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Influence of painful overloading using stair ascending in quadriceps neuromuscular function of women with patellofemoral pain syndrome. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-022-01020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Nunes GS, Rodrigues DZ, Hörbe L, Prates I, Tessarin BM, Serrão FV, de Noronha M. Is Postural Control Affected in People with Patellofemoral Pain and Should it be Part of Rehabilitation? A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:144. [PMID: 36504326 PMCID: PMC9742077 DOI: 10.1186/s40798-022-00538-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes. OBJECTIVE To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP. DATA SOURCES Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field. METHODS A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials. RESULTS From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40-1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31-1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI - 0.05-0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI - 0.51-0.53) and overall (SMD = 0.49, 95% CI - 0.14-1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04-1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26-1.38) and improve function (SMD = 0.44, 95% CI 0.09-0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI - 0.16-1.61). CONCLUSION People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP. Trial Registration The present systematic review was registered in PROSPERO (CRD42018091717).
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Affiliation(s)
- Guilherme S. Nunes
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Diênifer Zilmer Rodrigues
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Luiza Hörbe
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Izabela Prates
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Bruna M. Tessarin
- grid.411247.50000 0001 2163 588XDepartment of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Fábio V. Serrão
- grid.411247.50000 0001 2163 588XDepartment of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Marcos de Noronha
- grid.1018.80000 0001 2342 0938Rural Department of Allied Health, La Trobe University, Bendigo, VIC Australia
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Alvarez JT, Gerez LF, Araromi OA, Hunter JG, Choe DK, Payne CJ, Wood RJ, Walsh CJ. Toward Soft Wearable Strain Sensors for Muscle Activity Monitoring. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2198-2206. [PMID: 35925858 PMCID: PMC9421605 DOI: 10.1109/tnsre.2022.3196501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The force-generating capacity of skeletal muscle is an important metric in the evaluation and diagnosis of musculoskeletal health. Measuring changes in muscle force exertion is essential for tracking the progress of athletes during training, for evaluating patients’ recovery after muscle injury, and also for assisting the diagnosis of conditions such as muscular dystrophy, multiple sclerosis, or Parkinson’s disease. Traditional hardware for strength evaluation requires technical training for operation, generates discrete time points for muscle assessment, and is implemented in controlled settings. The ability to continuously monitor muscle force without restricting the range of motion or adapting the exercise protocol to suit specific hardware would allow for a richer dataset that can help unlock critical features of muscle health and strength evaluation. In this paper, we employ wearable, ultra-sensitive soft strain sensors for tracking changes in muscle deformation during contractions. We demonstrate the sensors’ sensitivity to isometric contractions, as well as the sensors’ capacity to track changes in peak torque over the course of an isokinetic fatiguing protocol for the knee extensors. The wearable soft system was able to efficiently estimate peak joint torque reduction caused by muscle fatigue (mean NRMSE = 0.15±0.03).
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Sondang Irawan D, Sinsurin K, Sonsukong A. Alteration of quadriceps muscle activity during functional step tasks after extended sitting session. Knee 2022; 37:20-27. [PMID: 35660535 DOI: 10.1016/j.knee.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/02/2022] [Accepted: 05/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prolonged sitting with high knee flexion is a common activity that may affect patellofemoral joint compression and quadriceps length. Exploring the quadriceps activation after sitting may help to explain the mechanism underlying muscle changes and the resulting patellofemoral pain. OBJECTIVES To examine changes in quadriceps activity after prolonged sitting in cross-legged sitting, side-sitting, and sitting on a chair. DESIGN Laboratory observational study. METHOD Thirty healthy women participated and were randomly allocated to three groups of different sitting positions (n = 10/group). Electromyography (EMG) of the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) was performed before and after 15 min after sitting. EMG was conducted during step-up and step-down tests and was reported as %MVIC. The results were analysed using Wilcoxon signed-rank test and Kruskal-Wallis ANOVA. RESULTS VM activity and EMG activity during the step-down test after sitting increased significantly in the cross-legged group (p = 0.01). Sitting postures significantly influenced (p = 0.02) muscle activity changes in the VL and VM during the step-up test. Pairwise comparisons revealed significant differences between the cross-legged sitting and sitting on a chair groups. CONCLUSIONS Prolonged cross-legged sitting and side-sitting caused changes in VM and VL activity during step tasks in healthy young women. After cross-legged sitting, the VM exhibited a significantly higher activity in descending control, and changes in VM and VL activity increased significantly during the step-up task. Increased VM and VL activation possibly controls the patellofemoral joint. Therefore, they may fatigue more easily when many step tasks or squatting exercises are performed.
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Affiliation(s)
- Dimas Sondang Irawan
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Thailand
| | - Komsak Sinsurin
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Thailand.
| | - Ainthira Sonsukong
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Salaya, Thailand
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Impact of pathological conditions on postural reflex latency and adaptability following unpredictable perturbations: A systematic review and meta-analysis. Gait Posture 2022; 95:149-159. [PMID: 35500364 DOI: 10.1016/j.gaitpost.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pathological conditions can impair responses to postural perturbations and increase risk of falls. RESEARCH QUESTION To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes? METHODS MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861). RESULTS Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3). CONCLUSIONS This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms); pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.
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Alsaleh SA, Murphy NA, Miller SC, Morrissey D, Lack SD. Local neuromuscular characteristics associated with patellofemoral pain: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2021; 90:105509. [PMID: 34678670 DOI: 10.1016/j.clinbiomech.2021.105509] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Local neuromuscular deficits have been reported in people with patellofemoral pain. We synthesised the neuromuscular characteristics associated with patellofemoral pain to help identify interventional targets and potential mechanisms. METHODS Five databases were searched for local neuromuscular characteristics in case-control studies. Electromyography, flexibility, muscle performance and cross-sectional area data were derived from functional or isolated task investigations and synthesised accordingly. An evidence gap map was constructed. FINDINGS Sixty-seven studies were included. In functional tasks, electromyographic investigations showed moderate evidence of small effect for vastus medialis onset-delays relative to vastus lateralis (0.44 [0.03, 0.85]) during stepping/stair negotiation tasks, and higher biceps femoris mean excitation amplitudes (0.55 [0.06, 1.04]) in single-leg triple-hop test. In isolated tasks, we found moderate evidence of medium effect for lower Hoffman-reflex amplitude of vastus medialis (-1.12 [-1.56, -0.67]). Muscle performance investigations showed; strong evidence with medium and small effects for lower extensors concentric (-0.61 [-0.81, -0.40]) and eccentric (-0.56 [-0.79, -0.33]) strength, and moderate evidence of medium effect of lower isometric (-0.64 [-0.87, -0.41]) strength, moderate evidence with small effect for rate of force development to 30% (-0.55[-0.89, -0.21]), 60% (-0.57[-0.90, -0.25]) and medium effect to 90% (-0.76[-1.43, -0.10]) of maximum voluntary contraction, and small effect for lower flexors concentric strength (-0.46 [-0.74, -0.19]) and extensors total work (-0.48 [-0.90, -0.07]). Flexibility investigations showed tighter hamstrings (-0.57 [-0.99, -0.14]). INTERPRETATION Differences within quadriceps and hamstrings motor-control, hamstrings tightness, and quadriceps and hamstrings weakness are associated with patellofemoral pain, and can be used to guide investigations of treatment effects.
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Affiliation(s)
- S A Alsaleh
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom; Medical Services Authority, Ministry of Defence, Kuwait.
| | - N A Murphy
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom
| | - S C Miller
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom
| | - D Morrissey
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, UK
| | - S D Lack
- Sports and Exercise Medicine, Queen Mary, University of London, London, United Kingdom; Pure Sports Medicine, London, UK
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Samani M, Shirazi ZR, Hadadi M, Sobhani S. A randomized controlled trial comparing the long-term use of soft lumbosacral orthoses at two different pressures in patients with chronic nonspecific low back pain. Clin Biomech (Bristol, Avon) 2019; 69:87-95. [PMID: 31302494 DOI: 10.1016/j.clinbiomech.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/22/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is concern that wearing soft lumbosacral orthoses for prolonged periods may impair motor function. Moreover, the pressure applied by lumbosacral orthoses on the abdominal wall is usually ignored when these orthoses are prescribed. METHOD In this randomized controlled trial study, 48 patients with chronic nonspecific low back pain were randomly divided into high pressure, normal pressure and control groups. All groups received medication for 4 weeks. The normal pressure and high pressure groups, in addition to medication, used soft lumbosacral orthoses at normal pressure and 50% increased pressure, respectively. Motor function outcome measures were strength, endurance, proprioception and electromyographic activity of the trunk muscles. Clinical outcome measures were pain and disability, which were evaluated in two sessions before and after a 4-week interval. FINDINGS Isometric strength, endurance and most of the electromyographic parameters were generally unaffected by wearing the lumbosacral orthosis. Pain improved in all groups, and disability and proprioception improved in the high pressure and normal pressure groups. Between-group differences in these three measures indicated better results in the lumbosacral orthoses groups than in the control group. The improvements in pain and proprioception were significantly greater in the high pressure group than the normal pressure group. INTERPRETATION Long-term use of lumbosacral orthoses had no significant adverse effects on motor function or clinical factors in patients with chronic low back pain. Increasing lumbosacral orthosis tightness may improve motor functioning and the clinical efficacy of the orthosis. CLINICAL TRIAL REGISTRATION NUMBER Code: IRCT201708192391N38.
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Affiliation(s)
- Mahbobeh Samani
- Student Research Committee, Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rojhani Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Hadadi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sobhan Sobhani
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Mirzaie GH, Rahimi A, Kajbafvala M, Manshadi FD, Kalantari KK, Saidee A. Electromyographic activity of the hip and knee muscles during functional tasks in males with and without patellofemoral pain. J Bodyw Mov Ther 2018; 23:54-58. [PMID: 30691762 DOI: 10.1016/j.jbmt.2018.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/31/2018] [Accepted: 11/01/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a common overuse injury in physically active individuals. It is characterized by anterior knee, retropatellar, or prepatellar pain associated with activities that increase patellofemoral joint stress such as squatting, stair ascending and descending, running, jumping, prolonged sitting, and kneeling. The etiology of PFP is believed to be multifactorial. Recently, proximal factors have been shown to influence the biomechanics of patellofemoral joint. OBJECTIVE The aim of the study was to assess hip and knee muscle activity during single leg stance and single leg squat in males with PFP and a control group without PFP. METHODS Eighteen males with PFP (age 24.2 ± 4.4 years) and 18 healthy subjects as controls (age 23.5 ± 3.8 years) were included. We evaluated gluteus medius, gluteus maximus, vastus medialis oblique (VMO), and vastus lateralis (VL) electromyographic (EMG) activity. The muscle activity and reaction time of the proposed muscles were assessed during single leg stance and single leg squat tasks. Independent t-test was used to identify significant differences between PFP and control groups. RESULTS No difference in activity of the gluteus maximus muscle was found in either task (p > 0.5). Significant differences were found in activity of gluteus medius and VMO in both tasks (p < 0.05). VL muscle activity had significant difference in single leg stance (p = 0.01), however, had no significant difference in single leg squat (p = 0.1). No significant differences were found in reaction time of the four studied muscles during both single leg stance and single leg squat (p > 0.5). CONCLUSION Males with PFP demonstrated altered gluteus medius, VMO, and VL muscle activity during single leg stance and single leg squat compared to healthy subjects. Gluteus maximus activity did not show any changes between groups. Moreover, muscle recruitment patterns were different between PFP and healthy groups.
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Affiliation(s)
- Gholam Hassan Mirzaie
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehrnaz Kajbafvala
- Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farideh Dehghan Manshadi
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Saidee
- Department of Statistical Research and Information Technology, Institute for Research and Planning in Higher Education, Tehran, Iran
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Lower-Extremity Muscle Activity, Kinematics, and Dynamic Postural Control in Individuals With Patellofemoral Pain. J Sport Rehabil 2018; 27:505-512. [PMID: 28714838 DOI: 10.1123/jsr.2016-0100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered lower-extremity muscle activity has been associated with lower-extremity kinematics in individuals with patellofemoral pain (PFP). However, few studies have examined these relationships, and the results are inconsistent. OBJECTIVE To compare the lower-extremity muscle activity, kinematics, pain level, and reach distance during the anterior reach of the star excursion balance test (SEBT) between participants with PFP and healthy individuals (control [CON] group). DESIGN Case control. SETTING Research laboratory. PARTICIPANTS Twenty-eight (PFP = 14 and CON = 14) participants volunteered. INTERVENTION Each participant performed 3 maximal voluntary isometric contractions of the gluteus maximus, gluteus medius (GMED), adductor longus (AL), and vastus medialis, and 5 anterior reaches of the SEBT. MAIN OUTCOME MEASURES Three-dimensional joint kinematics of the hip and knee at the time of touchdown of the SEBT and integrated electromyography of each muscle were recorded during the descent phase of the SEBT. Coactivation ratios between the GMED and AL were calculated (GMED/AL). Pain level was assessed at the baseline and during performance of the SEBT, using a visual analog scale. RESULTS Participants with PFP demonstrated decreased GMED/AL coactivation ratio (P = .01) and shorter reach distance (P = .01) during anterior reach of the SEBT compared with the CON group. Participants with PFP demonstrated higher pain levels at baseline (P = .03) and during test performance (P < .001) compared with the CON group and increased pain level during the test performance compared with the baseline (P < .001). No other significant differences were observed. CONCLUSIONS There were alterations in muscle activity during SEBT performance, suggesting that overactivity of AL relative to GMED is a unique neural recruitment pattern in those with PFP. However, hip and knee joint kinematics did not seem to contribute to deficits in the anterior reach distance, suggesting a need for continued assessment of these deficiencies.
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Spatial variation and inconsistency between estimates of onset of muscle activation from EMG and ultrasound. Sci Rep 2017; 7:42011. [PMID: 28176821 PMCID: PMC5296741 DOI: 10.1038/srep42011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 01/09/2017] [Indexed: 12/23/2022] Open
Abstract
Delayed onset of muscle activation can be a descriptor of impaired motor control. Activation onset can be estimated from electromyography (EMG)-registered muscle excitation and from ultrasound-registered muscle motion, which enables non-invasive measurements in deep muscles. However, in voluntary activation, EMG- and ultrasound-detected activation onsets may not correspond. To evaluate this, ten healthy men performed isometric elbow flexion at 20% to 70% of their maximal force. Utilising a multi-channel electrode transparent to ultrasound, EMG and M(otion)-mode ultrasound were recorded simultaneously over the biceps brachii muscle. The time intervals between automated and visually estimated activation onsets were correlated with the regional variation of EMG and muscle motion onset, contraction level and speed. Automated and visual onsets indicated variable time intervals between EMG- and motion onset, median (interquartile range) 96 (121) ms and 48 (72) ms, respectively. In 17% (computed analysis) or 23% (visual analysis) of trials, motion onset was detected before local EMG onset. Multi-channel EMG and M-mode ultrasound revealed regional differences in activation onset, which decreased with higher contraction speed (Spearman ρ ≥ 0.45, P < 0.001). In voluntary activation the heterogeneous motor unit recruitment together with immediate motion transmission may explain the high variation of the time intervals between local EMG- and ultrasound-detected activation onset.
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Comparative Evaluation of Core Muscle Recruitment Pattern in Response to Sudden External Perturbations in Patients With Patellofemoral Pain Syndrome and Healthy Subjects. Arch Phys Med Rehabil 2014; 95:1383-9. [DOI: 10.1016/j.apmr.2014.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/18/2014] [Accepted: 01/26/2014] [Indexed: 11/19/2022]
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Hodges PW, Mellor R, Crossley K, Bennell K. Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles. ACTA ACUST UNITED AC 2009; 61:70-7. [PMID: 19116977 DOI: 10.1002/art.24089] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Musculoskeletal conditions of the knee involve changes in sensorimotor function, but it is unclear whether these changes are a cause or result of pain. Induction of experimental pain may help solve this issue. Although this is commonly achieved by injection of hypertonic saline into muscle, muscle is commonly not the source of pain. This study investigated whether pain induced by injection of saline into the infrapatellar fat pad changes motor control of the quadriceps muscles of the knee. METHODS Ten participants performed a standardized task involving ascending and descending a series of steps. Electromyographic activity (EMG) of vastus medialis obliquus (VMO) and vastus lateralis (VL) was recorded with surface electrodes. Trials were conducted without pain, with anterior knee pain induced by injection (0.25 ml) of hypertonic saline (5%) into the infrapatellar fat pad, with anticipation of pain associated with unpredictable electrical shocks to the knee, and 20 minutes after pain cessation. EMG onset and amplitude were analyzed. RESULTS When participants ascended the steps with pain, the onset of VMO EMG was delayed relative to that of VL, in contrast to simultaneous or earlier activation of VMO EMG in the pre- and postpain trials. VL EMG amplitude was decreased significantly from the control condition. CONCLUSION These data show that alterations in coordination of knee muscle activity can be caused by pain, even when it is of nonmuscle origin. Treatment of pain is therefore important to facilitate performance of the quadriceps muscles, which are essential for locomotor and functional tasks as well as for knee stability.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
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Moya GBL, Siqueira CM, Caffaro RR, Fu C, Tanaka C. Can quiet standing posture predict compensatory postural adjustment? Clinics (Sao Paulo) 2009; 64:791-6. [PMID: 19690665 PMCID: PMC2728194 DOI: 10.1590/s1807-59322009000800014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 05/28/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze whether quiet standing posture is related to compensatory postural adjustment. INTRODUCTION The latest data in clinical practice suggests that static posture may play a significant role in musculoskeletal function, even in dynamic activities. However, no evidence exists regarding whether static posture during quiet standing is related to postural adjustment. METHODS Twenty healthy participants standing on a movable surface underwent unexpected, standardized backward and forward postural perturbations while kinematic data were acquired; ankle, knee, pelvis and trunk positions were then calculated. An initial and a final video frame representing quiet standing posture and the end of the postural perturbation were selected in such a way that postural adjustments had occurred between these frames. The positions of the body segments were calculated in these initial and final frames, together with the displacement of body segments during postural adjustments between the initial and final frames. The relationship between the positions of body segments in the initial and final frames and their displacements over this time period was analyzed using multiple regressions with a significance level of p < or = 0.05. RESULTS We failed to identify a relationship between the position of the body segments in the initial and final frames and the associated displacement of the body segments. DISCUSSION The motion pattern during compensatory postural adjustment is not related to quiet standing posture or to the final posture of compensatory postural adjustment. This fact should be considered when treating balance disturbances and musculoskeletal abnormalities. CONCLUSION Static posture cannot predict how body segments will behave during compensatory postural adjustment.
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Affiliation(s)
- Gabriel Bueno Lahóz Moya
- Department of Physical Therapy, Communication Science, and Disorders and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
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Kinematic analyses during stair descent in young women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2009; 24:88-94. [PMID: 18986741 DOI: 10.1016/j.clinbiomech.2008.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 09/08/2008] [Accepted: 09/09/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Compensatory movement strategies may develop in response to pain to avoid stress on the affected area. Patellofemoral pain is characterised by intermittent periods of pain and the present study addresses whether long-term pain leads to compensatory movement strategies that remain even when the pain is absent. METHOD Lower extremity kinematics in three dimensions was studied in stair descent in 17 women with patellofemoral and in 17 matched controls. A two-dimensional geometric model was constructed to normalise kinematic data for subjects with varying anthropometrics when negotiating stairs of fixed proportions. RESULTS There were minor differences in movement patterns between groups. Knee joint angular velocity in the stance leg at foot contact was lower and the movement trajectory tended to be jerkier in the patellofemoral group. The two-dimensional model showed greater plantar flexion in the swing leg in preparation for foot placement in the patellofemoral group. INTERPRETATION The results indicate that an altered stair descent strategy in the patellofemoral group may remain also in the absence of pain. The biomechanical interpretation presumes that the strategy is aimed to reduce knee joint loading by less knee joint moment and lower impact force.
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Bevilaqua-Grossi D, Felício LR, Silvério GWP. Início da atividade elétrica dos músculos estabilizadores da patela em indivíduos com SDPF. ACTA ORTOPEDICA BRASILEIRA 2009. [DOI: 10.1590/s1413-78522009000500009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Avaliar a porcentagem de disparo inicial (PDI) dos músculos estabilizadores da patela durante exercícios de contração isométrica voluntária máxima (CIVM) em indivíduos com e sem sinais da síndrome da dor patelofemural (SDPF) nos exercícios de cadeia cinética aberta (CCA) e fechada (CCF). MÉTODO: Foram avaliadas 10 mulheres sem queixa de dor anterior no joelho e 12 mulheres com sinais de SDPF durante a CIM em CCA e CCF com o joelho posicionado a 90º de flexão do joelho. O início da atividade eletromiográfica dos músculos vasto medial obliquo (VMO), vasto lateral obliquo (VLO) e vasto lateral longo (VLL) foi identificada por meio de um algoritmo no programa Myosystem Br 1. A análise estatística empregada foi o teste Qui-Quadrado e o teste t de student, ambos os teste com nível de significância de 5%. RESULTADOS: Os músculos VMO e VLO apresentaram uma maior PDI em relação ao músculo VLL durante os exercícios em CCA para ambos os grupo e para o grupo SDPF em CCF. Não foi observado diferença entre os grupos. CONCLUSÃO: Pode-se sugerir que tanto os exercícios em CCA quanto em CCF, parecem beneficiar o sincronismo na musculatura estabilizadora da patela, podendo ser indicado nos programas de tratamento fisioterapêutico.
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de Ruiter CJ, Hoddenbach JG, Huurnink A, de Haan A. Relative torque contribution of vastus medialis muscle at different knee angles. Acta Physiol (Oxf) 2008; 194:223-37. [PMID: 18691348 DOI: 10.1111/j.1748-1716.2008.01888.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We investigated the relative contribution of the vastus medialis (VM) muscle to total isometric knee extension torque at 10 degrees , 30 degrees , 60 degrees and 90 degrees knee flexion. In the past a more prominent role of the VM muscle at more extended knee angles has been put forward. However, different components of the quadriceps muscle converge via a common distal tendon. We therefore hypothesized that the relative contribution of the VM to total knee extension torque would be similar across angles. METHODS At each knee angle the EMG isometric torque relations [20%, 25%, 30%, 35% maximal voluntary contraction (MVC)] of the rectus femoris (RF), vastus lateralis (VL) and VM muscle were established in 10 healthy male subjects; rectified surface EMG was normalized to M-wave area. Subsequently, the VM was functionally eliminated by selective electrical surface stimulation with occluded blood flow. RESULTS There was no evidence for preferential activation of VM at any of the knee angles. Following VM elimination, total knee extension torque during maximal femoral nerve stimulation (three pulses at 300 Hz) at 10 degrees , 30 degrees , 60 degrees and 90 degrees , respectively, decreased (P < 0.05) to (mean +/- SD): 75.7 +/- 12.2, 75.1 +/- 9.3, 78.2 +/- 7.2 and 76.0 +/- 5.8% (P > 0.05 among knee angles). In addition, during voluntary contractions at 20% MVC the increases in torque output of RF and VL compensating for the loss of VM function were calculated from the increases in EMG and found to be similar (P > 0.05) at 10 degrees , 30 degrees , 60 degrees and 90 degrees values (%MVC), respectively, were: 9.1 +/- 6.8, 7.5 +/- 2.9, 5.9 +/- 3.7 and 6.9 +/- 3.4. CONCLUSION The present findings support our hypothesis that the VM contributes similarly to total knee extension torque at different knee angles.
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Affiliation(s)
- C J de Ruiter
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands. c_ j
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