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Cassidy RP, Lunt KM, Coppack RJ, Bennett AN, Bilzon JLJ, Mcguigan MP, Egginton N, Sellon E, Day J, Ladlow P. ADAPTations to low load blood flow restriction exercise versus conventional heavier load resistance exercise in UK military personnel with persistent knee pain: protocol for the ADAPT study, a multi-centre randomized controlled trial. BMC Musculoskelet Disord 2023; 24:580. [PMID: 37461024 DOI: 10.1186/s12891-023-06693-3] [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: 02/22/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Muscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual's one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to 'conventional' heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain. METHODS This is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18-55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study. DISCUSSION LL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI. TRIAL REGISTRATION ClinicalTrials.org reference number, NCT05719922.
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Affiliation(s)
- Robyn P Cassidy
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Kieran M Lunt
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Russell J Coppack
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James L J Bilzon
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Natalie Egginton
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
| | - Edward Sellon
- Royal Centre for Defence Medicine (RCDM), Birmingham, UK
- Radiology Department, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Jo Day
- Radiology Department, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK.
- Department for Health, University of Bath, Bath, UK.
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Bellizzi GL, Will-Lemos T, Resende RA, Cervi ACC, Santiago PRP, Fernández-de-las-Peñas C, Bevilaqua-Grossi D, Florencio LL. Knee Kinetics and Kinematics of Young Asymptomatic Participants during Single-Leg Weight-Bearing Tasks: Task and Sex Comparison of a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095590. [PMID: 35564985 PMCID: PMC9104880 DOI: 10.3390/ijerph19095590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022]
Abstract
This cross-sectional study aimed to describe and compare kinetic and kinematic variables of the knee joint during stair descent, single-leg step down, and single-leg squat tasks. It also aimed to investigate potential sex difference during the tasks. Thirty young asymptomatic individuals (15 males, 15 females) were assessed during the performance of single-leg weight-bearing tasks. The kinetic and kinematic data from the knee were evaluated at the peak knee moment and at peak knee flexion. Single-leg squat presented a higher peak knee moment (2.37 Nm/kg) and the greatest knee moment (1.91 Nm/kg) at knee peak angle in the frontal plane, but the lowest knee flexion (67°) than the other two tasks (p < 0.05). Additionally, the single-leg step down task presented a higher varus knee angle (5.70°) when compared to stair descent (3.71°) (p < 0.001). No substantial sex difference could be observed. In conclusion, in asymptomatic young individuals, single-leg squats presented the greatest demand in the frontal and sagittal planes. Single-leg step down demanded a greater angular displacement than stair descent in the frontal plane. We did not identify a significant difference among the sex and studied variables.
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Affiliation(s)
- Gustavo Luís Bellizzi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (G.L.B.); (T.W.-L.); (A.C.C.C.); (D.B.-G.)
| | - Tenysson Will-Lemos
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (G.L.B.); (T.W.-L.); (A.C.C.C.); (D.B.-G.)
| | - Renan Alves Resende
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil;
| | - Ana Cristina Corrêa Cervi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (G.L.B.); (T.W.-L.); (A.C.C.C.); (D.B.-G.)
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (G.L.B.); (T.W.-L.); (A.C.C.C.); (D.B.-G.)
| | - Lidiane Lima Florencio
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (G.L.B.); (T.W.-L.); (A.C.C.C.); (D.B.-G.)
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Correspondence: ; Tel.: +34-91-488-86-09
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Scinicarelli G, Trofenik M, Froböse I, Wilke C. The Reliability of Common Functional Performance Tests within an Experimental Test Battery for the Lower Extremities. Sports (Basel) 2021; 9:100. [PMID: 34357934 PMCID: PMC8309832 DOI: 10.3390/sports9070100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023] Open
Abstract
The main aim of this study was to determine the test-retest reliability of an experimental functional test battery: Y-balance test (YBT), single-leg countermovement jump (SLCMJ), single-leg hop for distance (SLH), side-hop (SH), speedy-jump (SJ), agility-T (AT), and lower extremity functional test (LEFT). Secondary aims were (1) to determine the mean range for the limb symmetry index (LSI) and (2) to detect significant differences in performance between test-retest sessions. Twenty-two healthy adults (14 males, 8 females; age 23.3 ± 3.9) were tested by the same rater during two different sessions (T1-T2), with a seven-day interval, under the same conditions. Reliability analysis showed good-to-excellent reliability (0.89 < ICC < 0.97; 0.80 < α < 0.98) for the test battery. LSI ranged from 95.9 ± 6.7% (SH-T1) to 104.4 ± 12.5% (SLCMJ-T2). Repeated measures ANOVA detected significant performance differences between sessions in the LEFT (p = 0.009) and for non-dominant sides in the SLH (p = 0.015), SH (p = 0.007), and SJ (p = 0.011). The high reliability of the test battery suggests a potential use in clinical sports practice. The LSI range of ≥95% was proposed as a benchmark for healthy adults. Learning effect seems to have played a crucial role in the T2 improvements of the non-dominant side for hop performances (SLH, SH, SJ) and speed performance (LEFT).
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Affiliation(s)
- Giordano Scinicarelli
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation Sciences, German Sport University, 50933 Cologne, Germany; (M.T.); (I.F.); (C.W.)
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Isın A, Melekoğlu T. Genu varum and football participation: Does football participation affect lower extremity alignment in adolescents? Knee 2020; 27:1801-1810. [PMID: 33197820 DOI: 10.1016/j.knee.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Genu varum is one of the most common anatomical variations of knee alignment which is considered a risk factor for anterior knee pain and anterior cruciate ligament injury among football players. Considering that millions of children participate in high-level football training, the purpose of this study was to determine the genu varum development in adolescent football players and non-athlete peers. The hypothesis of this study was that genu varum incidence was higher in adolescent football players compared with non-athletic peers. METHODS The design was a cross-sectional study. Two-hundred and thirty-seven male football players (FG) and aged-matched and anthropometrically similar non-athletes (CG) were recruited into the study. The quadriceps angle and intercondylar-intermalleolar distance were measured to evaluate the leg alignment. The distance between the medial edges of the condyles and malleoli was measured in millimeters using a digital caliper while angle measurements were performed using a photographic technique in a standing position. To analyze the variables, comparison, correlation and regression statistical tests were performed. RESULTS The intercondylar-intermalleolar distance and quadriceps angle values were significantly higher in FG than CG in all ages. In FG, a very strong correlation was found between number of training years and the intercondylar-intermalleolar distance. The prevalence of genu varum was markedly higher in FG than CG (~37% vs. 2%, respectively) based on intercondylar-intermalleolar distance. CONCLUSION This study determined that the prevalence of genu varum and abnormal quadriceps angles in adolescent football players is significantly higher compared with their non-athletic peers.
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Affiliation(s)
- A Isın
- Faculty of Sports Sciences, Akdeniz University, Antalya, Turkey
| | - T Melekoğlu
- Faculty of Sports Sciences, Akdeniz University, Antalya, Turkey.
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Differences in Lower Extremity and Trunk Kinematics between Single Leg Squat and Step Down Tasks. PLoS One 2015; 10:e0126258. [PMID: 25955321 PMCID: PMC4425598 DOI: 10.1371/journal.pone.0126258] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/31/2015] [Indexed: 12/02/2022] Open
Abstract
The single leg squat and single leg step down are two commonly used functional tasks to assess movement patterns. It is unknown how kinematics compare between these tasks. The purpose of this study was to identify kinematic differences in the lower extremity, pelvis and trunk between the single leg squat and the step down. Fourteen healthy individuals participated in this research and performed the functional tasks while kinematic data were collected for the trunk, pelvis, and lower extremities using a motion capture system. For the single leg squat task, the participant was instructed to squat as low as possible. For the step down task, the participant was instructed to stand on top of a box, slowly lower him/herself until the non-stance heel touched the ground, and return to standing. This was done from two different heights (16cm and 24cm). The kinematics were evaluated at peak knee flexion as well as at 60° of knee flexion. Pearson correlation coefficients (r) between the angles at those two time points were also calculated to better understand the relationship between each task. The tasks resulted in kinematics differences at the knee, hip, pelvis, and trunk at both time points. The single leg squat was performed with less hip adduction (p ≤ 0.003), but more hip external rotation and knee abduction (p ≤ 0.030), than the step down tasks at 60° of knee flexion. These differences were maintained at peak knee flexion except hip external rotation was only significant in the 24cm step down task (p ≤ 0.029). While there were multiple differences between the two step heights at peak knee flexion, the only difference at 60° of knee flexion was in trunk flexion (p < 0.001). Angles at the knee and hip had a moderate to excellent correlation (r = 0.51–0.98), but less consistently so at the pelvis and trunk (r = 0.21–0.96). The differences in movement patterns between the single leg squat and the step down should be considered when selecting a single leg task for evaluation or treatment. The high correlation of knee and hip angles between the three tasks indicates that similar information about knee and hip kinematics was gained from each of these tasks, while pelvis and trunk angles were less well predicted.
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Dingenen B, Malfait B, Vanrenterghem J, Verschueren SM, Staes FF. The reliability and validity of the measurement of lateral trunk motion in two-dimensional video analysis during unipodal functional screening tests in elite female athletes. Phys Ther Sport 2014; 15:117-23. [DOI: 10.1016/j.ptsp.2013.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/07/2013] [Accepted: 05/21/2013] [Indexed: 11/16/2022]
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