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The lower-extremity musculature in chronic symptomatic instability of the anterior cruciate ligament.

We studied the musculature of the lower extremity in forty-one patients with chronic symptomatic instability of the anterior cruciate ligament. Computed tomographic and clinical measurements of the limb were taken at levels fifteen and twenty-five centimeters proximal to the medial joint line and ten centimeters distal to it. Biopsy specimens from the vastus lateralis of both lower extremities were analyzed by histochemistry and electron microscopy. Computed tomography revealed a decrease in the muscle square area of the affected thigh of 8 per cent as compared with the control lower extremity. There was quadriceps atrophy of 10 per cent and hamstrings atrophy of only 4 per cent. The atrophy of the vastus medialis was significantly greater than that of the entire quadriceps. Histochemistry revealed a similar decrease in fiber size for all fiber types, and hence no shift in fiber type. Electron microscopy showed an increase in intracellular fat but no change in mitochondrial volume density or capillarization.

Adolescent↗

Isometric and isokinetic torque curves at the knee joint.

Isometric and isokinetic torques of bilateral quadriceps and hamstrings were measured with Isokinetic Rehabilitation and Testing System (Model No. Cybex 340) on 40 normal untrained subjects, 20 males and 20 females, ranging between the ages of 23 and 35 years. The mean peak isometric and isokinetic torque values of both muscle groups showed no significant differences between dominant (right) and nondominant (left) limbs in both sexes; however there were significant differences between the male and the female. As the angular velocity increased, the peak torque significantly decreased, and the point of peak torque output occurred significantly later in the range of motion for quadriceps and hamstrings (p less than 0.01). There were no significant changes in the hamstrings to quadriceps (H/Q) ratios as the angular velocity increased. However, there were significant differences of mean H/Q ratio between male and female (p less than 0.01). Height had significant positive correlation with peak isometric and isokinetic torques for both quadriceps and hamstrings (p less than 0.01). Weight was found to correlate significantly with peak isometric and isokinetic torques (p less than 0.01). The mean isometric torques were significantly higher than the mean isokinetic torques for any joint angles in both sexes (p less than .01).

Adult↗

Muscle weakness after anterior cruciate ligament reconstruction using patellar and quadriceps tendons.

Eighty-five knees of 85 patients who underwent anterior cruciate ligament reconstruction with autologous patellar and quadriceps tendon grafts were followed for 3-7 years. Hamstrings strength improved to normal. Quadriceps strength in men returned to the preoperative level, but not to normal strength. Quadriceps strength in women, at the final follow-up, was significantly less than it had been preoperatively. This weakness may be a consequence of impairment of the knee extensor mechanism resulting from harvesting the graft. Although favorable postoperative stability of the knee was obtained, we do not recommend this technique for ACL reconstruction because of the quadriceps weakness.

Adolescent↗

The effects of aerobic exercise on endurance, strength, function and self-perception in adolescents with spastic cerebral palsy: a report of three case studies.

PURPOSE: The purpose of this study was to investigate changes in endurance, strength, function, and self-perception before, during, and after aerobic exercise intervention in three ambulatory adolescents with spastic cerebral palsy. METHODS: Three individuals (17-20 years of age) with spastic cerebral palsy participated. An A1B1A2B2 design was employed. Data obtained during the different phases included energy expenditure index (EEI), lower extremity muscle strength using a handheld dynamometer, the Gross Motor Function Measure (GMFM), and the Self-Perception Profile for College Students (SPPCS). RESULTS: All participants had a significant improvement in at least one of the components of the EEI. Combined mean strength of quadriceps, hamstrings, and ankle plantarflexors and dorsiflexors increased bilaterally for all participants. Gross motor function improved for all participants in at least one phase of the study. The self-perception of appearance improved for all participants. CONCLUSIONS: Aerobic exercise may help increase strength of the lower extremity muscles, decrease energy required to ambulate, and improve gross motor function and self-perception for some adolescents with spastic cerebral palsy.

Adolescent↗

An overview of common soccer injuries. Management and prevention.

The most common injuries in soccer involve the ankle and knee joints, and the muscles and ligaments of the thigh and calf. Rehabilitation to restore strength and endurance after healing is extremely important to prevent a recurrence of the injury, which is much more severe and disabling than the initial injury. Sprains and strains of the hamstring and quadriceps, and injuries to the external and internal structures of the knee joints are frequent and relatively more disabling. Recent progress in the technical aspect of investigative medicine, such as magnetic resonance (MRI) imaging/quantitative only computer tomography (CT) scanning, ultrasonic imaging of soft tissues and isokinetic measurement of muscle characteristics, lead to better diagnosis and management of soccer injuries. Appropriate nutritional and physiological preparation, maintaining fluid and electrolytes during the game and restoration of the reserves following completion of exhaustive activities will help to minimise injuries.

Craniocerebral Trauma↗

Effects of age on the reciprocal peak torque ratios during knee muscle contractions in elite soccer players.

To investigate the effects of age on the reciprocal peak torque ratios during knee muscle contractions, 25 elite male soccer players, aged 22.3 +/- 3.8 yr (18-28), volunteered for the present study. The players were grouped as adult (> 21 years, n = 13) and young players (< or = 21 years, n = 12). Maximal concentric (CON) and eccentric (ECC) isokinetic thigh muscle strength was measured at angular velocities of 30 degrees, 180 degrees, 240 degrees and 300 degrees/s. ECC and CON peak torques of knee flexors (hamstring, HAM) and CON peak torques of knee extensors (quadriceps, QUA) in the dominant knee were greater (P < 0.05) in adult players than in young players at 180, 240 and 300 degrees/s. ECC HAM/CON QUA peak torque ratio at 300 degrees/s was greater (P < 0.05) for adult players compared to young players in the dominant knee but not in the nondominant knee. Furthermore, conventional HAM/QUA peak torque ratios of the dominant knee at all angular velocities for ECC contraction were higher (P < 0.05) in adult players than in young players. In conclusion, the findings of the present study indicate that the reciprocal torque ratio is influenced by age in the dominant knee of elite soccer players. Because there was no effect of age for the nondominant leg, the findings of the present study are more likely to be the result of the training background of the players than their age.

Adolescent↗

Chaotic analysis of electromyography signal at low back and lower limb muscles during forward bending posture.

The present study aims to perform further investigation on muscular activity during forward bending posture by applying a nonlinear dynamic (chaotic) analysis method. The objective is to determine the characteristics of the low back and lower limb muscle electromyography (EMG) signal under chaotic analysis while maintaining a certain posture. Twelve subjects were asked to maintain postures of six stages in bending angles from 0 to 180 degrees, and the EMG signals of erector spinae (ES) at L1 and L5 levels, hamstrings, and gastrocnemius were recorded. Two important concepts to characterize deterministic chaos, Correlation Dimension (D2) and Lyapunov Exponents (lambda, LE), were applied to observe the chaotic characteristic of the EMG signals, and the results were also compared to the FFT based total power value. The EMG signals in all observed muscles during bending posture showed results of positive LE and high D2 at 5.5 to 7.5, which led us to classify EMG as a high dimension chaotic signal. The result obtained showed that the correlation dimension could be used as a reliable method to compare the EMG signal in various postures (or muscle contraction conditions). However, Lyapunov exponents did not show a significant difference of comparison result thus leading to the conclusion that LE could not be a reliable measure for high dimension chaotic system, such as an EMG signal. It was also shown that in both light and deep bending, the EMG signal of the low back muscles was of the same complexity level due to the D2 result. It was evident that somehow the low back muscle remained loaded in all bending stages which was contrary to the hypothesis that the low back muscle was less active during the deep bending, as was the case in most of the previous studies. The reason of such phenomenon was elucidated with use of the theory of muscular functional differentiation, including corticalization and spinalization.

Adult↗

Relation between walking speed and muscle strength is affected by somatosensory loss in multiple sclerosis.

OBJECTIVE: To evaluate the correlation between gait speed and strength in multiple sclerosis (MS) with particular regard to patients presenting with proprioceptive loss. METHODS: Gait evaluation and isokinetic testing of muscular function were performed in 20 patients with unaided gait (expanded disability status scale < 6). Patients were separated into two groups in relation to the occurrence of somatosensory involvement: pyramidal group (8 patients) and sensory-pyramidal group (12 patients). Ten healthy subjects of similar age, sex, and height constituted a control group to evaluate gait parameters. RESULTS: In the whole patient group, gait speed was reduced and strongly related to hamstring peak torque but not with quadriceps peak torque. The gait speed and peak torques of quadriceps and hamstrings were similar in both groups of patients. However, in the patients with proprioceptive loss there was both a strong correlation between gait speed and hamstring torque and a significant correlation with quadriceps torque. In the pyramidal group there was poor or no correlation. CONCLUSION: In patients with undifferentiated MS there is some correlation between gait speed and muscle strength. In the case of sensory loss, a higher contribution of both flexor and extensors of the lower limbs was observed, suggesting that muscular compensation occurred in this situation to maintain gait speed. These results are relevant to assess rehabilitation modalities in MS.

Adult↗

Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season.

The following possible risk factors for leg injuries in female soccer players were studied: age, anatomical alignment, generalized joint laxity, thigh muscle torque, muscle flexibility, ligamentous laxity of the knee and ankle joints, recent injuries, and duration of soccer exposure. A total of 146 players from 13 teams in the second and third Swedish divisions underwent clinical examination, isokinetic measurements of quadriceps and hamstring torques, and testing of postural sway of the legs. All soccer-related leg injuries resulting in absence from at least one scheduled practice session or game were recorded during one outdoor season (April-October). In 50 players there were 61 traumatic injuries, and 17 players sustained 19 overuse injuries. The overall injury incidence rate (traumatic and overuse) was 5.49/1000 h of soccer. Variables significantly increasing the risk of traumatic leg injuries included generalized joint laxity, low postural sway of the legs, hyperextension of the knee joint, and a low hamstring-to-quadriceps ratio during concentric action. Multivariate logistic regression showed hyperextension of the knee joint, a low postural sway, reduced H/Q ratio during concentric action, and a higher exposure to soccer to significantly increase the risk of traumatic leg injury. All five players who suffered an anterior cruciate ligament injury during the study period had a lower hamstring-to-quadriceps ratio during concentric action on the injured side than on their noninjured side.

Adult↗

Mutability of bifunctional thigh muscle activity in pedaling due to contralateral leg force generation.

Locomotion requires uninterrupted transitions between limb extension and flexion. The role of contralateral sensorimotor signals in executing smooth transitions is little understood even though their participation is crucial to bipedal walking. However, elucidating neural interlimb coordinating mechanisms in human walking is difficult because changes to contralateral sensorimotor activity also affect the ipsilateral mechanics. Pedaling, conversely, is ideal for studying bilateral coordination because ipsilateral mechanics can be independently controlled. In pedaling, the anterior and posterior bifunctional thigh muscles develop needed anterior and posterior crank forces, respectively, to dominate the flexion-to-extension and extension-to-flexion transitions. We hypothesized that contralateral sensorimotor activity substantially contributes to the appropriate activation of these bifunctional muscles during the limb transitions. Bilateral pedal forces and surface electromyograms (EMGs) from four thigh muscles were collected from 15 subjects who pedaled with their right leg against a right-crank servomotor, which emulated the mechanical load experienced in conventional two-legged coupled-crank pedaling. In one pedaling session, the contralateral (left) leg pseudo-pedaled (i.e., EMG activity and pedal forces were pedaling-like, but pedal force was not allowed to affect crank rotation). In other sessions, the mechanically decoupled contralateral leg was first relaxed and then produced rhythmic isometric force trajectories during either leg flexion or one of the two limb transitions of the pedaling leg. With contralateral force production in the extension-to-flexion transition (predominantly by the hamstrings), rectus femoris activity and work output increased in the pedaling leg during its flexion-to-extension transition, which occurs simultaneously with contralateral extension-to-flexion in conventional pedaling. Similarly, with contralateral force production in the other transition (i.e., flexion-to-extension; predominantly by rectus femoris), hamstrings activity and work output increased in the pedaling leg during its extension-to-flexion transition. Therefore rhythmic isometric force generation in the contralateral leg supported the ongoing bifunctional muscle activity and resulting work output in the pedaling leg. The results suggest that neural interlimb coordinating mechanisms fine-tune bifunctional muscle activity in rhythmic lower-limb tasks to ensure limb flexion/extension transitions are executed successfully.

Adult↗

Architectural characteristics of muscle in black and white college football players.

PURPOSE: The purpose of this study was to determine whether architectural characteristics of skeletal muscle differ by race. METHODS: Skeletal muscle architectural characteristics and body composition were studied in 13 black and 31 white male college football players. Fat-free mass (FFM) and percentage body fat (% fat) were determined by hydrostatic weighing technique. Muscle thickness (MTH) was measured by B-mode ultrasound at 13 anatomical sites. Isolated MTH and muscle pennation angle (PANG) of the triceps long head, vastus lateralis, and gastrocnemius medialis muscles were measured by ultrasound, and fascicle length was estimated. RESULTS: There were no significant differences between blacks and whites in isolated MTH, PANG, and fascicle length in the triceps long head, vastus lateralis, and gastrocnemius medialis muscles. On average, % fat and FFM of black and white football players were 18.8 +/- 4.6% and 17.2 +/- 5.6% for % fat, and 89.9 +/- 15.6 kg and 89.1 +/- 10.4 kg for FFM, respectively. Blacks had a significantly greater, 30%-quadriceps (P < 0.05), 50%-hamstrings (P < 0.05), biceps (P < 0.01), and abdomen (P < 0.01) MTH than those of whites. Standing height and body weight were similar between blacks and whites, but the ratio of leg length to standing height was significantly greater in blacks compared with whites. CONCLUSIONS: It appears that although there may be race differences in anatomical stature, muscle architecture is likely independent of race.

Adult↗

Synergies and strategies underlying normal and vestibulary deficient control of balance: implication for neuroprosthetic control.

Future developments of neuroprosthetic control will probably permit locomotion and posture to be maintained without the aid of crutches and will therefore require some form of balance control. Three fundamental questions will arise. First, the question of the location of imbalance-sensing transducers must be assessed. Secondly, the synergy, which is the relative amplitude and timing of muscle activity, and/or the strategy of joint torques required to re-establish a stable posture for different types of balance disturbances must be addressed. Thirdly, the control laws that map either trunk muscle activity or imbalance-sensing transducer outputs into multi-joint postural control of standing by paraplegic individuals must be generated. The most appropriate means of gathering the relevant information applicable to neuroprosthetic control systems is through the detailed analysis of normal and non-normal human models. In order to gain such detailed insights into normal balance control and its dependence on head angular and linear accelerations, the synergy and strategy of balance corrections in normal subjects or patients with vestibular deficits were investigated for two types of support surface perturbation, a dorsiflexion rotation (ROT) and a rearward translation (TRANS). These experimentally induced perturbations to upright stance were adjusted to cause equal amplitudes of ankle dorsiflexion, thus providing additional information about the role of lower leg proprioception on balance control. Synergies defined on the basis of peak cross-correlations of each recorded muscle's EMG to that of the largest muscle response were significantly different for TRANS and ROT. Translation synergies consisted of a sequential coactivation at several levels (soleus and abdominals some 30 msec before hamstrings, and trapezius some 15 msec before paraspinals), whereas the sequential activation of paraspinals and tibialis anterior dominated the balance synergy to ROT. Likewise, response strategies, defined using cross-correlations of joint torques, differed. That for TRANS was organised as a multi-link strategy with neck torques leading those of all other joints by 40 msec or more; hip joint lead ankle torques by 30 msec. That for ROT was organised around hip and ankle torques without a major correlation to neck torques. Vestibulary deficient subjects developed weaker synergies with respect to subjects with normal balance systems under eyes-open conditions and there was no clear synergy with eyes closed. Consequently, hip torques were delayed some 180 msec with respect to ankle torques, and correlations to neck torques were completely out of phase under eyes-closed conditions. Fundamental changes in TRANS synergies and strategies also occurred in vestibulary deficient subjects for eyes-open and eyes-closed conditions.(ABSTRACT TRUNCATED AT 400 WORDS)

Ankle↗

Postural muscle activity during bilateral and unilateral arm movements at different speeds.

The muscle activation patterns in anterior and posterior leg muscles were investigated with two types of perturbations to standing balance. Subjects stood with each foot on adjacent force platforms and performed arm flexion movements to shoulder height. Nine subjects performed ten repetitions unilaterally and bilaterally at 100, 75, 50, 25, and 12.5% of maximal acceleration as measured by an accelerometer placed on the dominant hand. Four subjects also performed the fastest movements while leaning forwards and backwards. The area and latency of the EMG activity from the quadriceps (QUAD), hamstrings (BF), soleus (SOL), and tibialis anterior (TA) were measured bilaterally, along with the excursions of the center of pressure (COP) during each movement. In both unilateral and bilateral tasks, subjects showed a scaling of EMG area and COP excursion with the acceleration of the arm movement. Prior to movement onset, significant scaling of EMG area with movement speed occurred in both unilateral and bilateral tasks in most muscles. Following movement onset, EMG areas scaled significantly to movement speed in only the anterior musculature, with the exception of the left BF. The latency of BF was consistent for the four fastest movements. Only the slowest movements resulted in a significant rightward shift of the BF EMG latency. During the unilateral task, the ipsilateral hamstrings were activated significantly earlier than in the bilateral task and the contralateral hamstrings were activated significantly later. It was also observed that subjects utilized one of two different strategies to maintain balance. Five individuals displayed simultaneous anterior/posterior muscle activation while the other four displayed a reciprocal pattern of activation. Regardless of the initial standing position (leaning forwards or backwards), subjects used the same simultaneous or reciprocal activation strategy. The results indicate that muscle activation patterns change with different tasks, but remain the same during variations of the same task.

Adult↗

Electromyographic activity of back musculature during Williams' flexion exercises.

The purpose of this investigation was to determine the pattern and magnitude of electromyographic activity recorded from paraspinal musculature at four different vertebral levels while subjects performed six Williams' flexion exercises with anterior and posterior pelvic tilt. Bipolar surface electrodes were placed on the right sides, at C5, T6, L3, and S1, of eight men and eight women. Integrated electromyographic activity was analyzed at the end of range of each exercise. A significant (P less than .05) interaction effect was found between exercises and types of tilt at each vertebral level. The difference in electromyographic activity between the two pelvic positions was most evident in the lumbar and sacral areas, where electromyographic activity recorded for anterior tilt was greater than for posterior tilt. The results support the following conclusions: 1) pelvic tilt, curl up, knees to chest, and hamstring stretch performed with posterior tilt minimize the electromyographic activity in the lumbar and sacral regions that occurs in conjunction with lengthening of these muscles during posterior pelvic tilt, 2) use of the standing exercises and anterior tilt positions should be avoided if minimizing electromyographic activity in the lumbar and sacral regions is desired, and 3) the electromyographic activity of each of the four different vertebral levels responded independently of every other level during performance of Williams' flexion exercises.

Adult↗

Effect of patellectomy on the function of the quadriceps and hamstrings.

The Cybex-II isokinetic dynamometer was used to measure quadriceps and hamstrings function after unilateral patellectomy in twelve patients. The interval between surgery and testing averaged twenty-six months (range, fourteen to forty-two months). Data on isokinetic and isometric performance were compared with those of the untreated limb and with those of subjects who had not been operated on but who had been matched by age, sex, and weight. On the side that had been operated on, the peak torque of the quadriceps was significantly decreased whereas the peak torque of the hamstrings was preserved. Deficits in time factors related to the development of tension and high-speed performance were documented, revealing abnormalities in both muscle groups. Although patellectomy was successful in achieving relief of pain in these patients, the results of the study confirmed that the function of the knee muscles was compromised postoperatively. The objective findings documented alterations in muscle function that correlated well with the functional limitations described by the patients.

Adult↗