Hamstrings and quadriceps muscle contributions to energy generation and dissipation at the knee joint during stance, swing and flight phases of level running

Effect of Running Speed on Knee Biomechanics in Collegiate Athletes Following Anterior Cruciate Ligament Reconstruction

INTRODUCTION

Athletes after anterior cruciate ligament reconstruction (ACLR) demonstrate altered surgical knee running kinematics and kinetics compared with the nonsurgical limb and healthy controls. The effect of running speed on biomechanics has not been formally assessed in athletes post-ACLR. The purpose of this study was to characterize how knee biomechanics change with running speed between 3.5-7 (EARLY) and 8-13 (LATE) months post-ACLR.

METHODS

Fifty-five Division I collegiate athletes post-ACLR completed running analyses (EARLY: n = 40, LATE: n = 41, both: n = 26) at 2.68, 2.95, 3.35, 3.80, and 4.47 m·s -1 . Linear mixed-effects models assessed the influence of limb, speed, time post-ACLR, and their interactions on knee kinematics and kinetics.

RESULTS

A significant limb-speed interaction was detected for peak knee flexion, knee flexion excursion, and rate of knee extensor moment ( P < 0.02), controlling for time. From 3.35 to 4.47 m·s -1 , knee flexion excursion decreased by -2.3° (95% confidence interval, -3.6 to -1.0) in the nonsurgical limb and -1.0° (95% confidence interval, -2.3 to -0.3) in the surgical limb. Peak vertical ground reaction force, peak knee extensor moment, and knee negative work increased similarly with speed for both limbs ( P < 0.002). A significant limb-time interaction was detected for all variables ( P < 0.001). Accounting for running speed, improvements in all surgical limb biomechanics were observed from EARLY to LATE ( P < 0.001), except for knee flexion at initial contact ( P = 0.12), but between-limb differences remained ( P < 0.001).

CONCLUSIONS

Surgical and nonsurgical knee biomechanics increase similarly with speed in collegiate athletes at EARLY and LATE, with the exception of peak knee flexion, knee flexion excursion, and rate of knee extensor moment. Surgical knee biomechanics improved from EARLY and LATE, but significant between-limb differences persisted.

Acute Effects of Carbon Fiber Insole on Three Aspects of Sports Performance, Lower Extremity Muscle Activity, and Subjective Comfort

Carbon fiber insole (CFI), which is lightweight and stiff to reduce energy loss and help wearers perform better in sports, has recently been introduced. However, reports are scarce on the effects of CFI on sports performance, muscle activation, and wearing comfort. This study investigated the acute effects of CFI on sports performance, lower extremity muscle activity, and subjective comfort. Thirty young healthy males with shoe sizes between 260 and 270 mm performed various sports tasks (power generation, agility, and speed) and treadmill runs with wearable sensors under two experimental insole conditions (benchmark insole as a baseline, CFI). The results showed that, compared to the benchmark insole, CFI significantly improved sports performance in terms of power generation (~1.5%) and agility (~1%). However, it activated more of the Tibialis Anterior (~0.7%) and Gastrocnemius Medialis (~0.8%) muscles, and was perceived to be stiffer and less comfortable. These findings suggested that CFI could improve sports performance, but could cause more lower extremity muscle activation and subjective discomfort.

Effects of Focal Knee Joint Cooling on Static and Dynamic Strength of the Quadriceps: Innovative Approach to Muscle Conditioning

Recent evidence suggests an innovative approach to muscle conditioning: focal knee joint cooling (FKJC) appears to improve quadriceps function, including static (isometric) strength. However, there is limited evidence on the effects of FKJC on dynamic (concentric and eccentric) strength. Thus, the purpose of the study was to examine dynamic quadriceps strength following FKJC as well as static strength. Twenty-one college-aged participants volunteered. They randomly underwent 20 min of FKJC and control condition at least 72 h apart. FKJC involves two ice bags, placed on the anterior and posterior surfaces of the knee, whereas the control condition received a plastic ice bag filled with candy corn. We assessed isometric and isokinetic (concentric and eccentric) quadriceps strength at two different velocities (60°/s and 180°/s). Participants performed three maximal voluntary contractions for each mode of muscle contraction, before and after each treatment (immediately, 20, and 40 min after). The outcome variable was maximum knee extension peak torque. FKJC did not change peak torque during any mode of muscle contraction (p > 0.05). The current findings suggest that 20 min of FKJC does not change static (isometric) or dynamic (isokinetic) strength of the quadriceps. FKJC was neither beneficial nor harmful to static or dynamic muscular strength.

Neuromechanics of Middle-Distance Running Fatigue: A Key Role of the Plantarflexors?

PURPOSE

This study aimed to investigate the changes in lower limb kinematics, kinetics, and muscle activation during a high-intensity run to fatigue (HIRF).

METHODS

Eighteen male and female competitive middle-distance runners performed a HIRF on an instrumented treadmill at a constant but unsustainable middle-distance speed (~3 min) based on a preceding maximum oxygen uptake (V˙O2max) test. Three-dimensional kinematics and kinetics were collected and compared between the start, 33%, 67%, and the end of the HIRF. In addition, the activation of eight lower limb muscles of each leg was measured with surface EMG (sEMG).

RESULTS

Time to exhaustion was 181 ± 42 s. By the end of the HIRF (i.e., vs the start), ground contact time increased (+4.0%), whereas flight time (-3.2%), peak vertical ground reaction force (-6.1%), and vertical impulse (-4.1%) decreased (all P < 0.05), and joint angles at initial contact became more (dorsi)flexed (ankle, +1.9°; knee, +2.1°; hip, +3.6°; all P < 0.05). During stance, by the end of the HIRF: peak ankle plantarflexion moment decreased by 0.4 N·m·kg-1 (-9.0%), whereas peak knee extension moment increased by 0.24 N·m·kg-1 (+10.3%); similarly, positive ankle plantarflexion work decreased by 0.19 J·kg-1 (-13.9%), whereas positive knee extension work increased by 0.09 J·kg-1 (+33.3%; both P < 0.05) with no change in positive hip extension work. Hip extensor surface EMG amplitude increased during the late swing phase (+20.9-37.3%; P < 0.05).

CONCLUSION

Running at a constant middle-distance pace led primarily to the fatigue of the plantarflexors with a compensatory increase in positive work done at the knee. Improving the fatigue resistance of the plantarflexors might be beneficial for middle-distance running performance.

Commonly used clinical criteria following ACL reconstruction including time from surgery and isokinetic limb symmetry thresholds are not associated with between-limb loading deficits during running

OBJECTIVES

We included objective measures of gait and functional assessments to examine their associations in athletes who had recently commenced running after ACL reconstruction.

DESIGN

Cross-sectional.

SETTING

Sports medicine.

PARTICIPANTS

65 male athletes with a history of ACL reconstruction.

MAIN OUTCOME MEASURES

Time from surgery, isokinetic knee extension/flexion strength (60°/s), and peak vertical ground reaction force (pVGRF) measured during running using an instrumented treadmill. We also investigated if a range of recommended isokinetic thresholds (e.g. > 70% quadriceps limb symmetry index) affected the magnitude of pVGRF asymmetry during running.

RESULTS

There were significant relationships between quadriceps (r = 0.50) and hamstrings (r = 0.46) peak torque and pVGRF. Quadriceps peak torque explained a quarter of the variance in pVGRF (R² = 0.24; p < 0.001). There was no association was between running pVGRF and time from surgery. Between-group differences in running pVGRF LSI% were trivial (d < 0.20) for all quadriceps and hamstring peak torque LSI thresholds.

CONCLUSIONS

Current clinical criteria including time from surgery and isokinetic strength limb symmetry thresholds were not associated with lower pVGRF asymmetry measured during running. Quadriceps strength is important, but 'minimum symmetry thresholds' should be used with caution.

Inverse Kinematic Assessment of Rehabilitative Therapy in Children Using Orthotics

Pathologic movement patterns are characterized by abnormal kinematics that alter how muscles support the body during walking. Individual muscles are often the target of interventions with physical therapy and surgery alike, yet the tools to assess individual muscles clinically remain limited. The aim of this study is to assess OpenSim as a clinical tool for individualized rehabilitative evaluation of children using orthotics. This anatomic and kinematic modeling study was focused on pre- and post-treatment assessment of gait characteristics in fourteen children using orthotic devices. A range of four to twelve acceptable gait capture trials was collected for each child before therapy began and again after four weeks of treatment. The effects of therapy were significant in four of the lower extremity muscle analyses, three of the temporal parameters, and eighteen of the spatial parameters. All muscle lengths showed less deviation from normal values after physical therapy across all subjects. Results of this study support the further evaluation of OpenSim as a tool to improve quantitative assessment of musculoskeletal dynamics during the course of rehabilitative therapy in children using orthotics.

Variations in medial-lateral hamstring force and force ratio influence tibiofemoral kinematics

A change in hamstring strength and activation is typically seen after injuries or invasive surgeries such as anterior cruciate reconstruction or total knee replacement. While many studies have investigated the influence of isometric increases in hamstring load on knee joint kinematics, few have quantified the change in kinematics due to a variation in medial to lateral hamstring force ratio. This study examined the changes in knee joint kinematics on eight cadaveric knees during an open-chain deep knee bend for six different loading configurations: five loaded hamstring configurations that varied the ratio of a total load of 175 N between the semimembranosus and biceps femoris and one with no loads on the hamstring. The anterior-posterior translation of the medial and lateral femoral condyles' lowest points along proximal-distal axis of the tibia, the axial rotation of the tibia, and the quadriceps load were measured at each flexion angle. Unloading the hamstring shifted the medial and lateral lowest points posteriorly and increased tibial internal rotation. The influence of unloading hamstrings on quadriceps load was small in early flexion and increased with knee flexion. The loading configuration with the highest lateral hamstrings force resulted in the most posterior translation of the medial lowest point, most anterior translation of the lateral lowest point, and the highest tibial external rotation of the five loading configurations. As the medial hamstring force ratio increased, the medial lowest point shifted anteriorly, the lateral lowest point shifted posteriorly, and the tibia rotated more internally. The results of this study, demonstrate that variation in medial-lateral hamstrings force and force ratio influence tibiofemoral transverse kinematics and quadriceps loads required to extend the knee. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1707-1715, 2016.

Relationship between isometric thigh muscle strength and minimum clinically important differences in knee function in osteoarthritis: data from the osteoarthritis initiative

OBJECTIVE

To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower leg function.

METHODS

Isometric knee extensor and flexor strength of 4,553 Osteoarthritis Initiative participants (2,651 women and 1,902 men) was related to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scores by linear regression. Further, groups of male and female participant strata with minimum clinically important differences (MCIDs) in WOMAC function scores (6 of 68 units) were compared across the full range of observed values and to participants without functional deficits (WOMAC score 0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression.

RESULTS

Per regression equations, a 3.7% reduction in extensor strength and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and, respectively, a 3.6% and 4.8% reduction in men. For strength divided by body weight, reductions were 5.2% and 6.7%, respectively, in women and 5.8% and 6.7%, respectively, in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest nonlinear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information.

CONCLUSION

Reductions of approximately 4% in isometric muscle strength and of 6% in strength per body weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower leg function.