, muscular injury dramatically increases CK levels. (4) Elevation of serum CK is observed as early as 1 h after an intense weight-lifting session.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle

Isokinetic measurements of muscle strength in hysterical paresis.

The torque during isokinetic knee extensions and flexions was determined in repeated tests at 3 speeds of angular rotation in 25 patients with pareses considered to be hysterical after relevant examinations and follow-up. The torque records were combined with surface EMG from the quadriceps and the hamstring muscles in some patients. Besides the weakness, 3 signs were observed that are not usually seen in patients with pareses due to verified peripheral or central lesions. These signs were: Enlarged variability of torque in repeated tests of the same movement (larger than 20% of maximum torque in 22 patients). Higher torque in fast movements than in slow movements (8 patients). Force production in knee flexion less than that expected from the weight of leg and lever arm due to restraining activation of the quadriceps muscle (12 patients). The restraint was present although there was no spasticity. The signs reflect inconsistent and contradictory motor performance that is not compatible with a genuine paresis. Thus, they aid the identification of weakness of functional origin.

Adult

Topical anesthesia: H-reflex recovery changes by desensitization of the skin.

The H-reflex recovery curve of the soleus muscle was studied in 53 normal subjects before and after the application of topical anesthesia (20% benzocaine) to various skin areas and dermatomes of the lower limb. Skin areas were those overlying the calf, tibialis anterior, quadriceps and hamstrings muscles, and the dermatomes were L2, L3, L4, L5, S1, S2. In 42 subjects the H-reflex initial recovery decreased by 10-80 msec with a mean of 20 +/- 17 msec 30 min after application of topical anesthesia. Also, the test reflex (the second sequential H-reflex) had a faster recovery with less inhibition than that before anesthesia. It was also noticed that the longer the inhibition period before anesthesia, the greater the decrease in recovery time. These observations had no correlation with the skin area or dermatome desensitized by the anesthesia. furthermore, these observations were not noted when a placebo was sprayed on the skin. The results from this study indicate that input from cutaneous afferents may have an important inhibitory effect on the alpha-motoneurons of the soleus muscle. This effect is possibly more profound on the large phasic motoneurons. These results are discussed in relation to clinical interpretations of the H-reflex recovery curves.

Adolescent

Reflex responses of human thigh muscles to non-noxious sural stimulation during stepping.

An investigation of reflex responses of leg muscles to sural stimulation during stepping was performed on human subjects. Non-noxious electrical stimulation applied during the swing phase or the latter half of the stance phase produced a mixed increase and decrease of EMG activity in the hamstring muscles. No response or very weak response was observed when the same stimulus was applied during either quiet standing or various levels of constant voluntary effort at varying hip and knee joint angles.

Adult

Electromyographic analysis of postural adjustments in two methods of balance testing.

The primary purpose of this study was to compare postural responses during two methods of balance testing: 1) a platform perturbation test (PP), with destabilizing forces of uniform magnitude given at the base of support, and 2) a postural stress test (PST), with destabilizing forces of increasing magnitude given at the waist. A secondary purpose was to examine the relationship between balance strategy scores and the patterns of muscle responses as determined by electromyographic analysis on the PST. Postural responses to backward sway of 17 healthy subjects, aged 60 to 79 years (means = 69.0, s = 5.3), were characterized bilaterally by EMG recording of the tibialis anterior, quadriceps femoris, gastrocnemius, and hamstring muscles. We examined three measures of bilateral postural responses: 1) latency to first muscle response (FR) among the four lower extremity muscle groups, 2) tibialis anterior muscle latency (TA), and 3) patterns of muscle responses. Our results demonstrated significantly shorter (p less than .001) TAs and FRs (in milliseconds) on the PST than on the PP (PST TA: = means = 80.3, s = 12.4; PP TA: = means = 142.6, s = 13.4; PST FR: means = 75.9, s = 10.4; PP FR: = means = 140.4, s = 13.6). The ankle strategy was the most frequently used pattern of muscle response during both the PP and the PST, but it occurred less frequently on the PST than on the PP (PP = 72.5%, PST = 50.9%) (p less than .05). No consistent relationship was observed between the balance strategy scores as determined by videotape analysis of the PST and the patterns of muscle responses as determined by EMG analysis.

Aged

A clinical trial of strengthening and aerobic exercise to improve gait and balance in elderly male nursing home residents.

The purpose of this study was to determine whether a moderate to high intensity strengthening and aerobic exercise program can improve the strength, exercise capacity, gait and balance of deconditioned male nursing home residents. Ambulatory subjects who scored 30 or less on the modified Tinetti gait and balance assessment scale, who demonstrated less than 80% of age-matched lower extremity strength on isokinetic muscle testing and who gave informed consent were enrolled. Subjects were randomized to either an exercise (n = 8) or a control (n = 6) group. All participants underwent an exercise test to determine maximal oxygen uptake (VO2max) and received quantitative gait and balance measurements. The subjects assigned to the exercise group than completed a 12-wk program of weight training for the lower extremities and stationary cycling. Both the exercise and control groups were then retested. Ten outcome variables were assessed: Tinetti mobility scores, VO2max, isokinetic-tested lower extremity strength and endurance, stride length, gait velocity, stance time, gait duration, cadence and balance. The exercise group, after completion of the program, demonstrated significant improvements in Tinetti mobility scores (P < 0.05), combined right and left quadricep muscle strength (P < 0.01), right and left lower extremity muscular endurance (P < 0.01), left stride length and gait velocity (P < 0.05), although other outcome variables changed insignificantly. The control group revealed no changes of significance with the exception of improvement of the combined right and left hamstring muscle strength (P < 0.05). Nevertheless, for those outcome variables that had improved significantly in the exercise group, the changes amounted to only a 5 to 10% increase over the baseline measurements. These findings showed that an appropriately designed high intensity exercise program can result in significant although limited improvements for clinical mobility scores, strength, muscular endurance and certain gait parameters.

Aged