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Lack SD, Bartholomew C, North T, Miller SC, Neal BS. The effects of a two-week neuromuscular intervention on biopsychosocial variables in people with patellofemoral pain: an observational study. Front Sports Act Living 2023; 5:1087061. [PMID: 37255732 PMCID: PMC10225691 DOI: 10.3389/fspor.2023.1087061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Patellofemoral pain (PFP) is common and predominately affects active populations. Altered biomechanics and psychosocial variables have been reported in people with PFP, but the effects of neuromuscular exercise on these variables is unknown. We aimed to investigate changes in biopsychosocial measures following a two-week neuromuscular intervention in people with PFP. Materials and Methods We measured pain (visual analogue scale), function (Kujala), activity level (Tegner), psychological well-being (Orebro), lower-limb isometric strength (handheld dynamometry), three-dimensional (3D) lower limb kinematics, and surface electromyography (sEMG), in people with PFP. 3D lower-limb kinematics and sEMG were synchronously sampled during step-up, step-down, and overground running. All measures were repeated after participants had completed a two-week neuromuscular intervention consisting of three exercises completed once per day, five days per week. Results 18 participants completed pre/post testing (60% females, mean age 30.6 years ±7.0, height 173.4cm ±10.4, mass 70.2kg ±12.4, symptom duration 39.0 months ±58.8), with three of 21 participants lost to follow-up. Across all clinical measures (muscle onsets, muscle activation and kinematics), the 95% bootstrapped confidence intervals (CI) of the mean difference contained the null hypothesis following the two-week neuromuscular intervention, indicating no significant differences. Conclusion A two-week neuromuscular intervention did not change biomechanical or psychosocial measures in people with PFP. Interventions with a longer duration or greater load magnitude are required to fully evaluate the biopsychosocial mechanisms of effect for exercise in people with PFP.
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Affiliation(s)
- Simon David Lack
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
- Pure Sports Medicine, Point West Building, London, United Kingdom
| | - Clare Bartholomew
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Thomas North
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Stuart Charles Miller
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
| | - Bradley Stephen Neal
- Sports and Exercise Medicine, Queen Mary University London, Mile End Hospital, London, United Kingdom
- School of Sport, Rehabilitation and Exercise Science, University of Essex, Colchester, Essex, United Kingdom
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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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Muniz AMDS, Zeitoune G, Alvim F, Grassi GBA, Britto PAA, Nadal J. Do exist differences in kinematics and EMG of the hip and knee between male runners with and without patellofemoral pain in different running speeds? Phys Ther Sport 2023; 59:122-129. [PMID: 36529056 DOI: 10.1016/j.ptsp.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Patellofemoral pain (PFP) presents a higher prevalence in female runners, while PFP in male is somehow neglected. Moreover, the effects of progressive greater running speed have not been reported. This study investigates the influence of progressive greater running speed on lower limb tridimensional kinematics and muscle activation (EMG) in male runners with PFP while compared with controls. DESIGN Cross-Sectional Design. METHODS Thirteen runners with PFP and 18 controls ran in a treadmill under three different speeds: 9, 11, and 13 km/h. Principal component scores from kinematic data and EMG onset and amplitude were used to compare groups through the Mann-Whitney test at each running speed. RESULTS Male PFP subjects presented increased hip internal rotation at 11 km/h and increased hip and knee internal at 13 km/h, as well as reduced knee adduction at all speeds. PFP subjects also ran with delayed and shorter vastus medialis oblique pre-activation compared with normal subjects. CONCLUSIONS This study demonstrated that PFP increased knee and hip internal rotation at higher demand running, therefore, it is important to evaluate the transverse plane of the hip and knee biomechanics in male runners with PFP to optimize the rehabilitation and reconditioning method of these subjects.
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Affiliation(s)
- Adriane Mara de Souza Muniz
- Escola de Educação Física do Exército, EsEFEx, Exército Brasileiro, Rio de Janeiro, RJ, Brazil; Programa de Engenharia Biomédica - PEB/COPPE, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil.
| | - Gabriel Zeitoune
- Programa de Engenharia Biomédica - PEB/COPPE, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Felipe Alvim
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, SUPREMA, Juiz de Fora, MG, Brazil
| | - Giordano B A Grassi
- Escola de Educação Física do Exército, EsEFEx, Exército Brasileiro, Rio de Janeiro, RJ, Brazil
| | - Paulo A A Britto
- Programa de Engenharia Biomédica - PEB/COPPE, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Jurandir Nadal
- Programa de Engenharia Biomédica - PEB/COPPE, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
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Li F, Wu Y, Song Z, Tadum Arthur Vithran D, Li X, Fang K, Zeng M, Wen J, Xiao S, Qiu H. Characteristics of surface electromyogram signals after Pemberton pelvic osteotomy combined with femoral osteotomy in children with unilateral developmental dysplasia of the hip. Medicine (Baltimore) 2022; 101:e29794. [PMID: 35839016 PMCID: PMC11132326 DOI: 10.1097/md.0000000000029794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to assess the surface electromyogram (sEMG) signal characteristics of the muscle around the hip joint after Pemberton osteotomy in children with unilateral developmental dysplasia of the hip (DDH). A total of 21 children with unilateral DDH who had received Pemberton osteotomy were selected as the DDH group, and 21 healthy children of the same age were selected as the control group. The children in both groups were tested using sEMG, the Root mean square (RMS) values of the tensor fascia lata, rectus femurs, and medial head of the hamstring and gluteus maximum on both sides in standing and walking status were recorded. The value on the affected side in the DDH group was compared with the value on the healthy side himself and the value in the control group. The mean postoperative follow-up in the DDH group was 27.76 ± 24.30 months. The RMS value of the affected gluteus maximum muscle in the DDH group was significantly larger while standing (P < 0.05), the RMS value of bilateral tensor fascia lata muscle was significantly larger while walking (P < 0.05), and the RMS value of the affected hamstring muscle medial head was significantly less in the DDH group compared with the control group (P < 0.05). An asymmetry and compensatory increase in the sEMG activity of the muscles around the hip joint when standing and walking was noted in children with unilateral DDH who underwent Pemberton osteotomy combined with a femoral osteotomy. The rehabilitation training of the muscles around the hip joint after unilateral DDH should be strengthened.
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Affiliation(s)
- Fanling Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Yuyuan Wu
- Department of Pediatric Orthopedics, Traditional Chinese Medicine Hospital in Huaihua, Huaihua, Hunan, China
| | - Zhenqi Song
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Djandan Tadum Arthur Vithran
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Xin Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Ke Fang
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Ming Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
| | - Hailing Qiu
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical College of Hunan Normal University, Changsha, China
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Knox J, Gupta A, Banwell HA, Matricciani L, Turner D. Comparison of EMG signal of the flexor hallucis longus recorded using surface and intramuscular electrodes during walking. J Electromyogr Kinesiol 2021; 60:102574. [PMID: 34273727 DOI: 10.1016/j.jelekin.2021.102574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022] Open
Abstract
The purpose of this study was to compare the use of intramuscular (iEMG) and surface (sEMG) electromyography electrodes to record flexor hallucis longus (FHL) muscle activity during walking, and describe the role of the FHL. Muscle activity was recorded in 12 participants using sEMG and iEMG during treadmill and overground walking. Inter-tester reliability for visual detection of onset and offset of muscle activity was high (ICC = 1.00). During the loading period, the number of bursts of muscle activity was statistically significantly greater using iEMG compared to sEMG when treadmill walking (p = 0.016), and the duration of muscle activity was significantly greater for iEMG (p = 0.01) on both walking surfaces. There were no differences for peak and mean root mean squared (p ≥ 0.07). The FHL activity observed during the loading period (heel strike to forefoot strike) supports the function of the FHL to act as a dynamic ankle stabiliser of the rearfoot, as well as contributing to propulsion during the latter part of stance. The choice of electrodes to detect FHL activity should be dependent on whether the loading and propulsive periods are of interest, and whether treadmill or overground walking will be examined.
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Lima KMME, Flôr JDS, Barbosa RI, Marcolino AM, Almeida MGD, Silva DCD, Kuriki HU. Effects of a 12-week hip abduction exercise program on the electromyographic activity of hip and knee muscles of women with patellofemoral pain: A pilot study. MOTRIZ: REVISTA DE EDUCACAO FISICA 2020. [DOI: 10.1590/s1980-6574201900040103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Juliane da Silva Flôr
- Universidade Federal de Santa Catarina, Brasil; Universidade Federal de Santa Catarina, Brasil
| | - Rafael Inácio Barbosa
- Universidade Federal de Santa Catarina, Brasil; Universidade Federal de Santa Catarina, Brasil
| | | | | | | | - Heloyse Uliam Kuriki
- Universidade Federal de Santa Catarina, Brasil; Universidade Federal de Santa Catarina, Brasil
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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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Knee Extensor Rate of Torque Development Before and After Arthroscopic Partial Meniscectomy, With Analysis of Neuromuscular Mechanisms. J Orthop Sports Phys Ther 2017; 47:945-956. [PMID: 28992769 DOI: 10.2519/jospt.2017.7310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Descriptive, prospective single-cohort longitudinal study. Background Though rapid torque development is essential in activities of daily living and sports, it hasn't been specifically tested by most physical therapists or incorporated into rehabilitation programs until late in the treatment process. Little evidence is available on quadriceps torque development capacity before and after arthroscopic knee surgery. Objectives To study knee extensor rate of torque development, contributing mechanisms, and associations with strength and patient-reported outcomes before and during the first 6 weeks after arthroscopic partial meniscectomy. Methods Twenty subjects (mean ± SD age, 42.3 ± 13.7 years; body mass index, 26.6 ± 3.1 kg/m2) were tested before surgery, and at 2 and 5 weeks after surgery. Quadriceps muscle volume, strength, activation, rate of torque development, and patient-reported outcomes were evaluated across the study period. Results Significant side-to-side differences in quadriceps strength and voluntary rate of torque development were observed at each time point (P<.05). Changes in muscle activity were associated with changes in rapid torque development capacity. Side-to-side rate of torque development deficits after surgery were associated with lower patient-reported outcomes scores. Conclusion Diminished rapid torque development capacity is common in arthroscopic meniscal debridement patients. This reduced capacity is associated with an inability to quickly recruit and drive the quadriceps muscles (neural mechanisms) and not muscle atrophy or other peripheral factors tested. Patient-reported outcomes are associated with quadriceps rate of torque development, but not strength or muscle size. Rapid torque development warrants greater attention in rehabilitation. J Orthop Sports Phys Ther 2017;47(12):945-956. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7310.
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Pazzinatto MF, de Oliveira Silva D, Pappas E, Magalhães FH, de Azevedo FM. Is quadriceps H-reflex excitability a risk factor for patellofemoral pain? Med Hypotheses 2017; 108:124-127. [PMID: 29055385 DOI: 10.1016/j.mehy.2017.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022]
Abstract
Patellofemoral pain (PFP) is one of the most common conditions in orthopedic practice while recent evidence has suggested that it may be a predisposing factor to patellofemoral osteoarthritis. In addition to biomechanical alterations associated with the pathomechanisms underlying PFP, the investigation of neurophysiological alterations has provided novel information in the understanding of the pathophysiology of PFP. For instance, women with PFP present lower amplitude of the vastus medialis (VM) H-reflexes compared to pain-free controls, which suggests that the excitability of spinal reflexes might be a promising tool for discriminating woman with PFP in clinical practice. However, the cross-sectional design of the current research does not inform whether the reduced excitability predisposes to or is the consequence of PFP. Therefore, two hypotheses can be raised: (1) the reduction in excitability of the α-motoneurons is a risk factor for PFP; Or, (2) the reduction in H-reflex excitability is a consequence of PFP due to pain. If the former hypothesis is proven correct, it may help in the early identification of individuals with PFP. If the latter, it may help understand the reduced excitability as a consequence of the long-term pain, which may be interfering in the recovery of individuals with PFP in a long-term basis. In addition, exploring such hypotheses may have direct rehabilitative and prevention implications for PFP and its putative progression to knee osteoarthritis.
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Affiliation(s)
- Marcella Ferraz Pazzinatto
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil.
| | - Danilo de Oliveira Silva
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil; La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Evangelos Pappas
- The University of Sydney, Faculty of Health Sciences, Sydney, Australia
| | | | - Fábio Mícolis de Azevedo
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil
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Maffiuletti NA, Aagaard P, Blazevich AJ, Folland J, Tillin N, Duchateau J. Rate of force development: physiological and methodological considerations. Eur J Appl Physiol 2016; 116:1091-116. [PMID: 26941023 PMCID: PMC4875063 DOI: 10.1007/s00421-016-3346-6] [Citation(s) in RCA: 761] [Impact Index Per Article: 95.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/17/2016] [Indexed: 11/26/2022]
Abstract
The evaluation of rate of force development during rapid contractions has recently become quite popular for characterising explosive strength of athletes, elderly individuals and patients. The main aims of this narrative review are to describe the neuromuscular determinants of rate of force development and to discuss various methodological considerations inherent to its evaluation for research and clinical purposes. Rate of force development (1) seems to be mainly determined by the capacity to produce maximal voluntary activation in the early phase of an explosive contraction (first 50–75 ms), particularly as a result of increased motor unit discharge rate; (2) can be improved by both explosive-type and heavy-resistance strength training in different subject populations, mainly through an improvement in rapid muscle activation; (3) is quite difficult to evaluate in a valid and reliable way. Therefore, we provide evidence-based practical recommendations for rational quantification of rate of force development in both laboratory and clinical settings.
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Affiliation(s)
- Nicola A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Lengghalde 6, 8008, Zurich, Switzerland.
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
| | - Anthony J Blazevich
- Centre for Exercise and Sports Science Research (CESSR), School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jonathan Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Neale Tillin
- Department of Life Sciences, University of Roehampton, London, UK
| | - Jacques Duchateau
- Laboratory of Applied Biology, ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Delayed onset of electromyographic activity of the vastus medialis relative to the vastus lateralis may be related to physical activity levels in females with patellofemoral pain. J Electromyogr Kinesiol 2016; 26:137-42. [DOI: 10.1016/j.jelekin.2015.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/10/2015] [Accepted: 10/23/2015] [Indexed: 11/19/2022] Open
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de Oliveira Silva D, Magalhães FH, Faria NC, Pazzinatto MF, Ferrari D, Pappas E, de Azevedo FM. Lower Amplitude of the Hoffmann Reflex in Women With Patellofemoral Pain: Thinking Beyond Proximal, Local, and Distal Factors. Arch Phys Med Rehabil 2016; 97:1115-20. [PMID: 26763946 DOI: 10.1016/j.apmr.2015.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate whether vastus medialis (VM) Hoffmann reflexes (H-reflexes) differ on the basis of the presence or absence of patellofemoral pain (PFP) and to assess the capability of VM H-reflex measurements in accurately discriminating between women with and without PFP. DESIGN Cross-sectional study. SETTING Laboratory of biomechanics and motor control. PARTICIPANTS Women (N=30) aged 18 to 35 years were recruited, consisting of 2 groups: women with PFP (n=15) and asymptomatic controls (n=15). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Maximum evoked responses were obtained by electrical stimulation applied to the femoral nerve, and peak-to-peak amplitudes of maximal Hoffmann reflex (Hmax) and maximal motor wave (Mmax) ratios were calculated. Independent samples t tests were performed to identify differences between groups, and a receiver operating characteristic curve was constructed to assess the discriminatory capability of VM H-reflex measurements. RESULTS VM Hmax/Mmax ratios were significantly lower in participants with PFP than in pain-free participants (P=.007). In addition, the VM Hmax/Mmax ratios presented large and balanced discriminatory capability values (sensitivity, 73%; specificity, 67%). CONCLUSIONS This study is the first to show that VM H-reflexes are lower in women with PFP than in asymptomatic controls. Therefore, increasing the excitation of the spinal cord in PFP participants may be essential to maintaining the gains acquired during the rehabilitation programs.
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Affiliation(s)
- Danilo de Oliveira Silva
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil
| | | | - Nathálie Clara Faria
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil
| | - Marcella Ferraz Pazzinatto
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil
| | - Deisi Ferrari
- Bioengineering Department, School of Engineering, University of São Paulo, São Carlos, São Paulo, Brazil
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Fábio Mícolis de Azevedo
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, Brazil.
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Pazzinatto MF, Silva DDO, Briani RV, Ferrari D, Aragão FA, Albuquerque CED, Azevedo FMD. Reliability of electromyography parameters during stair deambulation in patellofemoral pain syndrome. MOTRIZ: REVISTA DE EDUCACAO FISICA 2015. [DOI: 10.1590/s1980-65742015000200012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Reliability is essential to all aspects of the measure, as it shows the quality of the information and allows rational conclusions with regard to the data. There has been controversial results regarding the reliability of electromyographic parameters assessed during stair ascent and descent in individuals with patellofemoral pain syndrome (PFPS). Therefore, this study aims to determine the reliability of time and frequency domain electromyographic parameters on both gestures in women with PFPS. Thirty-one women with PFPS were selected to participate in this study. Data from vastus lateralis and medialis were collected during stair deambulation. The selected parameters were: automatic onset, median frequency bands of low, medium and high frequency. Reliability was determined by intraclass correlation coefficient and the standard error of measurement. The frequency domain variables have shown good reliability, with the stair ascent presenting the best rates. On the other hand, onset has proved to be inconsistent in all measures. Our findings suggest that stair ascent is more reliable than stair descent to evaluate subjects with PFPS in the most cases.
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Briani RV, Silva DDO, Pazzinatto MF, Albuquerque CED, Ferrari D, Aragão FA, Azevedo FMD. Comparison of frequency and time domain electromyography parameters in women with patellofemoral pain. Clin Biomech (Bristol, Avon) 2015; 30:302-7. [PMID: 25583618 DOI: 10.1016/j.clinbiomech.2014.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite its high incidence, patellofemoral pain etiology remains unclear. No prior study has compared surface electromyography frequency domain parameters and surface electromyography time domain variables, which have been used as a classic analysis of patellofemoral pain. METHODS Thirty one women with patellofemoral pain and twenty eight pain-free women were recruited. Each participant was asked to descend a seven step staircase and data from five successful trials were collected. During the task, the vastus medialis and vastus lateralis muscle activities were monitored by surface electromyography. The data were processed and analyzed in four variables of the frequency domain (median frequency, low, medium and high frequency bands) and three time domain variables (Automatic, Cross-correlation and Visual Onset between the vastus medialis and vastus lateralis muscles). Reliability, Receiver Operating Characteristic curves and regression models were performed. FINDINGS The medium frequency band was the most reliable variable and different between the groups for both muscles, also demonstrated the best values of sensitivity and sensibility, 72% and 69% for the vastus medialis and 68% and 62% for the vastus lateralis, respectively. The frequency variables predicted the pain of individuals with patellofemoral pain, 26% for the vastus medialis and 20% for the vastus lateralis, being better than the time variables, which achieved only 7%. INTERPRETATION The frequency domain parameters presented greater reliability, diagnostic accuracy and capacity to predict pain than the time domain variables during stair descent and might be a useful tool to diagnose individuals with patellofemoral pain.
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Affiliation(s)
- Ronaldo Valdir Briani
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil; Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Danilo de Oliveira Silva
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Marcella Ferraz Pazzinatto
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil
| | - Carlos Eduardo de Albuquerque
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil
| | - Deisi Ferrari
- University of São Paulo, Post-graduation Program Interunits Bioengineering, EESC/FMRP/IQSC-USP, São Carlos, Brazil
| | - Fernando Amâncio Aragão
- Department of Physical Therapy, State University of West Parana, Research Laboratory of Human Movement, Cascavel, PR, Brazil
| | - Fábio Mícolis de Azevedo
- Department of Physical Therapy, University of São Paulo State, School of Science and Technology, Laboratory of Biomechanics and Motor Control, Presidente Prudente, SP, Brazil.
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15
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Lack S, Barton C, Woledge R, Laupheimer M, Morrissey D. The immediate effects of foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in individuals with patellofemoral pain. Clin Biomech (Bristol, Avon) 2014; 29:1056-62. [PMID: 25441771 DOI: 10.1016/j.clinbiomech.2014.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence shows that anti-pronating foot orthoses improve patellofemoral pain, but there is a paucity of evidence concerning mechanisms. We investigated the immediate effects of prefabricated foot orthoses on (i) hip and knee kinematics; (ii) electromyography variables of vastus medialis oblique, vastus lateralis and gluteus medius during a functional step-up task, and (iii) associated clinical measures. METHODS Hip muscle activity and kinematics were measured during a step-up task with and without an anti-pronating foot orthoses, in people (n=20, 9 M, 11 F) with patellofemoral pain. Additionally, we measured knee function, foot posture index, isometric hip abductor and knee extensor strength and weight-bearing ankle dorsiflexion. FINDINGS Reduced hip adduction (0.82°, P=0.01), knee internal rotation (0.46°, P=0.03), and decreased gluteus medius peak amplitude (0.9mV, P=0.043) were observed after ground contact in the 'with orthoses' condition. With the addition of orthoses, a more pronated foot posture correlated with earlier vastus medialis oblique onset (r=-0.51, P=0.02) whilst higher Kujala scores correlated with earlier gluteus medius onset (r=0.52, P=0.02). INTERPRETATION Although small in magnitude, reductions in hip adduction, knee internal rotation and gluteus medius amplitude observed immediately following orthoses application during a task that commonly aggravates symptoms, offer a potential mechanism for their effectiveness in patellofemoral pain management. Given the potential for cumulative effects of weight bearing repetitions completed with a foot orthoses, for example during repeated stair ascent, the differences are likely to be clinically meaningful.
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Affiliation(s)
- Simon Lack
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom
| | - Christian Barton
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom
| | - Roger Woledge
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom
| | - Markus Laupheimer
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, England, United Kingdom.
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16
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The reliability of determining the onset of medial gastrocnemius muscle activity during a stretch-shorten-cycle action. J Electromyogr Kinesiol 2014; 24:588-92. [DOI: 10.1016/j.jelekin.2014.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 04/10/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022] Open
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17
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Prolonged infrapatellar tendon vibration does not influence quadriceps maximal or explosive isometric force production in man. Eur J Appl Physiol 2014; 114:1757-66. [DOI: 10.1007/s00421-014-2904-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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18
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Ferrari D, Kuriki HU, Silva CR, Alves N, Mícolis de Azevedo F. Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome. Arch Phys Med Rehabil 2014; 95:1521-6. [PMID: 24742937 DOI: 10.1016/j.apmr.2014.03.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). DESIGN Sensitivity and specificity analysis. SETTING Physical rehabilitation center and laboratory of biomechanics and motor control. PARTICIPANTS Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The diagnostic accuracy was calculated for sEMG parameters' reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. RESULTS The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80-.90), precise (SEM=2.71-3.87 normalized unit), and able to differentiate participants with and without PFPS (P<.05). The association of B2 with anterior knee pain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). CONCLUSIONS The results provide evidence to support the use of EMG signals (B2-frequency band of 45-96 Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS.
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Affiliation(s)
- Deisi Ferrari
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil; Bioengineering Postgraduate Program, São Carlos School of Engineering, University of São Paulo, São Carlos, SP, Brazil
| | - Heloyse Uliam Kuriki
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil; Bioengineering Postgraduate Program, São Carlos School of Engineering, University of São Paulo, São Carlos, SP, Brazil
| | - Cristiano Rocha Silva
- Neuroscience Program and Biomedical Engineering Laboratory, University of São Paulo, SP, Brazil
| | - Neri Alves
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil; Bioengineering Postgraduate Program, São Carlos School of Engineering, University of São Paulo, São Carlos, SP, Brazil
| | - Fábio Mícolis de Azevedo
- Physical Therapy Department, School of Science and Technology, University of São Paulo State, Presidente Prudente, SP, Brazil.
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Folland JP, Buckthorpe MW, Hannah R. Human capacity for explosive force production: neural and contractile determinants. Scand J Med Sci Sports 2013; 24:894-906. [PMID: 25754620 DOI: 10.1111/sms.12131] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
This study assessed the integrative neural and contractile determinants of human knee extension explosive force production. Forty untrained participants performed voluntary and involuntary (supramaximally evoked twitches and octets - eight pulses at 300 Hz that elicit the maximum possible rate of force development) explosive isometric contractions of the knee extensors. Explosive force (F0-150 ms) and sequential rate of force development (RFD, 50-ms epochs) were measured. Surface electromyography (EMG) amplitude was recorded (superficial quadriceps and hamstrings, 50-ms epochs) and normalized (quadriceps to Mmax, hamstrings to EMGmax). Maximum voluntary force (MVF) was also assessed. Multiple linear regressions assessed the significant neural and contractile determinants of absolute and relative (%MVF) explosive force and sequential RFD. Explosive force production exhibited substantial interindividual variability, particularly during the early phase of contraction [F50, 13-fold (absolute); 7.5-fold (relative)]. Multiple regression explained 59-93% (absolute) and 35-60% (relative) of the variance in explosive force production. The primary determinants of explosive force changed during the contraction (F0-50, quadriceps EMG and Twitch F; RFD50-100, Octet RFD0-50; F100-150, MVF). In conclusion, explosive force production was largely explained by predictor neural and contractile variables, but the specific determinants changed during the phase of contraction.
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Affiliation(s)
- J P Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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RATHLEFF MICHAELS, SAMANI AFSHIN, OLESEN JENSL, ROOS EWAM, RASMUSSEN STEN, CHRISTENSEN BIRGITTEH, MADELEINE PASCAL. Neuromuscular Activity and Knee Kinematics in Adolescents with Patellofemoral Pain. Med Sci Sports Exerc 2013; 45:1730-9. [DOI: 10.1249/mss.0b013e318292be30] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tillin NA, Pain MT, Folland JP. Identification of contraction onset during explosive contractions. Response to Thompson et al. “Consistency of rapid muscle force characteristics: Influence of muscle contraction onset detection methodology” [J Electromyogr Kinesiol 2012;22(6):893–900]. J Electromyogr Kinesiol 2013; 23:991-4. [DOI: 10.1016/j.jelekin.2013.04.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 04/16/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022] Open
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22
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An Investigation Into the Onset, Pattern, and Effects of Pain Relief on Lumbar Extensor Electromyography in People With Acute and Chronic Low Back Pain. J Manipulative Physiol Ther 2013; 36:91-100. [DOI: 10.1016/j.jmpt.2012.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 11/21/2012] [Accepted: 12/07/2012] [Indexed: 11/23/2022]
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