Isokinetic and static plantar flexion characteristics

Age-related changes and sex differences in ankle plantarflexion velocity

Ankle plantar flexors play a vital role in the mobility of older adults. The strength and velocity of plantarflexion are critical factors in determining walking speed. Despite reports on how age and sex affect plantarflexion strength, basic information regarding plantarflexion velocity is still lacking. This cross-sectional observational study investigated age-related changes and sex differences in plantarflexion velocity by comparing them with plantarflexion strength. A total of 550 healthy adults were classified into four age groups for each sex: Young (< 40 years old), Middle-aged (40-64 years old), Young-old (65-74 years old), and Older-old (≧ 75 years old). We measured plantarflexion velocity and strength in the long-sitting position using a gyroscope and a hand-held dynamometer, respectively. Two-way analysis of variance revealed no interaction between age and sex for either plantarflexion velocity or strength. Plantarflexion velocity exhibited a significant decline with aging, as did the plantarflexion strength. We found no significant sex differences in plantarflexion velocity in contrast to plantarflexion strength. The results indicated a significant decrease with age and no difference in plantarflexion velocity between males and females characteristic plantarflexion velocity. Understanding the characteristics of plantarflexion velocity could contribute to preventing a decline in mobility in older adults.

Age-related changes in the passive properties of the plantarflexors: Influence of tissue size and quality

BACKGROUND

Limited research exists examining the influence of age on the passive mechanical properties of the muscle-tendon unit. The purpose of the present study was to 1) investigate the age-related differences in maximum range of motion (MRoM), stretch tolerance (maximal tolerable torque), and the dissipation coefficient (DC), and 2) examine the influence of plantarflexor muscle size and quality on the age-related differences in the DC.

METHODS

Twenty-one young and 14 older men completed a MRoM assessment to determine peak torque (PT_pass), energy stored (area under the loading curve), energy restituted (area under the unloading curve), and the DC (normalized hysteresis) from the angle-torque curve. Ultrasonography was used to determine muscle cross-sectional area (CSA) and subcutaneous fat corrected echo intensity (EI) of the gastrocnemii.

FINDINGS

The PT_pass, MRoM, and energy restituted were greater (P ≤ 0.046) in the young men, whereas the DC and EI were greater (P ≤ 0.024) in the older men. When accounting for CSA, differences between groups for the DC remained (P = 0.028), while there were no longer differences between groups when accounting for EI (P = 0.120). PT_pass was also strongly related to MRoM (r = 0.755, P < 0.001).

INTERPRETATION

Older men exhibited lower dorsiflexion MRoM and a greater DC, which may be explained by an altered stretch tolerance and qualitative changes (i.e., non-contractile tissue infiltration) in aged skeletal muscle leading to greater energy dissipated, respectively.

Mobility related physical and functional losses due to aging and disease - a motivation for lower limb exoskeletons

BACKGROUND

Physical and functional losses due to aging and diseases decrease human mobility, independence, and quality of life. This study is aimed at summarizing and quantifying these losses in order to motivate solutions to overcome them with a special focus on the possibilities by using lower limb exoskeletons.

METHODS

A narrative literature review was performed to determine a broad range of mobility-related physical and functional measures that are affected by aging and selected cardiovascular, respiratory, musculoskeletal, and neurological diseases.

RESULTS

The study identified that decreases in limb maximum muscle force and power (33% and 49%, respectively, 25-75 yrs) and in maximum oxygen consumption (40%, 20-80 yrs) occur for older adults compared to young adults. Reaction times more than double (18-90 yrs) and losses in the visual, vestibular, and somatosensory systems were reported. Additionally, we found decreases in steps per day (75%, 60-85 yrs), maximum walking speed (24% 25-75 yrs), and maximum six-minute and self-selected walking speed (38% and 21%, respectively, 20-85 yrs), while we found increases in the number of falls relative to the number of steps per day (800%), injuries due to falls (472%, 30-90 yrs) and deaths caused by fall (4000%, 65-90 yrs). Measures were identified to be worse for individuals with impaired mobility. Additional detrimental effects identified for them were the loss of upright standing and locomotion, freezing in movement, joint stress, pain, and changes in gait patterns.

DISCUSSION

This review shows that aging and chronic conditions result in wide-ranging losses in physical and sensory capabilities. While the impact of these losses are relatively modest for level walking, they become limiting during more demanding tasks such as walking on inclined ground, climbing stairs, or walking over longer periods, and especially when coupled with a debilitating disease. As the physical and functional parameters are closely related, we believe that lost functional capabilities can be indirectly improved by training of the physical capabilities. However, assistive devices can supplement the lost functional capabilities directly by compensating for losses with propulsion, weight support, and balance support.

CONCLUSIONS

Exoskeletons are a new generation of assistive devices that have the potential to provide both, training capabilities and functional compensation, to enhance human mobility.

Sex-specific reliability and multidimensional stability of responses to tests assessing neuromuscular function

The objective of this study was to estimate sex-specific effects in the test-retest cross-reliability of peripheral and central changes in nonlinear and linear measures of a surface electromyography signal during a brief (5 second) and sustained (2minute) isometric maximal voluntary contraction, combined with superimposed electrical stimulation involving the ankle plantar flexors over five identical trials. In this study, we repeated the testing protocol used in our previous study of 10 women (age 20.9, SD=0.3 years) (Bernecke et al., 2015) in a group of 10 men (age 21.2, SD=0.4 years). Despite the central (sex effect; p<0.05, η_p²>0.71, SP>70%) and peripheral fatigability (sex effect; p<0.01, η_p²>0.8, SP>90%) during sustained isometric maximal voluntary contraction, and lower reliability for central activation ratio during brief (intraclass correlation coefficient [ICC]=0.95 for men and ICC=0.82 for women) and sustained maximal voluntary contraction (ICC>0.82 for men and ICC>0.66 for women) over ankle plantar flexors expressed in women more than in men, all the ICCs of all indices measured by tests assessing neuromuscular function across the five identical test-retest trials were found as meaningful (correlation significance of p<0.05 was reached) and no significant differences were found between trials for any of the measured variables. In conclusion, the present study demonstrated greater central and peripheral fatigue for female participants following sustained (2minute) isometric maximal voluntary contraction of the plantar flexor muscles for all repeated trials and indicated an acceptable agreement between measurements of the characteristic variables made using the three different devices (dynamometry, electrical stimulation, and surface electromyography) over time for both sexes.

Gastrocnemius Recession Leads to Increased Ankle Motion and Improved Patient Satisfaction After 2 Years of Follow-Up

The isolated gastrocnemius contracture present in neurologic healthy patients results in a significant limitation of ankle dorsiflexion causing pathologic gait patterns and a greater risk of further foot disorders. Gastrocnemius recession is an established procedure to increase ankle dorsiflexion. However, little evidence is available of the use of gastrocnemius recession in these patients. Complication rates, recurrence of gastrocnemius contracture, and the prevalence of additional foot disorders needs further evaluation. A study group of 64 operated limbs undergoing gastrocnemius recession was evaluated to determine the prevalence of foot disorders, pre- and postoperative ankle dorsiflexion, and incidence of complications. A subgroup of 15 (23.4%) patients without additional operative procedures was examined regarding ankle dorsiflexion, strength (Janda method), sensitivity in the operated limb, and the pre- and postoperative Foot Function Index scores. The prevalence of foot disorders showed pes planus (41%), hallux valgus (38%), metatarsalgia (19%), hammertoe deformity (13%), and symptomatic Haglund exostosis (11%). At 31 months of follow-up, the patients had significantly benefited from increased ankle dorsiflexion of 13.3° ± 7.9° (p < .001). Postoperatively, 16% patients experienced complications. In the subgroup of 15 patients, the follow-up examination after 44 months showed ankle dorsiflexion of 14° ± 7.1°. The plantarflexion strength was 4 of 5 (Janda method). The Foot Function Index score had improved significantly from 65.4 ± 26.5 points to 33.4 ± 19.5 points (p < .001). Patients with isolated gastrocnemius contracture seem to have a high prevalence of symptomatic foot disorders. At a mid-term follow-up examination, gastrocnemius recession (Strayer) was shown to be an effective procedure to significantly improve ankle dorsiflexion, functionality, and pain symptoms. More attention should be given to the development of postoperative complications.

3D strength surfaces for ankle plantar- and dorsi-flexion in healthy adults: an isometric and isokinetic dynamometry study

BACKGROUND

The ankle is an important component of the human kinetic chain, and deficits in ankle strength can negatively impact functional tasks such as balance and gait. While peak torque is influenced by joint angle and movement velocity, ankle strength is typically reported for a single angle or movement speed. To better identify deficits and track recovery of ankle strength after injury or surgical intervention, ankle strength across a range of movement velocities and joint angles in healthy adults is needed. Thus, the primary goals of this study were to generate a database of strength values and 3-dimensional strength surface models for plantarflexion (PF) and dorsiflexion (DF) ankle strength in healthy men and women. Secondary goals were to develop a means to estimate ankle strength percentiles as well as examine predictors of maximal ankle strength in healthy adults.

METHODS

Using an isokinetic dynamometer, we tested PF and DF peak torques at five joint angles (-10° [DF], 0° [neutral], 10° [PF], 20° [PF] and 30° [PF]) and six velocities (0°/s, 30°/s, 60°/s, 90°/s, 120°/s and 180°/s) in 53 healthy adults. These data were used to generate 3D plots, or "strength surfaces", for males and females for each direction; surfaces were fit using a logistic equation. We also tested predictors of ankle strength, including height, weight, sex, and self-reported physical activity levels.

RESULTS

Torque-velocity and torque-angle relationships at the ankle interact, indicating that these relationships are interdependent and best modeled using 3D surfaces. Sex was the strongest predictor of ankle strength over height, weight, and self-reported physical activity levels. 79 to 97 % of the variance in mean peak torque was explained by joint angle and movement velocity using logistic equations, for men and women and PF and DF directions separately.

CONCLUSIONS

The 3D strength data and surface models provide a more comprehensive dataset of ankle strength in healthy adults than previously reported. These models may allow researchers and clinicians to quantify ankle strength deficits and track recovery in patient populations, using angle- and velocity-specific ankle strength values and/or strength percentiles from healthy adults.

Sex differences in soleus strength may predispose middle age women to falls

This study investigated middle age healthy adults to elucidate if plantar flexion (PF) strength differences exist because of the triceps surae or the soleus when comparing between sexes. A random population sample was stratified by sex and included 25 healthy (12 women and 13 men) subjects who volunteered for participation. Dorsiflexion range of motion was measured using a biplane goniometer. Self-reported function was assessed using the Foot and Ankle Ability Measure. Ankle PF strength was assessed using the Biodex System 3. To determine triceps surae vs. soleus strength, testing positions included (1) full ankle dorsiflexion with the knee in full extension and (2) full ankle dorsiflexion with 90° of knee flexion. Results indicated that women were significantly weaker than men in absolute PF strength for both triceps surae and soleus testing positions. Furthermore, even with normalizing PF strength to body mass PF strength deficits persisted. Additionally, when the contribution of the soleus was accounted for in the full knee extended position (triceps surae), normalized strength differences no longer existed between sexes. Therefore, these results indicate that what appeared as triceps surae complex strength deficits in middle age women compared with men was actually soleus weakness. This may suggest that middle age women are predisposed to increased falls at an early age than previously reported. Additionally, this may indicate that the soleus muscle should be a focus of strength training for women during middle age.

Biomechanics of the heel-raise test performed on an incline in two knee flexion positions

BACKGROUND

Although single-legged heel-raise cycles are often performed on an incline in different knee flexion positions to discriminate the relative contribution of the triceps surae muscles, detailed kinematic and kinetic analyses of this procedure are not available. Our study characterizes and compares the biomechanics and clinical outcomes of single-legged heel-raise cycles performed to volitional exhaustion on an incline with the knee straight (0°) and bent (45°), considering the effect of sex and age.

METHODS

Fifty-six male and female volunteers, with equal numbers of younger (20 to 40 years of age) and older (40 to 60 years of age) individuals, completed a maximal number of heel-raise cycles on an incline at both nominal knee angles. Kinematic and kinetic data were acquired during testing using a 3D motion capturing system and multi-axial force plate. The impact of fatigue on performance was quantified using changes in maximal voluntary isometric contraction force and biomechanical performance of cycles.

FINDINGS

Overall, participants completed three more cycles and maintained better biomechanical performance with 45° than 0° of knee flexion. More precisely, the decreases in maximal heel-raise heights, plantar-flexion angles at maximal height and ranges of ankle motion per cycle were all smaller with the knee bent. However, several outcomes indicated similar plantar-flexion fatigue at both knee angles. Males demonstrated a more rapid decline in peak ground reaction forces during testing; but otherwise, neither sex nor age significantly impacted outcomes.

INTERPRETATION

It is concluded that the differences discerned here in the biomechanics of single-legged heel-raise cycles performed at 0° and 45° of knee flexion to volitional exhaustion on an incline may be too small to identify in clinical settings or reflect substantial alterations in the relative contribution of the triceps surae muscles.

Gait strategy changes with acceleration to accommodate the biomechanical constraint on push-off propulsion

To maintain steady and level walking, push-off propulsion during the double support phase compensates for the energy loss through heel strike collisions in an energetically optimal manner. However, a large portion of daily gait activities also contains transient gait responses, such as acceleration or deceleration, during which the observed dominance of the push-off work or the energy optimality may not hold. In this study, we examined whether the push-off propulsion during the double support phase served as a major energy source for gait acceleration, and we also studied the energetic optimality of accelerated gait using a simple bipedal walking model. Seven healthy young subjects participated in the over-ground walking experiments. The subjects walked at four different constant gait speeds ranging from a self-selected speed to a maximum gait speed, and then they accelerated their gait from zero to the maximum gait speed using a self-selected acceleration ratio. We measured the ground reaction force (GRF) of three consecutive steps and the corresponding leg configuration using force platforms and an optical marker system, respectively, and we compared the mechanical work performed by the GRF during each single and double support phase. In contrast to the model prediction of an increase in the push-off propulsion that is proportional to the acceleration and minimizes the mechanical energy cost, the push-off propulsion was slightly increased, and a significant increase in the mechanical work during the single support phase was observed. The results suggest that gait acceleration occurs while accommodating a feasible push-off propulsion constraint.

The potential of human toe flexor muscles to produce force

The maximal force a muscle produces depends among others on the length of the muscle and therefore on the positions of the joints the muscle crosses. Long and short toe flexor muscles (TFM) cross the ankle joints and metatarsal phalangeal joints (MPJ) and work against gravity during human locomotion. The purpose of this study was to describe the maximal moments around the MPJ during maximal voluntary isometric contractions (MVIC) of the TFM as a function of ankle joint and MPJ position. Twenty men performed MVIC of the TFM in a custom-made dynamometer. Ankle and MPJ angles were modified after each contraction. External moments of force around the MPJ were determined. Moments ranged between 6.3 ± 2.6 Nm and 14.2 ± 5.8 Nm. Highest moments were produced at 0°-10° ankle joint dorsal flexion and 25°-45° MPJ dorsal flexion. Lowest moments were generated at 35° ankle joint plantar flexion and 0° MPJ dorsal flexion. In conclusion, if the ankle is plantar-flexed, dorsal flexion of the MPJ avoids a disadvantage of the force-length relationship of TFM. Therefore, MPJ dorsal flexion is a necessary function in the push-off phase of human locomotion to work against the loss of the mechanical output at the forefoot caused by plantar flexion of the ankle.

Do changes in dynamic plantar pressure distribution, strength capacity and postural control after intra-articular calcaneal fracture correlate with clinical and radiological outcome?

Fractures of the calcaneus are often associated with serious permanent disability, a considerable reduction in quality of life, and high socio-economic cost. Although some studies have already reported changes in plantar pressure distribution after calcaneal fracture, no investigation has yet focused on the patient's strength and postural control.

METHOD

60 patients with unilateral, operatively treated, intra-articular calcaneal fractures were clinically and biomechanically evaluated >1 year postoperatively (physical examination, SF-36, AOFAS score, lower leg isokinetic strength, postural control and gait analysis including plantar pressure distribution). Results were correlated to clinical outcome and preoperative radiological findings (Böhler angle, Zwipp and Sanders Score).

RESULTS

Clinical examination revealed a statistically significant reduction in range of motion at the tibiotalar and the subtalar joint on the affected side. Additionally, there was a statistically significant reduction of plantar flexor peak torque of the injured compared to the uninjured limb (p<0.001) as well as a reduction in postural control that was also more pronounced on the initially injured side (standing duration 4.2±2.9s vs. 7.6±2.1s, p<0.05). Plantar pressure measurements revealed a statistically significant pressure reduction at the hindfoot (p=0.0007) and a pressure increase at the midfoot (p=0.0001) and beneath the lateral forefoot (p=0.037) of the injured foot. There was only a weak correlation between radiological classifications and clinical outcome but a moderate correlation between strength differences and the clinical questionnaires (CC 0.27-0.4) as well as between standing duration and the clinical questionnaires. Although thigh circumference was also reduced on the injured side, there was no important relationship between changes in lower leg circumference and strength suggesting that measurement of leg circumference may not be a valid assessment of maximum strength deficits. Self-selected walking speed was the parameter that showed the best correlation with clinical outcome (AOFAS score).

CONCLUSION

Calcaneal fractures are associated with a significant reduction in ankle joint ROM, plantar flexion strength and postural control. These impairments seem to be highly relevant to the patients. Restoration of muscular strength and proprioception should therefore be aggressively addressed in the rehabilitation process after these fractures.

Peak torque and rate of torque development in elderly with and without fall history

BACKGROUND

Falls are one of the greatest concerns among the elderly. A number of studies have described peak torque as one of the best fall-related predictor. No studies have comprehensively focused on the rate of torque development of the lower limb muscles among elderly fallers. Then, the aim of this study was to determine the relationship between muscle peak torque and rate of torque development of the lower limb joints in elderly with and without fall history. It was also aimed to determine whether these parameters of muscle performance (i.e., peak torque and rate of torque development) are related to the number of falls.

METHODS

Thirty-one women volunteered to participate in the study and were assigned in one of the groups according to the number of falls over the 12 months that preceded the present. Then, participants with no fall history (GI; n=13; 67.6[7.5] years-old), one fall (GII; n=8; 66.0[4.9] years-old) and two or more falls (GIII; n=10; 67.8[8.8] years-old) performed a number of lower limb maximal isometric voluntary contractions from which peak torque and rate of torque development were quantified.

FINDINGS

Primary outcomes indicated no peak torque differences between experimental groups in any lower limb joint. The rate of torque development of the knee flexor muscles observed in the non-fallers (GI) was greater than that observed in the fallers (P<0.05) and had a significant relationship with the number of falls (P<0.05).

INTERPRETATION

The greater knee flexor muscles' rate of torque development found in the non-fallers in comparison to the fallers indicated that the ability of the elderly to rapidly reorganise the arrangement of the lower limb may play a significant role in allowing the elderly to recover balance after a trip. Thus, training stimulus aimed to improve the rate of torque development may be more beneficial to prevent falls among the elderly than other training stimulus, which are not specifically designed to improve the ability to rapidly produce large amounts of torque.

Function and strength following gastrocnemius recession for isolated gastrocnemius contracture

BACKGROUND

Isolated gastrocnemius contracture (IGC), which limits ankle dorsiflexion with full knee extension, can affect function and quality of life. Gastrocnemius recession is a treatment option for IGC when conservative treatment fails. The goal of this study was to assess range of motion, function, and plantarflexion strength pre- and 3-months post-gastrocnemius recession for subjects with IGC.

MATERIALS AND METHODS

Ankle range of motion, function, and plantarflexion strength in seven legs (four subjects), clinically diagnosed with IGC, before and after surgery were compared to matched control subjects to elucidate pre- and post-surgical intervention differences. All subjects with IGC were also diagnosed with plantar fasciitis with one leg having an additional diagnosis of metatarsalgia.

RESULTS

Subjects with IGC had significant post surgical improvements at 3 months after surgery in dorsiflexion range of motion (p = 0.016), function (p = 0.016) and isokinetic plantarflexion strength (p = 0.018).

CONCLUSIONS

Surgical recession enhanced range of motion and self reported function while not inducing any detrimental effects to plantarflexion strength at a 3-month followup. Post-surgically IGC subjects were more similar to healthy controls.

Changes in postural sway as a consequence of wearing a military backpack

Military personnel are often required to carry all of their personal supplies and equipment for long distances during both training and combat situations, creating many biomechanical and postural challenges for these individuals. In addition to other problems such as generalized fatigue and the development of stress fractures, significant external loads may also affect a soldier's postural sway. The purpose of this study was to assess changes in postural sway as a consequence of wearing a military backpack in females. Forty-three female subjects between the ages of 18 and 25 volunteered to participate. There were two conditions: unloaded and while wearing an 18.1 kg military backpack. Each subject stood with two feet on a force platform for 30s under both conditions while center of pressure (COP) data were collected. COP path length increased 64%, medial-lateral excursion increased 131%, anterior-posterior excursion increased 54%, and COP area increased 229% with addition of the backpack (p<0.0001 for all of these measures). These data show that wearing 18.1 kg of external weight in a military backpack increases the postural sway of females, which may in turn increase the likelihood of falls and injury.

The reliability of isokinetic testing of the ankle joint and a heel-raise test for endurance

The aim of the present study was to investigate the reliability of different methods used for isokinetic testing of calf muscle strength and endurance. The detailed evaluation of test-retest reliability serves the purpose of establishing reliable research tools when evaluating patients who have sustained an Achilles tendon rupture. The test-retest reliability of isokinetic measurements at the ankle for eccentric and concentric muscle action was calculated in ten healthy male volunteers using intra-class correlation (ICC) and coefficient of variation (CV). Three different positions were compared at the angular velocities of 30 degrees /s and 180 degrees /s for right and left ankles. The ICC for plantar flexion was 0.37-0.95, whilst it was 0.00-0.96 for dorsiflexion. The corresponding CVs were 4.0-19.9 and 2.4-19.8 respectively. The test-retest reliability of standardised heel-raises, Achilles tendon width, calf circumference and ankle range of motion revealed ICC values of 0.71-0.98 and CVs of 0.67-19.1. The test-retest interval was 5 to 7 days. We conclude that all three positions studied for the isokinetic evaluation of calf muscle function are equally reliable concerning plantar flexion at the ankle joint. The same level of reliability was also found in the evaluation of the standing heel-raise test and the isokinetic dorsiflexion test, except for dorsiflexion in the supine position. The reliability of the investigated methods was only fair despite the use of a detailed and standardised test protocol.

Inversion and eversion strengths in the weightbearing ankle of young women. Effects of plantar flexion and basketball shoe height

Maximum isometric ankle inversion and eversion muscle strengths were measured under full unipedal weightbearing in 20 healthy young adult women. When the women wore a low-top shoe, the mean (standard deviation) maximum external eversion moments resisted with the foot in 0 degrees and 32 degrees of ankle plantar flexion were 24.1 (7.6) and 24.1 (8.1) N x m, respectively, while the corresponding values for maximum inversion moments resisted were 14.7 (6.8) and 17.4 (6.4) N x m, respectively. Both shoe height and ankle plantar flexion affected the overall inversion moment resisted by 17% (P = 0.03) at 0 degrees of ankle plantar flexion to 11.9% (P = 0.003) at 32 degrees of ankle plantar flexion. However, neither shoe height nor ankle plantar flexion significantly affected the maximum eversion moment resisted. Although eversion muscle strength of the young women averaged 39% less than the corresponding value found in young men, the sex difference was not significant when ankle strengths were normalized by body size (body weight x height). Thus, when data from healthy young men and women were averaged, eversion and inversion strengths averaged 1.6% and 2.7%, respectively, of body weight x height.

Passive extensibility of skeletal muscle: review of the literature with clinical implications

The purpose of this article was to review the literature on passive extensibility of skeletal muscle with reference to its anatomic and physiologic properties, mechanisms of adaptations and clinical implications. Studies with animal muscles have shown that passive extensibility is influenced by the size (mass) and length of muscle fibers, and the amount and arrangement of the connective tissues of the muscle belly. The resistance to passive lengthening is influenced by the readily adaptable amount of muscle tissue, including the contractile proteins and the non-contractile proteins of the sarcomere cytoskeletons. The relationship of adaptable changes in the muscle tissue and in the extracellular connective tissues remains unclear. Muscle length adaptations result from changes in the number of sarcomeres in series, which depend on the imposed length of muscles, not on the level of muscle activation and tension. This mechanism of muscle length adaptations, termed 'myogenic', has not been demonstrated in human muscles, but it has been intimated by therapeutic lengthening studies showing that both healthy and neurologically impaired human muscles can undergo increased length adaptations in the presence of muscle activations. Studies have suggested that optimal muscle function is probably achieved by increasing muscle length, length extensibility, passive elastic stiffness, mass and strength, but additional studies are needed to investigate these relationships, particularly for aged muscles and for muscles affected by clinical disorders, disease and injury. Such studies could contribute to the development of new intervention strategies designed to promote the passive muscle extensibility that enhances total muscle function, and ultimately improves the ability to complete functional activities and excel in athletic performances.

Plantar flexor muscle function in open and closed chain

In the present study, the torque or work produced during isometric, pure concentric and eccentric-concentric plantar flexions, performed in sitting, standing and prone were measured. The electromyographic (EMG) activity was measured from the soleus, gastrocnemius medialis, tibialis anterior and rectus femoris muscles. The isometric tests showed the highest torques in the standing test. The rectus femoris and gastrocnemius activities were lower in the prone than in the standing test. The sitting test showed lower activities in all muscles of the lower leg compared with the standing test. No differences in work between the prone and sitting tests were found during the concentric phases. Higher rectus femoris activity in the eccentric-concentric test and lower activity in the triceps surae during the concentric phases were seen in the sitting compared with the prone test. We conclude that tests of overall functional ability should be performed in the standing position while specific tests of the plantar flexors should be performed in the prone position.

Relationships between plantar flexor muscle stiffness, strength, and range of motion in subjects with diabetes-peripheral neuropathy compared to age-matched controls

STUDY DESIGN

Descriptive study to compare relationships between muscle performance measures in 2 subject groups.

OBJECTIVES

To determine the relationships between plantar flexor (PF) muscle stiffness, strength (concentric peak torque), and dorsiflexion (DF) range of motion (ROM) in subjects with diabetes who have peripheral neuropathy (n = 17, 10 men, 7 women; age = 58 +/- 11 years) and age-matched controls (n = 17, 10 men, 7 women; age = 62 +/- 6 years).

BACKGROUND

The relationships between muscle stiffness, strength, and joint ROM have not been clearly established. Furthermore, the effect of neuromuscular pathology on these relationships is unknown.

METHODS AND MEASURES

PF stiffness and strength measurements were obtained with an isokinetic dynamometer. DF ROM was measured with a goniometer. A Pearson correlation matrix was constructed for each subject group using stiffness, strength, and ROM variables. The percent contribution of passive torque to total torque was computed at 2 joint angles.

RESULTS

In subjects with diabetes and peripheral neuropathy (DM-PN) peak concentric PF torque was positively correlated with passive torque at 5 degrees DF (r = 0.77), Stiffness #1 (r = 0.58), and Stiffness #2 (r = 0.50). The percentage of passive PF torque at 5 degrees DF was greater in subjects with DM-PN, compared to control subjects (29.3 +/- 9.4% versus 12.6 +/- 5.9%).

CONCLUSIONS

The positive correlation between PF stiffness and strength, and the greater percentage of passive PF torque in subjects with DM-PN suggest that patients with decreased strength may use passive torque to maximize total torque. Therefore, treatment methods designed to decrease stiffness should be used cautiously.

Increasing obstacle height and decreasing toe-obstacle distance affect the joint moments of the stance limb differently when stepping over an obstacle

Foot placement during gait is important in regulating the dynamics of the joints of the supporting limb and in maintaining balance of the whole body. We hypothesized that increasing obstacle height and decreasing toe-obstacle distance (distance between the trailing foot and the obstacle during stance of the trailing foot just prior to stepping over the obstacle) would affect the joint moments of the stance limb differently when stepping over an obstacle. A total of 14 healthy young adults stepped over an obstacle 51, 102, 153, and 204 mm in height in a self-selected manner (i.e. toe-obstacle distance was not controlled) and for toe-obstacle distance targets of 10, 20, 30, and 40% of their step lengths measured during unobstructed gait. The adduction and internal rotation moments at the ankle joint increased as toe-obstacle distance decreased. The adduction and internal rotation moments at the hip joint during early stance, the internal rotation moment at the knee joint during late stance, and the dorsiflexion moment at the ankle joint during late stance increased with obstacle height. Reductions in toe-obstacle distance had greater effects on the moments of the ankle joint, and increases in obstacle height had greater effects on the moments of the hip joint. These greater demands on joint moments may affect the abilities of those elderly having decreased muscle strengths to safely step over obstacles. Copyright 1998 Elsevier Science B.V.

Individual muscle contributions to the in vivo achilles tendon force

OBJECTIVE: To ascertain the possibility of non-uniform stress within the achilles tendon due to individual force contributions of the triceps surae. DESIGN: Calculation of non-uniform stress through discrepancies in moments about the ankle joint. BACKGROUND: Non-uniform stress over the cross-sectional area have been implied in the etiology of achilles tendon injury and may influence functional aspects. However, this has not been empirically demonstrated. METHODS: In vivo achilles tendon forces were measured with an optic fibre technique during isometric plantarflexions at systematically varied knee angles and contraction intensities. A comparison to the plantar force measured underneath the metatarsal heads permitted the calculation of the achilles tendon contribution to the resultant plantarflexion moment. The achilles tendon force was further differentiated into gastrocnemius and soleus contributions. Individual muscle activation patterns were described. RESULTS: The average achilles tendon contribution to the resultant moment was 67.4%. Variations were found at different knee angles and contraction intensities. A force discrepancy of 967 N occurred between gastrocnemius and soleus over a gastrocnemius length change of 2.67 cm. This corresponded to a stress discrepancy of 21 N/mm(2) over the tendon cross-sectional area. Separate muscles showed individual activation patterns. CONCLUSIONS: Non-uniform stress in the achilles tendon can occur through modifications of individual muscle contributions. RELEVANCE: Non-uniform stress in the achilles tendon has been implied in its injury etiology. This study demonstrated such loading resulting from discrepancies in individual muscle forces.

Kinesiological Factors in Vertical Jump Performance: Differences among Individuals

The purpose of this study was to investigate the kinesiological factors that distinguish good jumpers from poor ones, in an attempt to understand the critical factors in vertical jump performance(VJP).Fifty-two normal, physically active male college students each performed five maximal vertical jumps with arms akimbo. Ground reaction forces and video data were collected during the jumps. Subjects' strength was tested isometrically. Thirty-five potential predictor variables were calculated for statistical modeling by multiple-regression analysis. At the whole-body level of analysis, the best models (which included peak and average mechanical power) accounted for 88% ofVJPvariation (p< .0005). At the segmental level, the best models accounted for 60% of variation inVJP(p< .0005). Unexpectedly, coordination variables were not related toVJP. These data suggested thatVJPwas most strongly associated with the mechanical power developed during jump execution.

A mechanical model to study the relationship between gait speed and muscular strength

This study proposes a mechanical model to investigate the relationship between gait speed and strength of the ankle plantarflexor muscles. The model calculates the muscular utilization ratio (MUR) of the plantarflexor muscles during gait by comparing the plantarflexion moment used while walking to the maximal moment of the plantarflexors estimated from dynamometric measurements. To verify the model, MURs of the plantarflexor muscles were calculated for five healthy subjects and one hemiparetic subject walking at different speeds (slow, self-selected, and fast). Generally, the results of the healthy subjects revealed that MURs increase with an increasing gait speed: average (+/-SD) peak values of MUR reached 58.8% (+/-18.5), 65.6% (+/-17.2) and 71.0% (+/-17.8) for the slow, self-selected, and fast speeds, respectively. The average peak value of MURs at the self-selected speed corresponds to values reported in electromyographic studies of the plantarflexor muscles. At self-selected gait speed, the hemiparetic subject presented a higher peak MUR (80.5%) of the plantarflexors and a lower gait velocity when compared to healthy subjects. For the hemiparetic subject, peak values of MUR of the plantarflexor muscles at maximal walking speed reached 100% suggesting that full activation of the plantarflexors had been reached preventing him from walking faster. From these preliminary results, it appears that MURs calculated by the proposed model are sensitive to the mechanical demands imposed on a group of muscles during a task (eg., increase in gait speed) and to change in the maximal plantarflexor's strength (eg., weakness). The proposed model seems to have the potential to demonstrate whether muscle weakness limits maximal gait speed in hemiparetic subjects. However, considering the complexity of gait speed regulation in hemiparetic patients, the model should be tested on a large number of hemiparetic subjects.

Influence of age on concentric isokinetic torque and passive extensibility variables of the calf muscles of women

The purpose of this study was to investigate the influence of age on concentric isokinetic torque (CIT) and passive extensibility (PE) variables of the calf muscles of healthy women. Ten younger women [31.9 (SD 6.1) years] and ten older women [71.1 (SD 6.6) years] were tested using a KIN-COM 500H dynamometer. The PE was tested by stretching the muscles from relaxed plantarflexion to the maximal dorsiflexion (DF) angle at 5 degrees.s-1 without raw electromyogram (EMG) activity exceeding 0.05 mV. The maximal CIT was tested from the maximal DF angle 60 degrees into plantarflexion at four randomly ordered velocities of 30,60, 120, and 180 degrees.s-1. Separate analysis of variance (ANOVA) tests showed that the standardized (% body mass) concentric peak and mean torques were lower for the older women for all isokinetic velocities (p < 0.001). The "angular delay" from the onset of concentric activation to peak torque was smaller for the older women at 120 and 180 degrees.s-1 (p < 0.05). Age showed negative relationships (Pearson r) with all standardized peak torques (p < or = 0.001) and mean torques (p < 0.001), and the "angular delay" at 120 and 180 degrees.s-1 (p < or = 0.05). Independent t-tests showed that the maximal DF angle and the change in the PE angle from an initial angle (defined at 10% of the maximal passive torque) to the maximal DF angle were less for the older women (p < 0.05). Age was negatively related to the maximal DF angle and the change in the PE angle (p < 0.01). The results suggest an age-related decrease in calf muscle CIT, muscle length and PE. The smaller "angular delay" for the older women at 120 and 180 degrees.s-1 indicates that CIT testing at rapid velocities can be used to examine age-related changes in calf muscle contractile properties in relation to rapid velocities of movement.

Calf muscle strength in former elite distance runners

The purpose of this investigation was to examine calf muscle strength and cross-sectional area in 29 middle-aged men (current mean = 48.3 +/- 3.1 years) who had significant differences in their physical activity levels. These men were initially evaluated to determine the physiological requirements for successful distance running in the late 1960s at a time when they were all considered elite distance runners. Based on their training regimens in the interim between testing, subjects were described as highly trained (HI; n = 10), fitness trained (FIT; n = 12), or untrained (UT; n = 7). In addition, an aged-matched sedentary group (CON; n = 7) was tested. Each subject was evaluated for VO2max, plantar flexion calf muscle strength and cross-sectional area (CSA) of the lower leg (gastrocnemius and soleus). Muscle CSA was determined by computed tomography, whereas calf strength measurements were made using a specially designed leg restraint system and an isokinetic dynamometer. There were no significant differences in plantar flexion strength (at 60 and 180 degrees/s) or CSA of the gastrocnemius and soleus muscles among the groups. Calf muscle strength per CSA was also similar at both test velocities for all groups. These data demonstrate that middle-aged distance runners who have continued to run at a relatively high level for 20-25 years have similar calf muscle CSA and strength compared with aged-matched males who run significantly less or not at all.

A method of measuring standing isokinetic plantar and dorsiflexion peak torques

Different methods have been used for concentric (CONC) isokinetic testing of ankle dorsiflexion (DF) and plantar flexion (PF). However, little information is available on either the reliability of these protocols or eccentric (ECC) torque production. As well, previous studies utilized non-weight-bearing test positions. The purpose of this study was to develop a reliable method of testing CONC and ECC DF and PF in a weight-bearing position. One group of adults, including older men and women were tested on two occasions with a standing protocol. Another group of older and younger men and women were compared between the standing method and a supine protocol. For both positions the velocity was 30 degrees.s-1 for the CONC and ECC actions, and the range of motion was 10 degrees DF to 20 degrees PF. Reliability coefficients for peak torque (PT) were acceptable and ranged from 0.65 to 0.90. The two testing positions were significantly related (r = 0.84-0.91), but CONC PT in standing were greater than supine. Therefore, this method of testing isokinetic DF and PF in a standing position has acceptable reliability and produces results consistent with those acquired with the supine protocol. It provides a means of comparing groups and examining intervention strategies while weight-bearing.

Reliability of isokinetic measurements of ankle dorsal and plantar flexors in normal subjects and in patients with peripheral neuropathy

OBJECTIVE

To establish a reliable method for evaluation of motor performance of ankle dorsal and plantar flexors in healthy subjects and in patients with peripheral neuropathy.

DESIGN

Thirty-eight control subjects and 7 patients with peripheral neuropathy were studied. All patients and 25 control subjects were test twice.

PATIENTS AND CONTROL SUBJECTS

An outdoor clinic sample of 7 patients with hereditary motor sensory neuropathy (HMSN) and 38 control subjects.

MAIN OUTCOME MEASURES

The effect of a rest interval, a displacement of the axis of rotation, examination by three investigators on the peak torque and work of dorsal and plantar flexors, and the percentage difference at test-retests.

RESULTS

Control subjects had percentage differences of 5.6% and 8.0% for dorsal flexion and 3.8% and 8.7% for plantar flexion at 60 degrees/sec and 180 degrees/sec, respectively. In neuropathic patients the percentage differences were 0% and 8.6% for dorsal and 5.1% and 12.3% for plantar flexion at 30 degrees/sec and 60 degrees/sec, respectively. No interindividual differences between 3 investigators were found. A rest interval between trials resulted in an increased plantar flexion peak torque (P < .05). Displacement of 1.5cm of the axis of rotation resulted in a change of the peak torque of 8.3% for plantar flexion (P < .01).

CONCLUSIONS

A well-defined test protocol for isokinetic motor performance of the ankle dorsal and plantar flexors provides a reliable procedure for quantification of motor function in healthy subjects and in patients with HMSN1.

Cross-sectional study of muscle strength and bone mineral density in a population of 106 women between the ages of 44 and 87 years: relationship with age and menopause

This study examined the correlations between isokinetic muscle strength of knee and elbow flexors and extensors with vertebral and femoral bone mineral density in a population of 106 women between the ages of 44 and 87 years. The absolute value of muscle strength correlated significantly with bone mineral density; muscle strength of the upper limb appeared to be more closely correlated with bone mass, while muscle strength in the lower limb was more specific for femoral mineral bone density. The most important finding that these results demonstrated was a concomitant decline in muscle strength of the upper limb and bone mineral density between the 5th and 6th decades. In contrast, they also showed a decline in muscle strength of the lower limbs after the 6th decade, occurring before the decline in bone mineral density observed between the 7th and 8th decades. From these results it would appear that other studies are required to examine the relationship between the essentially hormonal role in postmenopausal decline in muscle strength and the decline in physical activity during the senile period. These elements are important because they must be taken into account in physical exercise programmes designed to prevent osteoporosis.

Stretch-shortening cycle during plantar flexion in young and elderly women and men

The stretch-shortening cycle (SSC) is a combination of eccentric and concentric muscle actions. The purpose of the study was to compare the SSC of four different groups comprising a total of 29 women and 30 men, divided according to sex and age (i.e. 20-40 years and 70-85 years). A KIN-COM dynamometer was used for strength measurements of the plantar flexion of the right foot. An electromyogram (EMG) from the gastrocnemius muscle was recorded simultaneously. Maximal voluntary concentric muscle actions at 120 degrees.s-1 and 240 degrees.s-1 with and without prior eccentric muscle actions were performed. Average torque values of the range of motion between 90 degrees and 99 degrees of the ankle joint were extracted. All four groups were significantly stronger at 120 degrees.s-1 than at 240 degrees.s-1 for pure concentric actions. The average torque values of the concentric phases in the SSC movement were significantly higher than the torque values for pure concentric actions in all four groups and at both velocities. The EMG was significantly lower or unchanged in the SSC movement compared to a pure concentric action in all groups. A larger percentage increase in torque with prior eccentric action was found in young women compared to young men at both velocities. Our results suggested that the enhanced performance was even more marked when a concentric action was preceded by an eccentric action in the young women than in the young men, probably due to better utilization of elastic forces, but we could not demonstrate any age-related differences in enhanced performance with SSC.

Isokinetic profile of dorsiflexors and plantar flexors of the ankle--a comparative study of élite versus untrained subjects

A comparative study was made of the isokinetic characteristics of the ankle (plantar-flexion and dorsiflexion) in young men. Six cyclists, seven gymnasts, 10 soccer players and 25 non-athletic young men were tested on the Cybex II+ dynamometer. Peak torque, torque acceleration energy (TAE), total work and average power were measured. Cyclists had slightly higher (5%) mean plantar flexion than the others, but this was not significant. The situation was reversed for dorsiflexion. Moreover, the average dorsiflexion per unit of plantar flexion was significantly higher in the gymnasts than it was in the cyclists for both torque and work. This suggests that at a specific level of plantar flexion, the gymnasts had stronger dorsiflexion compared with the cyclists and that in sports involving jumping and running, increased attention should be given to strengthening the antagonist muscle groups (dorsiflexors) in order to achieve greater agonist-to-antagonist muscle balance thus preventing injury. The non-athletic subjects had substantially lower endurance capability in both flexors as measured by the endurance ratio. This implies that identifiable specialization in particular muscles results from training or participating in specialized sports.

Effects of hip center location on the moment-generating capacity of the muscles

We have developed a three-dimensional biomechanical model of the human lower extremity to study how the location of the hip center affects the moment-generating capacity of four muscle groups: the hip abductors, adductors, flexors, and extensors. The model computes the maximum isometric force and the resulting joint moments that each of 25 muscle-tendon complexes develops at any body position. Abduction, adduction, flexion, and extension moments calculated with the model correspond closely with isometric joint moments measured during maximum voluntary contractions. We used the model to determine (1) the hip center locations that maximize and minimize the moment-generating capacity of each muscle group and (2) the effects of superior-inferior, anterior-posterior, and medial-lateral displacement of the hip center on the moment arms, maximum isometric muscle forces, and maximum isometric moments generated by each muscle group. We found that superior-inferior displacement of the hip center has the greatest effect on the force- and moment-generating capacity of the muscles. A 2 cm superior displacement decreases abduction force (44%), moment arm (12%), and moment (49%), while a 2 cm inferior displacement increases abduction force (20%), moment arm (7%) and moment (26%). Similarly, a 2 cm superior displacement decreases flexion force (27%), moment arm (6%), and moment (22%), while inferior displacement increases all three variables. Anterior-posterior displacement alters the moment-generating capacity of the flexors and extensors considerably, primarily due to moment arm changes. Medial-lateral displacement has a large effect on the moment-generating capacity of the adductors only. A 2 cm medial displacement decreases adduction moment arm (20%), force (26%) and moment (40%). These results demonstrate that the force- and moment-generating capacities of the muscles are sensitive to the location of the hip center.

Experimental determination of force-length relations of intact human gastrocnemius muscles

The purpose of this study was to determine force-length relations of intact human gastrocnemius muscles experimentally. Changes in maximal active isometric forces of the gastrocnemius muscle were calculated from resultant ankle joint moments of carefully executed maximal effort contractions at systematically changing knee and ankle joint configurations. Changes in muscle lengths were obtained using second-order polynomial regression equations that relate the length of the gastrocnemius muscle-tendon unit to knee and ankle joint angles. From these changes in muscle lengths, changes in muscle fibre lengths were estimated based on assumptions about fibre structure and series elastic properties. The results indicate that intact human gastrocnemius muscles operate on the ascending limb of the force-length relation, and that passive forces are minimal within a normal range of ankle and knee joint configurations.

Use of a Kin-Com dynamometer to study the stretch-shortening cycle during plantar flexion

The aim of this study was to evaluate the Kin-Com II dynamometer in the study of the stretch-shortening cycle (a concentric muscle action preceded by an eccentric muscle action). Measurements were made of plantar flexion at different angular velocities (120 degrees.s-1 and 240 degrees.s-1) with the knee at two different angles (0 degree and 90 degrees). Ten healthy women ranging in age from 22 to 41 years were studied. Torque values were recorded simultaneously with surface electromyograms (EMG): maximal voluntary concentric torque values were recorded and, after a short rest, the torque values of the concentric action which followed immediately after an eccentric action of the same velocity, both with maximal effort. Mean values were taken at different ankle positions and also averaged over different ranges. A concentric action preceded by an eccentric action generated a torque value on an average about 100% larger than a concentric action alone. The EMG activity was lower or unchanged. It was concluded that the present method could be useful in the study of the stretch-shortening cycle in plantar flexion and in the testing of the behaviour of the elastic components in people with disabilities in the lower limbs.

Evidence of fibre hyperplasia in human skeletal muscles from healthy young men? A left-right comparison of the fibre number in whole anterior tibialis muscles

Cross-sections (thickness 10 microns) of whole autopsied left and right anterior tibialis muscles of seven young previously healthy right-handed men (mean age 23 years, range 18-32 years) were prepared for light-microscope enzyme histochemistry. Muscle cross-sectional area and total number of fibres, mean fibre size (indirectly determined) and proportion of the different fibre types (type 1 and type 2 on basis of myofibrillar adenosine triphosphatase characteristics), in each muscle cross-section were determined. The analysis showed that the cross-sectional area of the left muscle was significantly larger (P less than 0.05), and the total number of fibres was significantly higher (P less than 0.05), than for the corresponding right muscle. There was no significant difference for the mean fibre size or the proportion of the two fibre types. The results imply that long-term asymmetrical low-level daily demands on muscles of the left and the right lower leg in right-handed individuals provide enough stimuli to induce an enlargement of the muscles on the left side, and that this enlargement is due to an increase in the number of muscle fibres (fibre hyperplasia). Calculations based on the data also explain why the underlying process of hyperplasia is difficult, or even impossible, to detect in standard muscle biopsies.

Functional restitution after lower leg fractures. A long-term follow-up

Twenty-five patients with fractures of the lower leg treated by closed reduction and plaster fixation were examined an average of 7 years and 8 months after trauma. The end result was assessed according to the following: (1) The patient's own opinion; (2) clinical examination including comparing range of motion in knee and ankle in the fractured and non-fractured leg, leg length discrepancy, malrotation of the injured extremity and muscle force analysis; (3) radiological examination. All fractures had healed after a mean of 13.4 weeks. Twelve of the 25 patients had no complaints. Subjective and objective assessment of the end results were in good correlation. Only eight patients had remaining radiological displacement, in only one of which it was severe. The slight remaining malpositionings did not influence the final functional result. The muscle force analysis showed that fractures caused by high-energy trauma also brought permanent reduction of muscular strength to the fractured extremity.

Angle dependency in strength measurements of the ankle plantar flexors

Muscle strength (or muscular moment) generated during dynamic contractions varies with joint angle. This raises the question about the choice of a representative angle in the evaluation of strength capacity. To assess this angle dependency in strength measurements, dynamic moment-angle curves for plantar flexor muscles were obtained in 43 healthy subjects (28 men and 15 women) with a controlled acceleration dynamometer at 0.52 rad s-1 (30 degrees s-1) and using maximal static preloading before the beginning of movement to attenuate the force development phase. Differences between gender and correlations between strength and anthropometric measures were calculated at each 0.087 rad (5 degrees). The plantar flexion moment was larger in men, in general, but this difference was largest when the ankle was most dorsiflexed. The correlations between moment and anthropometric measures were also higher in the first half of the plantar flexion movement. These results stress the importance of reporting joint angles at which moment of force measures were made. Furthermore, they show that the maximal strength capacity of the plantar flexors is best represented by the moment measured in dorsiflexion angles when the muscles are lengthened.

Isokinetic plantar flexion: experimental results and model calculations

In isokinetic experiments on human subjects, conducted to determine moments that can be exerted about a joint at different angular velocities, joint rotation starts as soon as the moment increases above the resting level. This contraction history differs from the one in experiments on isolated muscle, where the force is allowed to increase to an isometric level before shortening is initiated. The purpose of the present study was to determine the influence of contraction history on plantar flexing moments found during maximal voluntary plantar flexion on an isokinetic dynamometer. In ten subjects, plantar flexing moments were measured as a function of ankle angle at different angular velocities. They were also calculated using a model of the muscle-tendon complex of the human triceps surae. The model incorporates elastic tendinous tissue in series with muscle fibers. The input of the model consists of time histories of active state (the force generating capacity of contractile elements) and shortening velocity of the muscle-tendon complex. Different time courses of active state were offered at fixed length of the muscle-tendon complex. The time course yielding a close match between the calculated rise of plantar flexing moment and the rise measured during fixed angle contractions was used to calculate moment-angle curves for isokinetic plantar flexion. The active state value reached when a peak occurred in calculated moment-angle curves was found to be lower if the angular velocity was made higher. Comparing measured and calculated results, it was concluded that moment-angular velocity diagrams determined in studies of isokinetic plantar flexion in human subjects reflect not only the influence of shortening velocity of contractile elements on the force which can be produced by plantar flexors.

Tibiofemoral joint forces during isokinetic knee extension

Using a Cybex II, eight healthy male subjects performed isokinetic knee extensions at two different speeds (30 and 180 deg/sec) and two different positions of the resistance pad (proximal and distal). A sagittal plane, biomechanical model was used for calculating the magnitude of the tibiofemoral joint compressive and shear forces. The magnitude of isokinetic knee extending moments was found to be significantly lower with the resistance pad placed proximally on the leg instead of distally. The tibiofemoral compressive force was of the same magnitude as the patellar tendon force, with a maximum of 6300 N or close to 9 times body weight (BW). The tibiofemoral shear force changed direction from being negative (tibia tends to move posteriorly in relation to femur) to a positive magnitude of about 700 N or close to 1 BW, indicating that high forces arise in the ACL when the knee is extended more than 60 degrees. The anteriorly directed shear force was lowered considerably by locating the resistance pad to a proximal position on the leg. This model may be used when it is desirable to control stress on the ACL, e.g., in the rehabilitative period after ACL repairs or reconstructions.

Reliability of isokinetic muscle testing at the ankle

The purpose of this study was to determine the intrarater and interrater reliability of mean peak torque values for the reciprocal motions of plantarflexion/dorsiflexion (PF/DF) and inversion/eversion (INV/EVER), generated isokinetically at 60 and 120 degrees /sec. Forty-one healthy subjects, ranging in age from 20-75, were tested on three different occasions. The three test sessions were performed at the same time of day and separated by at least 24 hours. Pearson product-moment correlations were used to determine reliability for all ankle motions tested. Intrarater reliability of peak torque values for PF/DF and INV/EVER at both speeds ranged from 0.78-0.94, while the range of interrater coefficients was from 0.82-0.94. The results of this study suggest that when using a well defined clinical protocol, acceptable reliability for both test-retest and interrater situations can be obtained for isokinetic peak torque values of the ankle musculature at low and relatively high test speeds. J Orthop Sports Phys Ther 1989;11(4):150-154.

The relationship of knee and ankle weakness to falls in nursing home residents: an isokinetic study

The strength of the knees and ankles of a group of nursing home residents with a history of falls was compared to age-matched controls. Peak torque (PT) and power (POW) were recorded at two limb velocities (60 degrees/s and 120 degrees/s) on a Cybex II Isokinetic dynamometer for four muscle groups: knee extensors, knee flexors, ankle plantar flexors and ankle dorsiflexors. The PT and POW of fallers were significantly decreased for all four muscle groups in comparison to controls, with the ankles showing the greatest decrements. Although POW in fallers was significantly lower at the higher velocity in both joints, the decrease was most prominent in the ankles. Dorsiflexion POW production in fallers was the most affected of all the motions (7.5 times less than the control value). At the higher, more functional limb velocities, ankle weakness particularly involving the dorsiflexors appears to be an important factor underlying poor balance.

Ageing and isokinetic plantar flexion

Isokinetic torques (Cybex II) of the plantar flexors in 25 healthy men were compared at 5 angular velocities (30, 60, 90, 120 and 180 degrees X s-1). The purposes were to compare plantar flexion torques in young and old subjects, and to determine whether the expected decrease was significantly associated with age, physical activity, or aerobic fitness. Four groups were studied: young (21.7 +/- 2.0 years) and older (63.3 +/- 2.8 years), active and sedentary. Measurements of height, weight, % body fat, VO2max, and daily leisure energy expenditure (questionnaire) were determined for each subject. Statistical measures of analysis of variance were used to determine significant differences among groups; product moment correlation and stepwise regression analysis were used to describe the degree of association between the dependent variable of plantar flexion torque and the independent variables at each velocity. A decline in torque was observed as the isokinetic velocity of angular motion increased. Age alone was a significant determinant of plantar flexion torque, whereas at the slowest speed, when VO2max was used as an explanatory variable, age was not a significant determinant of torque. At 30 degrees X s-1 47% of the variance in torque was explained by VO2max while at 180 degrees X s-1 49% of the variance was explained by age.

Prediction of peak torque and contraction work at different isokinetic angular velocities of plantarflexion

Contraction work (CW) and peak torque (PT) of maximum isokinetic plantar flexions were measured in clinically healthy subjects randomly chosen from the official census list of Umeå, Sweden, in three groups: 40-44, 50-54 and 60-64 years of age, with similar proportions of men and women. Maximum isokinetic plantar-flexions were performed at angular velocities of 30, 60, 120 and 180 degrees X s-1. Body-weight, height and crural circumference were measured. Subjects rated their levels of leisure and occupational activities. To establish formulae to predict CW and PT, stepwise regression procedures were applied. The predictive powers (r2) of the formulae which incorporated age, sex and crural circumference, were higher for PT (30 degrees X s-1: 0.82, 60 degrees X s-1: 0.79, 120 degrees X s-1: 0.75, 180 degrees X s-1: 0.56) than for CW (30 degrees s-1: 0.63, 60 degrees s-1: 0.63, 120 degrees s-1: 0.60, 180 degrees s-1: 0.52). Thus the part of the variance explained decreased with increasing angular velocity, but more than 50% was still explained at 180 degrees s-1. The results indicate that the mechanical output of the plantar flexors is predictable.

Mechanical output and iEMG of isokinetic plantar flexion in 40-64-year-old subjects

Peak torque (PT), contractional work (CW) and mean power of isokinetic plantar flexions were measured in unselected, clinically healthy subjects, randomly chosen from the official census lists of Umeå, in three age groups: 40-44, 50-54 and 60-64 years. Simultaneous recordings of integrated electromyograms (iEMG) were obtained by surface electrodes from all three heads of the m. triceps surae. PT and CW decreased exponentially with increasing velocity of angular motion and at 60 degrees X s-1 (r2 = 0.79 and 0.63, respectively) were adequately determined by crural circumference, age and sex. The muscular output declined with increasing age. Both output and iEMG showed an approximate 3:2 male:female ratio. Therefore, the ratio CW/iEMG was age, but not sex-dependent at any given velocity of angular motion. Independently of this age, the iEMGs were inversely proportional to velocity of angular motion, while iEMG/manoeuvre time was constant indicating that torque/velocity and work/velocity exponential relationships are mainly determined by muscular properties. Based on the literature it is suggested that the dependence of the measured parameters on age and sex is determined by muscular properties, rather than by the central nervous system. Moreover, the CW/iEMG ratio appears to provide a comprehensive picture of excitation and mechanical output of the muscle group studied and may therefore be a useful measure.