1
|
Nuccio S, Germer CM, Casolo A, Borzuola R, Labanca L, Rocchi JE, Mariani PP, Felici F, Farina D, Falla D, Macaluso A, Sbriccoli P, Del Vecchio A. Neuroplastic alterations in common synaptic inputs and synergistic motor unit clusters controlling the vastii muscles of individuals with ACL reconstruction. J Appl Physiol (1985) 2024; 137:835-847. [PMID: 39024407 DOI: 10.1152/japplphysiol.00056.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024] Open
Abstract
This cross-sectional study aims to elucidate the neural mechanisms underlying the control of knee extension forces in individuals with anterior cruciate ligament reconstruction (ACLR). Eleven soccer players with ACLR and nine control players performed unilateral isometric knee extensions at 10% and 30% of their maximum voluntary force (MVF). Simultaneous recordings of high-density surface electromyography (HDEMG) and force output were conducted for each lower limb, and HDEMG data from the vastus lateralis (VL) and vastus medialis (VM) muscles were decomposed into individual motor unit spike trains. Force steadiness was estimated using the coefficient of variation of force. An intramuscular coherence analysis was adopted to estimate the common synaptic input (CSI) converging to each muscle. A factor analysis was applied to investigate the neural strategies underlying the control of synergistic motor neuron clusters, referred to as motor unit modes. Force steadiness was similar between lower limbs. However, motor neurons innervating the VL on the reconstructed side received a lower proportion of CSI at low-frequency bandwidths (<5 Hz) compared with the unaffected lower limbs (P < 0.01). Furthermore, the reconstructed side demonstrated a higher proportion of motor units associated with the neural input common to the synergistic muscle, as compared with the unaffected lower limbs (P < 0.01). These findings indicate that the VL muscle of reconstructed lower limbs contribute marginally to force steadiness and that a plastic rearrangement in synergistic clusters of motor units involved in the control of knee extension forces is evident following ACLR.NEW & NOTEWORTHY Chronic quadriceps dysfunction is common after anterior cruciate ligament reconstruction (ACLR). We investigated voluntary force control strategies by estimating common inputs to motor neurons innervating the vastii muscles. Our results showed attenuated common inputs to the vastus lateralis and plastic rearrangements in functional clusters of motor neurons modulating knee extension forces in the reconstructed limb. These findings suggest neuroplastic adjustments following ACLR that may occur to fine-tune the control of quadriceps forces.
Collapse
Affiliation(s)
- Stefano Nuccio
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Carina M Germer
- Departamento de Eletrônica e Engenharia Biomédica, Faculdade de Engenharia Elétrica e de Computação, Universidade Estadual de Campinas, São Paulo, Brazil
- Laboratório de Pesquisa em Neuroengenharia, Centro de Engenharia Biomédica, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Andrea Casolo
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Riccardo Borzuola
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCSS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jacopo E Rocchi
- Villa Stuart Sport Clinic - FIFA Medical Centre of Excellence, Rome, Italy
| | - Pier Paolo Mariani
- Villa Stuart Sport Clinic - FIFA Medical Centre of Excellence, Rome, Italy
| | - Francesco Felici
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Paola Sbriccoli
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Alessandro Del Vecchio
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
2
|
Lecce E, Conti A, Nuccio S, Felici F, Bazzucchi I. Characterising sex-related differences in lower- and higher-threshold motor unit behaviour through high-density surface electromyography. Exp Physiol 2024; 109:1317-1329. [PMID: 38888901 PMCID: PMC11291872 DOI: 10.1113/ep091823] [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: 02/14/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
Emerging questions in neuromuscular physiology revolve around whether males and females share similar neural control in diverse tasks across a broad range of intensities. In order to explore these features, high-density electromyography was used to record the myoelectrical activity of biceps brachii during trapezoidal isometric contractions at 35% and 70% of maximal voluntary force (MVF) on 11 male and 13 female participants. Identified motor units were then classified as lower-threshold (recruited at ≤30%MVF) and higher-threshold (recruited at >30%MVF). The discharge rate, interspike interval variability, recruitment and derecruitment thresholds, and estimates of neural drive to motor neurons were assessed. Female lower-threshold motor units showed higher neural drive (P < 0.001), accompanied by higher discharge rate at recruitment (P = 0.006), plateau (P = 0.001) and derecruitment (P = 0.001). On the other hand, male higher-threshold motor units showed greater neural drive (P = 0.04), accompanied by higher discharge rate at recruitment (P = 0.005), plateau (P = 0.04) and derecruitment (P = 0.01). Motor unit discharge rate normalised by the recruitment threshold was significantly higher in female lower-threshold motor units (P < 0.001), while no differences were observed in higher-threshold motor units. Recruitment and derecruitment thresholds are higher in males across all intensities (P < 0.01). However, males and females have similar activation and deactivation strategies, as evidenced by similar recruitment-to-derecruitment ratios (P > 0.05). This study encompasses a broad intensity range to analyse motor unit sex-related differences, highlighting higher neural drive and discharge rates in female lower-threshold motor units, elevated recruitment and derecruitment thresholds in males, and convergences in activation and deactivation strategies. HIGHLIGHTS: What is the central question of the study? Do male and female motor units behave similarly in low- and high-intensity contractions? What is the main finding and its importance? Female motor units show higher discharge rates in low-intensity tasks and lower discharge rates in high-intensity tasks, with no differences in recruitment behaviour. A broader inter-spike interval variability was also observed in females. These findings underline that there are sex-specific differences concern the firing strategies based on task intensity.
Collapse
Affiliation(s)
- Edoardo Lecce
- Department of Movement, Human and Health Sciences, Laboratory of Exercise PhysiologyUniversity of Rome ‘Foro Italico’RomeItaly
| | - Alessandra Conti
- Department of Movement, Human and Health Sciences, Laboratory of Exercise PhysiologyUniversity of Rome ‘Foro Italico’RomeItaly
| | - Stefano Nuccio
- Department of Movement, Human and Health Sciences, Laboratory of Exercise PhysiologyUniversity of Rome ‘Foro Italico’RomeItaly
| | - Francesco Felici
- Department of Movement, Human and Health Sciences, Laboratory of Exercise PhysiologyUniversity of Rome ‘Foro Italico’RomeItaly
| | - Ilenia Bazzucchi
- Department of Movement, Human and Health Sciences, Laboratory of Exercise PhysiologyUniversity of Rome ‘Foro Italico’RomeItaly
| |
Collapse
|
3
|
Cobian DG, Oppenheim ZR, Roehl TJ, Joachim MR, Heiderscheit BC. Knee Extensor Torque Steadiness and Quadriceps Activation Variability in Collegiate Athletes 4, 6, and 12 Months After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241253843. [PMID: 38867919 PMCID: PMC11168251 DOI: 10.1177/23259671241253843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/16/2023] [Indexed: 06/14/2024] Open
Abstract
Background Quadriceps performance after anterior cruciate ligament reconstruction (ACLR) is typically characterized by peak force/torque, but the ability to generate consistent knee extensor torque may be clinically meaningful. Purpose/Hypothesis The purpose of this study was to evaluate knee extensor torque steadiness and quadriceps activation variability in collegiate athletes 4 to 12 months after ACLR. It was hypothesized that between-limb asymmetries in torque steadiness and activation variability would be observed and that steadiness would be associated with activation variability and peak knee extensor torque symmetry. Study Design Case-control study; Level of evidence, 3. Methods A total of 30 National Collegiate Athletic Association Division I athletes completed maximal voluntary isometric contractions 4, 6, and 12 months after ACLR. Torque and surface electromyography of the superficial quadriceps were recorded. Torque steadiness was calculated as the mean difference between initial and low-pass filtered torque signals and was expressed as a percentage of peak torque. Quadriceps activation variability was calculated similarly and was expressed as a percentage of peak electromyography. Linear mixed models were used to assess change in torque steadiness and activation variability over time. Associations between torque steadiness of the operated limb, activation variability, and quadriceps strength symmetry were evaluated using the Spearman correlation coefficient. Results Limb-by-time interactions were detected for torque steadiness and activation variability (P < .001), with reductions (improvements) in limb steadiness and activation variability observed with increasing time since surgery. Between-limb differences in torque steadiness and activation variability were observed at 4 and 6 months postoperatively (P < .05). Significant associations between operated limb torque steadiness and quadriceps activation variability were observed at 4 months (P < .001) and 6 months (P < .01). Torque steadiness of the operated limb was associated with peak knee extensor torque symmetry at 4 months (r S = -0.49; P < .01) and 6 months (r S = -0.49; P < .01). Conclusion In collegiate athletes, impaired knee extensor torque steadiness of the operated limb and associated abnormal quadriceps activation patterns were observed 4 to 12 months after ACLR, and the consistency of knee extensor torque production was associated with greater quadriceps strength asymmetries, particularly 4 to 6 months after surgery. Operated limb torque steadiness and activation variability improved from 4 to 12 months after ACLR. Clinical assessment of knee extensor torque steadiness after ACLR may improve prognosis and specificity of rehabilitation efforts.
Collapse
Affiliation(s)
- Daniel G. Cobian
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Zachary R. Oppenheim
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Tyler J. Roehl
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Joachim
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
| |
Collapse
|
4
|
Kositsky A, Stenroth L, Barrett RS, Korhonen RK, Vertullo CJ, Diamond LE, Saxby DJ. Muscle Morphology Does Not Solely Determine Knee Flexion Weakness After Anterior Cruciate Ligament Reconstruction with a Semitendinosus Tendon Graft: A Combined Experimental and Computational Modeling Study. Ann Biomed Eng 2024; 52:1313-1325. [PMID: 38421479 PMCID: PMC10995045 DOI: 10.1007/s10439-024-03455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The distal semitendinosus tendon is commonly harvested for anterior cruciate ligament reconstruction, inducing substantial morbidity at the knee. The aim of this study was to probe how morphological changes of the semitendinosus muscle after harvest of its distal tendon for anterior cruciate ligament reconstruction affects knee flexion strength and whether the knee flexor synergists can compensate for the knee flexion weakness. Ten participants 8-18 months after anterior cruciate ligament reconstruction with an ipsilateral distal semitendinosus tendon autograft performed isometric knee flexion strength testing (15°, 45°, 60°, and 90°; 0° = knee extension) positioned prone on an isokinetic dynamometer. Morphological parameters extracted from magnetic resonance images were used to inform a musculoskeletal model. Knee flexion moments estimated by the model were then compared with those measured experimentally at each knee angle position. A statistically significant between-leg difference in experimentally-measured maximal isometric strength was found at 60° and 90°, but not 15° or 45°, of knee flexion. The musculoskeletal model matched the between-leg differences observed in experimental knee flexion moments at 15° and 45° but did not well estimate between-leg differences with a more flexed knee, particularly at 90°. Further, the knee flexor synergists could not physiologically compensate for weakness in deep knee flexion. These results suggest additional factors other than knee flexor muscle morphology play a role in knee flexion weakness following anterior cruciate ligament reconstruction with a distal semitendinosus tendon graft and thus more work at neural and microscopic levels is required for informing treatment and rehabilitation in this demographic.
Collapse
Affiliation(s)
- Adam Kositsky
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher J Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
5
|
Valli G, Sarto F, Casolo A, Del Vecchio A, Franchi MV, Narici MV, De Vito G. Lower limb suspension induces threshold-specific alterations of motor units properties that are reversed by active recovery. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:264-276. [PMID: 37331508 PMCID: PMC10980901 DOI: 10.1016/j.jshs.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to non-invasively test the hypothesis that (a) short-term lower limb unloading would induce changes in the neural control of force production (based on motor units (MUs) properties) in the vastus lateralis muscle and (b) possible changes are reversed by active recovery (AR). METHODS Ten young males underwent 10 days of unilateral lower limb suspension (ULLS) followed by 21 days of AR. During ULLS, participants walked exclusively on crutches with the dominant leg suspended in a slightly flexed position (15°-20°) and with the contralateral foot raised by an elevated shoe. The AR was based on resistance exercise (leg press and leg extension) and executed at 70% of each participant's 1 repetition maximum, 3 times/week. Maximal voluntary isometric contraction (MVC) of knee extensors and MUs properties of the vastus lateralis muscle were measured at baseline, after ULLS, and after AR. MUs were identified using high-density electromyography during trapezoidal isometric contractions at 10%, 25%, and 50% of the current MVC, and individual MUs were tracked across the 3 data collection points. RESULTS We identified 1428 unique MUs, and 270 of them (18.9%) were accurately tracked. After ULLS, MVC decreased by 29.77%, MUs absolute recruitment/derecruitment thresholds were reduced at all contraction intensities (with changes between the 2 variables strongly correlated), while discharge rate was reduced at 10% and 25% but not at 50% MVC. Impaired MVC and MUs properties fully recovered to baseline levels after AR. Similar changes were observed in the pool of total as well as tracked MUs. CONCLUSION Our novel results demonstrate, non-invasively, that 10 days of ULLS affected neural control predominantly by altering the discharge rate of lower-threshold but not of higher-threshold MUs, suggesting a preferential impact of disuse on motoneurons with a lower depolarization threshold. However, after 21 days of AR, the impaired MUs properties were fully restored to baseline levels, highlighting the plasticity of the components involved in neural control.
Collapse
Affiliation(s)
- Giacomo Valli
- Department of Biomedical Sciences, University of Padova, Padova 35131, Italy.
| | - Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova 35131, Italy
| | - Andrea Casolo
- Department of Biomedical Sciences, University of Padova, Padova 35131, Italy
| | - Alessandro Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University, Erlangen-Nürnberg 91052, Germany
| | - Martino V Franchi
- Department of Biomedical Sciences, University of Padova, Padova 35131, Italy
| | - Marco V Narici
- Department of Biomedical Sciences, University of Padova, Padova 35131, Italy
| | - Giuseppe De Vito
- Department of Biomedical Sciences, University of Padova, Padova 35131, Italy
| |
Collapse
|
6
|
Koyanagi M, Matsuo T, Nakae N, Okimoto R, Nobekawa S, Tsukuda H, Ogasawara I, Shino K. Leaf spring exercise: A safe quadriceps strengthening exercise after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 113:106213. [PMID: 38458001 DOI: 10.1016/j.clinbiomech.2024.106213] [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: 07/13/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Leg extensions should be avoided in the early stages after anterior cruciate ligament reconstruction because the force exerted by the quadriceps muscle leads to anterior tibial displacement. To allow for safe quadriceps training in the knee extension range during this period, we devised the leaf spring exercise, which involves placing subjects in the prone position with their knee slightly flexed and instructing them to perform maximum isometric quadriceps contractions while supporting the proximal region of the lower leg's anterior surface and immobilizing the femur's posterior surface to prevent lifting. The current study aimed to examine the safety of Leaf spring exercise by determining the femur-tibia relationship using ultrasound imaging. METHODS This controlled laboratory study included patients with unilateral anterior cruciate ligament-deficient knees (8 men and 8 women; age, 24.2 ± 8.3 years) who were instructed to perform Leaf spring exercise of both lower limbs. We measured the femur-tibia-step-off, which indicates the distance between the last point of the medial and lateral condyles of the femur and posterior margin of the tibial plateau, as a parameter to evaluate anterior tibial displacement via ultrasound diagnostic device. Further, peak torque of the quadriceps muscle was calculated using force measurement device. FINDINGS No difference in anterior tibial displacement and peak torque was observed between the uninjured and injured sides during Leaf spring exercise. INTERPRETATION Leaf spring exercise may add some strain on the reconstructed anterior cruciate ligament; hence, it can be considered a safe quadriceps exercise in the knee extension range.
Collapse
Affiliation(s)
- Maki Koyanagi
- Faculty of Medical Science and Health-Promotion, Osaka Electro-communication University, 1130-70 Kiyotaki, Shijonawate, Osaka 575-0063, Japan.
| | - Takayuki Matsuo
- Osaka Yukioka College of Health Science, 1 Chome, 1-41 Sojiji, Ibaraki, Osaka 567-0801, Japan
| | - Naruhiko Nakae
- Department of Rehabilitation, Kansai Medical Hospital, 1 Chome-1-7-2 Shinsenri Nishimachi, Toyonaka, Osaka 560-0083, Japan
| | - Ryo Okimoto
- Department of Rehabilitation, Yokoi Health Care Sports Clinic, 1 Chome-1-31 Nishimidorigaoka, Toyonaka, Osaka 560-0005, Japan
| | - Shota Nobekawa
- Department of Rehabilitation, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
| | - Hideki Tsukuda
- Department of Rehabilitation, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
| | - Issei Ogasawara
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2 Chome-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2 Chome-2-3 Ukida, Kita Ward, Osaka 530-0021, Japan
| |
Collapse
|
7
|
Möck S, Wirth K. Bilateral differences of isokinetic knee extensor strength are velocity- and task-dependent. Sports Biomech 2024:1-13. [PMID: 38329274 DOI: 10.1080/14763141.2024.2315260] [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: 12/21/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
The purpose of this study was to investigate the concordance of isokinetic bilateral strength differences of the knee extensors in single- and multi-joint movement tasks. One hundred and nineteen male athletes performed isokinetic legpresses at 0.1 m/s and 0.7 m/s as well as isokinetic knee extensions at 60°/s and 180°/s. Bilateral differences and directed bilateral differences (sign indicating the direction of the difference) were calculated for all measurements. Bland-Altman-Plots were plotted to investigate if the different conditions detect bilateral differences of the same magnitude. Additionally, concordance correlations for the directed bilateral differences of the different tests were calculated to investigate magnitude and direction. The results indicate poor to fair concordance between the bilateral differences in the legpress conditions as well as between single- and multi-joint tasks. The single-joint knee extensions displayed a moderate level of agreement. Bilateral strength differences in isokinetic movement tasks are dependent on movement velocity and the nature of the task (single- or multi-joint movement) in the lower extremities. Both the value and the direction of the strength differences show no clear pattern across the investigated measurements and cannot be used interchangeably. Therefore, to assess interlimb strength balance, multiple different tests should be performed.
Collapse
Affiliation(s)
- Sebastian Möck
- Department of Exercise Science, Olympic Training and Testing Center of Hessen, Frankfurt am Main, Germany
| | - Klaus Wirth
- Sport and Exercise Sciences, University of Applied Sciences Wiener Neustadt, Wiener Neustadt, Austria
| |
Collapse
|
8
|
Riehm CD, Bonnette S, Rush JL, Diekfuss JA, Koohestani M, Myer GD, Norte GE, Sherman DA. Corticomuscular cross-recurrence analysis reveals between-limb differences in motor control among individuals with ACL reconstruction. Exp Brain Res 2024; 242:355-365. [PMID: 38092900 PMCID: PMC10872341 DOI: 10.1007/s00221-023-06751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 01/04/2024]
Abstract
Surgical reconstruction of the anterior cruciate ligament (ACL) and subsequent physical therapy can help athletes return to competition; however, re-injury rates remain disproportionately high due, in part, to lingering biomechanical and neurological factors that are not fully addressed during rehabilitation. Prior reports indicate that individuals exhibit altered electrical activity in both brain and muscle after ACL reconstruction (ACLR). In this investigation, we aimed to extend existing approaches by introducing a novel non-linear analysis of corticomuscular dynamics, which does not assume oscillatory coupling between brain and muscle: Corticomuscular cross-recurrence analysis (CM-cRQA). Our findings indicate that corticomuscular dynamics vary significantly between involved (injured) and uninvolved legs of participants with ACLR during voluntary isometric contractions between the brain and both the vastus medialis and lateralis. This finding points to a potential lingering neural deficit underlying re-injury for athletes after surgical reconstruction, namely the dynamical structure of neuromuscular (brain to quad muscle) coordination, which is significantly asymmetric, between limbs, in those who have ACLR.
Collapse
Affiliation(s)
- Christopher D Riehm
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.
- Emory Sports Medicine Center, Atlanta, GA, USA.
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin L Rush
- Division of Physical Therapy, School of Rehabilitation Sciences, Ohio University, Athens, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Moein Koohestani
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Grant E Norte
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - David A Sherman
- Live4 Physical Therapy and Wellness, Acton, MA, USA
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| |
Collapse
|
9
|
Valli G, Ritsche P, Casolo A, Negro F, De Vito G. Tutorial: Analysis of central and peripheral motor unit properties from decomposed High-Density surface EMG signals with openhdemg. J Electromyogr Kinesiol 2024; 74:102850. [PMID: 38065045 DOI: 10.1016/j.jelekin.2023.102850] [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: 07/20/2023] [Revised: 10/05/2023] [Accepted: 11/28/2023] [Indexed: 01/29/2024] Open
Abstract
High-Density surface Electromyography (HD-sEMG) is the most established technique for the non-invasive analysis of single motor unit (MU) activity in humans. It provides the possibility to study the central properties (e.g., discharge rate) of large populations of MUs by analysis of their firing pattern. Additionally, by spike-triggered averaging, peripheral properties such as MUs conduction velocity can be estimated over adjacent regions of the muscles and single MUs can be tracked across different recording sessions. In this tutorial, we guide the reader through the investigation of MUs properties from decomposed HD-sEMG recordings by providing both the theoretical knowledge and practical tools necessary to perform the analyses. The practical application of this tutorial is based on openhdemg, a free and open-source community-based framework for the automated analysis of MUs properties built on Python 3 and composed of different modules for HD-sEMG data handling, visualisation, editing, and analysis. openhdemg is interfaceable with most of the available recording software, equipment or decomposition techniques, and all the built-in functions are easily adaptable to different experimental needs. The framework also includes a graphical user interface which enables users with limited coding skills to perform a robust and reliable analysis of MUs properties without coding.
Collapse
Affiliation(s)
- Giacomo Valli
- Department of Biomedical Sciences, University of Padova, Padova, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Paul Ritsche
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Andrea Casolo
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Giuseppe De Vito
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
| |
Collapse
|
10
|
Brightwell CR, Latham CM, Keeble AR, Thomas NT, Owen AM, Reeves KA, Long DE, Patrick M, Gonzalez-Velez S, Abed V, Annamalai RT, Jacobs C, Conley CE, Hawk GS, Stone AV, Fry JL, Thompson KL, Johnson DL, Noehren B, Fry CS. GDF8 inhibition enhances musculoskeletal recovery and mitigates posttraumatic osteoarthritis following joint injury. SCIENCE ADVANCES 2023; 9:eadi9134. [PMID: 38019905 PMCID: PMC10686569 DOI: 10.1126/sciadv.adi9134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023]
Abstract
Musculoskeletal disorders contribute substantially to worldwide disability. Anterior cruciate ligament (ACL) tears result in unresolved muscle weakness and posttraumatic osteoarthritis (PTOA). Growth differentiation factor 8 (GDF8) has been implicated in the pathogenesis of musculoskeletal degeneration following ACL injury. We investigated GDF8 levels in ACL-injured human skeletal muscle and serum and tested a humanized monoclonal GDF8 antibody against a placebo in a mouse model of PTOA (surgically induced ACL tear). In patients, muscle GDF8 was predictive of atrophy, weakness, and periarticular bone loss 6 months following surgical ACL reconstruction. In mice, GDF8 antibody administration substantially mitigated muscle atrophy, weakness, and fibrosis. GDF8 antibody treatment rescued the skeletal muscle and articular cartilage transcriptomic response to ACL injury and attenuated PTOA severity and deficits in periarticular bone microarchitecture. Furthermore, GDF8 genetic deletion neutralized musculoskeletal deficits in response to ACL injury. Our findings support an opportunity for rapid targeting of GDF8 to enhance functional musculoskeletal recovery and mitigate the severity of PTOA after injury.
Collapse
Affiliation(s)
- Camille R. Brightwell
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Christine M. Latham
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Alexander R. Keeble
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Nicholas T. Thomas
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Allison M. Owen
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Kelsey A. Reeves
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Douglas E. Long
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
| | - Matthew Patrick
- Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, KY, USA
| | | | - Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Ramkumar T. Annamalai
- Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, KY, USA
| | - Cale Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Caitlin E. Conley
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Gregory S. Hawk
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Austin V. Stone
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jean L. Fry
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Katherine L. Thompson
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Darren L. Johnson
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Brian Noehren
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Christopher S. Fry
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
11
|
Harput G, Demirci S, Nyland J, Soylu AR, Tunay VB. Sports activity level after ACL reconstruction is predicted by vastus medialis or vastus medialis obliquus thickness, single leg triple hop distance or 6-m timed hop, and quality of life score. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3483-3493. [PMID: 37198499 DOI: 10.1007/s00590-023-03571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Recovery after anterior cruciate ligament reconstruction (ACLR) may take > 2 years, and younger athletes have higher re-injury risk. The purpose of this prospective longitudinal study was to determine how the early to mid-term Tegner Activity Level Scale (TALS) scores of athletically active males ≥ 2 years post-ACLR follow-up was predicted by bilateral isokinetic knee extensor and flexor torque, quadriceps femoris thickness, single leg hop test performance, and self-reported knee function (Knee Injury and Osteoarthritis Outcome Score (KOOS); International Knee Documentation Committee (IKDC) Subjective Assessment score). METHODS After ACLR with a hamstring tendon autograft and safely returning to sports at least twice weekly, 23 men (18.4 ± 3.5 years of age) were evaluated at final follow-up (mean = 4.5, range = 2-7 years). Exploratory forward stepwise multiple regression was used to determine the relationship between independent surgical and non-surgical lower limb variables peak concentric isokinetic knee extensor-flexor torque at 60°/sec and 180°/sec, quadriceps femoris muscle thickness, single leg hop test profile results, KOOS subscale scores, IKDC Subjective Assessment scores, and time post-ACLR on TALS scores at final follow-up. RESULTS Subject TALS scores were predicted by KOOS quality of life subscale score, surgical limb vastus medialis obliquus (VMO) thickness, and surgical limb single leg triple hop for distance (SLTHD) performance. Subject TALS scores were also predicted by KOOS quality of life subscale score, non-surgical limb vastus medialis (VM) thickness, and non-surgical limb 6 m single leg timed hop (6MSLTH) performance. CONCLUSION TALS scores were influenced differently by surgical and non-surgical lower extremity factors. At ≥ 2 years post-ACLR, ultrasound VM and VMO thickness measurements, single leg hop tests that challenge knee extensor function, and self-reported quality of life measurements predicted sports activity levels. The SLTHD test may be better than the 6MSLTH for predicting long-term surgical limb function.
Collapse
Affiliation(s)
- Gulcan Harput
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Serdar Demirci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
| | - John Nyland
- Kosair Charities College of Health and Natural Sciences, Athletic Training Program, Norton Orthopedic Institute, Spalding University, 901 South 4Th Street, Louisville, KY, USA.
| | - Abdullah Ruhi Soylu
- Department of Biophysics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Volga Bayrakci Tunay
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| |
Collapse
|
12
|
Sherman DA, Rush J, Stock MS, D. Ingersoll C, E. Norte G. Neural drive and motor unit characteristics after anterior cruciate ligament reconstruction: implications for quadriceps weakness. PeerJ 2023; 11:e16261. [PMID: 37818333 PMCID: PMC10561646 DOI: 10.7717/peerj.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose The purpose of this investigation was to compare the quality of neural drive and recruited quadriceps motor units' (MU) action potential amplitude (MUAPAMP) and discharge rate (mean firing rate (MFR)) relative to recruitment threshold (RT) between individuals with anterior cruciate ligament reconstruction (ACLR) and controls. Methods Fourteen individuals with ACLR and 13 matched controls performed trapezoidal knee extensor contractions at 30%, 50%, 70%, and 100% of their maximal voluntary isometric contraction (MVIC). Decomposition electromyography (dEMG) and torque were recorded concurrently. The Hoffmann reflex (H-reflex) and central activation ratio (CAR) were acquired bilaterally to detail the proportion of MU pool available and volitionally activated. We examined MUAPAMP-RT and MFR-RT relationships with linear regression and extracted the regression line slope, y-intercept, and RT range for each contraction. Linear mixed effect modelling used to analyze the effect of group and limb on regression line slope and RT range. Results Individuals with ACLR demonstrated lower MVIC torque in the involved limb compared to uninvolved limb. There were no differences in H-reflex or CAR between groups or limbs. The ACLR involved limb demonstrated smaller mass-normalized RT range and slower MU firing rates at high contraction intensities (70% and 100% MVIC) compared to uninvolved and control limbs. The ACLR involved limb also demonstrated larger MU action potentials in the VM compared to the contralateral limb. These differences were largely attenuated with relative RT normalization. Conclusions These results suggest that persistent strength deficits following ACLR may be attributable to a diminished quadriceps motor neuron pool and inability to upregulate the firing rate of recruited MUs.
Collapse
Affiliation(s)
- David A. Sherman
- Live4 Physical Therapy and Wellness, Acton, Massachusetts, United States of America
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
| | - Justin Rush
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, Ohio, United States of America
| | - Matt S. Stock
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, United States of America
| | - Christopher D. Ingersoll
- College of Health Professions and Sciences, School of Kinesiology and Rehabilitation Sciences, University of Central Florida, Orlando, Florida, United States of America
| | - Grant E. Norte
- Cognition, Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, United States of America
| |
Collapse
|
13
|
Sengoku T, Nakase J, Mizuno Y, Yoshimizu R, Kanayama T, Yanatori Y, Tsuchiya H. Outcome comparison of femoral nerve block and adductor canal block during anterior cruciate ligament reconstruction: adductor canal block may cause an unexpected decrease in knee flexor strength at 6 months postoperatively. Arch Orthop Trauma Surg 2023; 143:6305-6313. [PMID: 37432497 DOI: 10.1007/s00402-023-04980-1] [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: 10/05/2022] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Peripheral nerve blocks are frequently used in anterior cruciate ligament (ACL) reconstruction. While femoral nerve block (FNB) has been associated with knee extensor strength reduction in the early postoperative period, no consistent view of knee extensor strength several months after ACL reconstruction exists. This study aimed to compare the impact of intraoperative FNB and adductor canal block (ACB) during ACL reconstruction on knee extensor strength at 3 and 6 months postoperatively. MATERIALS AND METHODS This retrospective study included 108 patients divided into FNB (70 patients) and ACB (38 patients) groups based on their postoperative pain management methods. Knee joint extensor and flexor strength were measured at 3 and 6 months postoperatively, using BIODEX at angular velocities of 60°/s and 180°/s. From these results, peak torque, limb symmetry index (LSI), peak knee extensor torque (time to peak torque and angle of peak torque), hamstrings-to-quadriceps (HQ) ratio, and amount of work were computed for two-group comparison. RESULTS There were no statistically significant differences in peak torque, LSI of knee extensor strength, HQ ratio, and amount of work between the two groups. However, maximum knee extension torque at 60°/s occurred significantly later in the FNB than in the ACB group at 3 months postoperatively. Additionally, the LSI of the knee flexor at 6 months postoperatively was significantly lower in the ACB group. CONCLUSIONS In ACL reconstruction, FNB may delay the time to peak torque for knee extension at 3 months postoperatively, which is likely to improve over the treatment course. In contrast, ACB may result in unexpected loss of knee flexor strength at 6 months postoperatively and should be considered with caution. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Takuya Sengoku
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Yushin Mizuno
- Section of Rehabilitation, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| |
Collapse
|
14
|
Xia M, Chen C, Xu Y, Li Y, Sheng X, Ding H. Extracting Individual Muscle Drive and Activity From High-Density Surface Electromyography Signals Based on the Center of Gravity of Motor Unit. IEEE Trans Biomed Eng 2023; 70:2852-2862. [PMID: 37043313 DOI: 10.1109/tbme.2023.3266575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Neural interfacing has played an essential role in advancing our understanding of fundamental movement neurophysiology and the development of human-machine interface. However, direct neural interfaces from brain and nerve recording are currently limited in clinical areas for their invasiveness and high selectivity. Here, we applied the surface electromyogram (EMG) in studying the neural control of movement and proposed a new non-invasive way of extracting neural drive to individual muscles. Sixteen subjects performed isometric contractions to complete six hand tasks. High-density surface EMG signals (256 channels in total) recorded from the forearm muscles were decomposed into motor unit firing trains. The location of each decomposed motor unit was represented by its center of gravity and was put into clustering for distinct muscle regions. All the motor units in the same cluster served as a muscle-specific motor pool from which individual muscle drive could be extracted directly. Moreover, we cross-validated the self-clustered muscle regions by magnetic resonance imaging (MRI) recorded from the subjects' forearms. All motor units that fall within the MRI region are considered correctly clustered. We achieved a clustering accuracy of 95.72% ± 4.01% for all subjects. We provided a new framework for collecting experimental muscle-specific drives and generalized the way of surface electrode placement without prior knowledge of the targeting muscle architecture.
Collapse
|
15
|
Lecce E, Nuccio S, Del Vecchio A, Conti A, Nicolò A, Sacchetti M, Felici F, Bazzucchi I. Sensorimotor integration is affected by acute whole-body vibration: a coherence study. Front Physiol 2023; 14:1266085. [PMID: 37772061 PMCID: PMC10523146 DOI: 10.3389/fphys.2023.1266085] [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: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction: Several whole-body vibration (WBV) effects on performance have been related to potential changes in the neural drive, motor unit firing rate, and sensorimotor integration. In the present paper, motor unit coherence analysis was performed to detect the source of neural modulation based on the frequency domain. Methods: Thirteen men [25 ± 2.1 years; Body Mass Index (BMI) = 23.9 ± 1.3 kg m2; maximal voluntary force (MVF): 324.36 ± 41.26 N] performed sustained contractions of the Tibialis Anterior (TA) at 10%MVF before and after acute WBV. The vibrating stimulus was applied barefoot through a platform to target the TA. High-Density surface Electromyography (HDsEMG) was used to record the myoelectrical activity of TA to evaluate coherence from motor unit cumulative spike-trains (CSTs). Results: Mean coherence showed a significant decrease in the alpha and low-beta bandwidths (alpha: from 0.143 ± 0.129 to 0.132 ± 0.129, p = 0.035; low-beta: from 0.117 ± 0.039 to 0.086 ± 0.03, p = 0.0001), whereas no significant changes were found in the other ones (p > 0.05). The discharge rate (DR) and the Force Covariance (CovF%) were not significantly affected by acute WBV exposure (p > 0.05). Discussion: According to the significant effects found in alpha and low-beta bandwidths, which reflect sensorimotor integration parameters, accompanied by no differences in the DR and CovF%, the present results underlined that possible neural mechanisms at the base of the previously reported performance enhancements following acute WBV are likely based on sensorimotor integration rather than direct neural drive modulation.
Collapse
Affiliation(s)
- E. Lecce
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - S. Nuccio
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - A. Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Faculty of Engineering, Zentralinstitut für Medizintechnik (ZIMT), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - A. Conti
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - A. Nicolò
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - M. Sacchetti
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - F. Felici
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - I. Bazzucchi
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| |
Collapse
|
16
|
Di Giminiani R, Marinelli S, La Greca S, Di Blasio A, Angelozzi M, Cacchio A. Neuromuscular Characteristics of Unilateral and Bilateral Maximal Voluntary Isometric Contractions following ACL Reconstruction. BIOLOGY 2023; 12:1173. [PMID: 37759573 PMCID: PMC10525486 DOI: 10.3390/biology12091173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Despite the advancement of diagnostic surgical techniques in anterior cruciate ligament (ACL) reconstruction and rehabilitation protocols following ACL injury, only half of the athletes return to sports at a competitive level. A major concern is neuromechanical dysfunction, which occurs with injuries persisting in operated and non-operated legs following ACL rehabilitation. One of the criteria for a safe return to sports participation is based on the maximal voluntary isometric contraction (MVIC) performed unilaterally and a comparison between the 'healthy knee' and the 'operated knee'. The present study aimed to investigate MVIC in athletes following ACL rehabilitation during open kinetic chain exercise performed unilaterally and bilateral exercises. Twenty subjects participated in the present investigation: 10 male athletes of regional-national level (skiers, rugby, soccer, and volleyball players) who were previously operated on one knee and received a complete rehabilitation protocol (for 6-9 months) were included in the ACL group (age: 23.4 ± 2.11 years; stature: 182.0 ± 9.9 cm; body mass: 78.6 ± 9.9 kg; body mass index: 23.7 ± 1.9 kg/m2), and 10 healthy male athletes formed the control group (CG: age: 24.0 ± 3.4 years; stature: 180.3 ± 10.7 cm; body mass: 74.9 ± 13.5 kg; body mass index: 22.8 ± 2.7 kg/m2). MVICs synchronised with electromyographic (EMG) activity (recorded on the vastus lateralis, vastus medialis, and biceps femoris muscles) were performed during unilateral and bilateral exertions. The rate of force development (RFD) and co-activation index (CI) were also calculated. The differences in the MVIC and RFD between the two legs within each group were not significant (p > 0.05). Vastus lateralis EMG activity during MVIC and biceps femoris EMG activity during RFD were significantly higher in the operated leg than those in the non-operated leg when exertion was performed bilaterally (p < 0.05). The CI was higher in the operated leg than that in the non-operated leg when exertion was performed bilaterally (p < 0.05). Vice versa, vastus medialis EMG activity during RFD was significantly higher in the right leg than that in the left leg when exertion was performed bilaterally (p < 0.05) in the CG. MVICs performed bilaterally represent a reliability modality for highlighting neuromechanical asymmetries. This bilateral exercise should be included in the criteria for a safe return to sports following ACL reconstruction.
Collapse
Affiliation(s)
- Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano Marinelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Stefano La Greca
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (S.M.); (S.L.G.)
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, ‘G. D’Annunzio’ University of Chieti-Pescara, 66013 Chieti, Italy;
| | - Massimo Angelozzi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
| | - Angelo Cacchio
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.A.); (A.C.)
| |
Collapse
|
17
|
Borzuola R, Nuccio S, Scalia M, Parrella M, Del Vecchio A, Bazzucchi I, Felici F, Macaluso A. Adjustments in the motor unit discharge behavior following neuromuscular electrical stimulation compared to voluntary contractions. Front Physiol 2023; 14:1212453. [PMID: 37324379 PMCID: PMC10267458 DOI: 10.3389/fphys.2023.1212453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: The application of neuromuscular electrical stimulation superimposed on voluntary muscle contractions (NMES+) has demonstrated a considerable potential to enhance or restore muscle function in both healthy and individuals with neurological or orthopedic disorders. Improvements in muscle strength and power have been commonly associated with specific neural adaptations. In this study, we investigated changes in the discharge characteristics of the tibialis anterior motor units, following three acute exercises consisting of NMES+, passive NMES and voluntary isometric contractions alone. Methods: Seventeen young participants participated in the study. High-density surface electromyography was used to record myoelectric activity in the tibialis anterior muscle during trapezoidal force trajectories involving isometric contractions of ankle dorsi flexors with target forces set at 35, 50% and 70% of maximal voluntary isometric contraction (MVIC). From decomposition of the electromyographic signal, motor unit discharge rate, recruitment and derecruitment thresholds were extracted and the input-output gain of the motoneuron pool was estimated. Results: Global discharge rate increased following the isometric condition compared to baseline at 35% MVIC while it increased after all experimental conditions at 50% MVIC target force. Interestingly, at 70% MVIC target force, only NMES + led to greater discharge rate compared to baseline. Recruitment threshold decreased after the isometric condition, although only at 50% MVIC. Input-output gain of the motoneurons of the tibialis anterior muscle was unaltered after the experimental conditions. Discussion: These results indicated that acute exercise involving NMES + induces an increase in motor unit discharge rate, particularly when higher forces are required. This reflects an enhanced neural drive to the muscle and might be strongly related to the distinctive motor fiber recruitment characterizing NMES+.
Collapse
Affiliation(s)
- Riccardo Borzuola
- Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Stefano Nuccio
- Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Martina Scalia
- Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Martina Parrella
- Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Alessandro Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Faculty of Engineering, Zentralinstitut für Medizintechnik (ZIMT), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ilenia Bazzucchi
- Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Francesco Felici
- Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Andrea Macaluso
- Department of Movement, Human, and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| |
Collapse
|
18
|
Criss CR, Lepley AS, Onate JA, Clark BC, Simon JE, France CR, Grooms DR. Brain activity associated with quadriceps strength deficits after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:8043. [PMID: 37198275 PMCID: PMC10192374 DOI: 10.1038/s41598-023-34260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Prolonged treatment resistant quadriceps weakness after anterior cruciate ligament reconstruction (ACL-R) contributes to re-injury risk, poor patient outcomes, and earlier development of osteoarthritis. The origin of post-injury weakness is in part neurological in nature, but it is unknown whether regional brain activity is related to clinical metrics of quadriceps weakness. Thus, the purpose of this investigation was to better understand the neural contributions to quadriceps weakness after injury by evaluating the relationship between brain activity for a quadriceps-dominated knee task (repeated cycles of unilateral knee flexion/extension from 45° to 0°), , and strength asymmetry in individuals returned to activity after ACL-R. Forty-four participants were recruited (22 with unilateral ACL reconstruction; 22 controls) and peak isokinetic knee extensor torque was assessed at 60°/s to calculate quadriceps limb symmetry index (Q-LSI, ratio of involved/uninvolved limb). Correlations were used to determine the relationship of mean % signal change within key sensorimotor brain regions and Q-LSI. Brain activity was also evaluated group wise based on clinical recommendations for strength (Q-LSI < 90%, n = 12; Q-LSI ≥ 90%, n = 10; controls, all n = 22 Q-LSI ≥ 90%). Lower Q-LSI was related to increased activity in the contralateral premotor cortex and lingual gyrus (p < .05). Those who did not meet clinical recommendations for strength demonstrated greater lingual gyrus activity compared to those who met clinical recommendations Q-LSI ≥ 90 and healthy controls (p < 0.05). Asymmetrically weak ACL-R patients displayed greater cortical activity than patients with no underlying asymmetry and healthy controls.
Collapse
Affiliation(s)
- Cody R Criss
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
| | - Adam S Lepley
- School of Kinesiology; Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA.
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
| |
Collapse
|
19
|
Kunugi S, Hirono T, Yoshimura A, Holobar A, Watanabe K. Association between force fluctuation during isometric ankle abduction and variability of neural drive in peroneus muscles. J Electromyogr Kinesiol 2023; 70:102780. [PMID: 37126978 DOI: 10.1016/j.jelekin.2023.102780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/03/2023] Open
Abstract
Analyzing motor unit (MU) activities of peroneus muscles may reveal the causes of force control deficits of ankle eversion. This study aimed to examine peroneus muscles' MU discharge characteristics and associations between force fluctuation and variability of the neural drive in healthy participants. Thirty-one healthy males participated in this study. MU activities were identified from high-density surface electromyography of peroneus muscles during ankle eversion at 15 and 30% of maximal voluntary contraction (MVC). Participants increased the contraction level until reaching the target and held it for 15 s. The central 10 s of the hold phase were used for analysis. A cumulative spike train (CST) was calculated using MU firings. Variabilities of the force and CST are represented by the coefficient of variation (CoV). Spearman's rank correlation coefficient was used to assess the association between CoV of force and CoV of CST. For 15 and 30 % MVC trials, CoV of force was 1.86 ± 1.59 and 1.57 ± 1.26%, and CoV of CST was 5.01 ± 3.24 and 4.51 ± 2.78%, respectively. The correlation was significant at 15% (rho = 0.27, p < 0.001) and 30% (rho = 0.32, p < 0.001) MVC. Our findings suggest that in peroneus muscles, force fluctuation weakly to moderately correlates with neural drive variability.
Collapse
Affiliation(s)
- Shun Kunugi
- Center for General Education, Aichi Institute of Technology, 1247 Yachigusa, Yakusa-cho, Toyota-shi, Aichi 470-0392, Japan; Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan.
| | - Tetsuya Hirono
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
| | - Akane Yoshimura
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
| | - Aleš Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000 Maribor, Slovenia
| | - Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of Health and Sport Sciences, Chukyo University 101 Tokodachi, Kaizu-cho, Toyota-shi, Aichi 470-0393, Japan
| |
Collapse
|
20
|
Del Vecchio A, Marconi Germer C, Kinfe TM, Nuccio S, Hug F, Eskofier B, Farina D, Enoka RM. The Forces Generated by Agonist Muscles during Isometric Contractions Arise from Motor Unit Synergies. J Neurosci 2023; 43:2860-2873. [PMID: 36922028 PMCID: PMC10124954 DOI: 10.1523/jneurosci.1265-22.2023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 03/17/2023] Open
Abstract
The purpose of our study was to identify the low-dimensional latent components, defined hereafter as motor unit modes, underlying the discharge rates of the motor units in two knee extensors (vastus medialis and lateralis, eight men) and two hand muscles (first dorsal interossei and thenars, seven men and one woman) during submaximal isometric contractions. Factor analysis identified two independent motor unit modes that captured most of the covariance of the motor unit discharge rates. We found divergent distributions of the motor unit modes for the hand and vastii muscles. On average, 75% of the motor units for the thenar muscles and first dorsal interosseus were strongly correlated with the module for the muscle in which they resided. In contrast, we found a continuous distribution of motor unit modes spanning the two vastii muscle modules. The proportion of the muscle-specific motor unit modes was 60% for vastus medialis and 45% for vastus lateralis. The other motor units were either correlated with both muscle modules (shared inputs) or belonged to the module for the other muscle (15% for vastus lateralis). Moreover, coherence of the discharge rates between motor unit pools was explained by the presence of shared synaptic inputs. In simulations with 480 integrate-and-fire neurons, we demonstrate that factor analysis identifies the motor unit modes with high levels of accuracy. Our results indicate that correlated discharge rates of motor units that comprise motor unit modes arise from at least two independent sources of common input among the motor neurons innervating synergistic muscles.SIGNIFICANCE STATEMENT It has been suggested that the nervous system controls synergistic muscles by projecting common synaptic inputs to the engaged motor neurons. In our study, we reduced the dimensionality of the output produced by pools of synergistic motor neurons innervating the hand and thigh muscles during isometric contractions. We found two neural modules, each representing a different common input, that were each specific for one of the muscles. In the vastii muscles, we found a continuous distribution of motor unit modes spanning the two synergistic muscles. Some of the motor units from the homonymous vastii muscle were controlled by the dominant neural module of the other synergistic muscle. In contrast, we found two distinct neural modules for the hand muscles.
Collapse
Affiliation(s)
- Alessandro Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University, 91052 Erlangen, Germany
| | - Carina Marconi Germer
- Department of Bioengineering, Federal University of Pernambuco, CEP 50670-901 Recife, Brazil
| | - Thomas M Kinfe
- Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University, 91052 Erlangen, Germany
| | - Stefano Nuccio
- Department Human Movement Science, University of Rome Foro Italico, 00185 Rome, Italy
| | - François Hug
- Le Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, 06103 Nice, France
| | - Bjoern Eskofier
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University, 91052 Erlangen, Germany
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado CO 80309
| |
Collapse
|
21
|
Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Weaker Quadriceps Corticomuscular Coherence in Individuals after ACL Reconstruction during Force Tracing. Med Sci Sports Exerc 2023; 55:625-632. [PMID: 36730761 DOI: 10.1249/mss.0000000000003080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare quadriceps corticomuscular coherence (CMC) and force steadiness between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a force tracing task. METHODS Individuals with ACLR ( n = 20) and controls ( n = 20) performed a knee extension force-control task at 50% of maximal voluntary effort. Electrocortical activity, electromyographic activity, and torque output were recorded concurrently. CMC in beta (13-30 Hz) and gamma (31-80 Hz) frequency bands was assessed using partial directed coherence between the contralateral motor cortex (e.g., C4-C2-Cz electrodes) and the ipsilateral quadriceps muscles (e.g., left vastus medialis and lateralis). Force steadiness was quantified using root-mean-square error and coefficient of variation. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) were assessed using peak knee extension strength and active motor threshold as a priori covariates. RESULTS Participants with ACLR had lower gamma band connectivity bilaterally when compared with controls (vastus medialis: d = 0.8; vastus lateralis: d = 0.7). Further, the ACLR group demonstrated worse quadriceps force steadiness (root-mean-square error, d = 0.5), lower involved limb quadriceps strength ( d = 1.1), and higher active motor threshold ( d = 1.0) compared with controls. CONCLUSIONS Lower quadriceps gamma band CMC in the ACLR group suggests lower cortical drive (e.g., corticomotor decoupling) to the quadriceps compared with matched controls. Further, the ACLR group demonstrated worse quadriceps force steadiness, suggesting impaired ability to modulate quadriceps neuromuscular control. Notably, CMC differences were present only in the gamma frequency band, suggesting impairments may be specific to multisensory integration and force modulation.
Collapse
Affiliation(s)
| | - Jochen Baumeister
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, GERMANY
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL
| | - Amanda M Murray
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| |
Collapse
|
22
|
Bodkin SG, Pethick JT, Dooley EA, Russell SD, Hart JM. Torque complexity of maximal knee extensor isometric contraction in individuals following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2023; 104:105932. [PMID: 36931165 DOI: 10.1016/j.clinbiomech.2023.105932] [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: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Current rehabilitation goals following anterior cruciate ligament reconstruction are structured around the maximal force generating capabilities of the muscle. Force fluctuations, an index of force control, have been observed to alter post- anterior cruciate ligament reconstruction. The temporal structure, or "complexity" of force fluctuations may provide important insight into the post-operative muscular recovery. The aims of this study were 1) to compare quadriceps torque complexity in anterior cruciate ligament reconstructed patients to the contralateral limb and to healthy, controls and 2) to assess the relationships between torque complexity to patient outcomes. METHODS Data from 120 anterior cruciate ligament reconstructed participants (65 Females, 21.0 ± 8.3 years, 5.96 ± 0.48-months post-surgery) and 95 healthy controls (50 Females, 21.5 ± 2.9 years) were collected. A 30-s knee extensor maximal isometric contraction was completed to calculate approximate entropy, a measure of torque complexity. FINDINGS Approximate entropy was found to decrease throughout the 30-s trial (P < .001, Cohen's d = 1.87 [1.64,2.10]). The anterior cruciate ligament reconstructed limb demonstrated greater approximate entropy compared to the contralateral limb or to healthy controls (P < .001, Cohen's d = 0.64 [0.38,0.90]). approximate entropy at the end of the trial demonstrated weak, negatively relationships with peak torque, patient reported outcome measures, and knee extensor fatigue (r = -0.21 to -0.32, P < .05). INTERPRETATION A greater torque complexity in individuals following anterior cruciate ligament reconstruction was weakly related to lower quadriceps strength, lower subjective function, and quadriceps fatigue resistance. The complexity of force fluctuations during a sustained maximal task may draw clinical insight into the recovery of motor function following anterior cruciate ligament reconstruction.
Collapse
Affiliation(s)
- S G Bodkin
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - J T Pethick
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - E A Dooley
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - S D Russell
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - J M Hart
- Deparment of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
23
|
Lecce E, Nuccio S, Del Vecchio A, Conti A, Nicolò A, Sacchetti M, Felici F, Bazzucchi I. The acute effects of whole-body vibration on motor unit recruitment and discharge properties. Front Physiol 2023; 14:1124242. [PMID: 36895636 PMCID: PMC9988902 DOI: 10.3389/fphys.2023.1124242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Introduction: several studies have reported improved neuromuscular parameters in response to whole-body vibration (WBV). This is likely achieved by modulation of the central nervous system (CNS). Reduced recruitment threshold (RT), which is the % of Maximal Voluntary Force (%MVF) at which a given Motor Unit (MU) is recruited, may be responsible for the force/power improvements observed in several studies. Methods: 14 men (25 ± 2.3 years; BMI = 23.3 ± 1.5 kg m2 MVF: 319.82 ± 45.74 N) performed trapezoidal isometric contractions of the tibialis anterior (TA) at 35-50-70 %MVF before and after three conditions: WBV, STAND (standing posture), and CNT (no intervention). The vibration was applied through a platform for targeting the TA. High-density surface electromyography (HDsEMG) recordings and analysis were used to detect changes in the RT and Discharge Rate (DR) of the MUs. Results: Mean motor unit recruitment threshold (MURT) reached 32.04 ± 3.28 %MVF before and 31.2 ± 3.72 %MVF after WBV, with no significant differences between conditions (p > 0.05). Additionally, no significant changes were found in the mean motor unit discharge rate (before WBV: 21.11 ± 2.94 pps; after WBV: 21.19 ± 2.17 pps). Discussion: The present study showed no significant changes in motor unit properties at the base of neuromuscular changes documented in previous studies. Further investigations are needed to understand motor unit responses to different vibration protocols and the chronic effect of vibration exposure on motor control strategies.
Collapse
Affiliation(s)
- E Lecce
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - S Nuccio
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - A Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Faculty of Engineering, Zentralinstitut für Medizintechnik (ZIMT), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - A Conti
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - A Nicolò
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - M Sacchetti
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - F Felici
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - I Bazzucchi
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| |
Collapse
|
24
|
Lower motor unit discharge rates in gastrocnemius lateralis, but not in gastrocnemius medialis or soleus, in runners with Achilles tendinopathy: a pilot study. Eur J Appl Physiol 2023; 123:633-643. [PMID: 36418751 PMCID: PMC9684880 DOI: 10.1007/s00421-022-05089-w] [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: 05/11/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Deficits in muscle performance could be a consequence of a reduced ability of a motor neuron to increase the rate in which it discharges. This study aimed to investigate motor unit (MU) discharge properties of each triceps surae muscle (TS) and TS torque steadiness during submaximal intensities in runners with Achilles tendinopathy (AT). METHODS We recruited runners with (n = 12) and without (n = 13) mid-portion AT. MU discharge rate was analysed for each of the TS muscles, using high-density surface electromyography during 10 and 20% isometric plantar flexor contractions. RESULTS MU mean discharge rate was lower in the gastrocnemius lateralis (GL) in AT compared to controls. In AT, GL MU mean discharge rate did not increase as torque increased from 10% peak torque, 8.24 pps (95% CI 7.08 to 9.41) to 20%, 8.52 pps (7.41 to 9.63, p = 0.540); however, in controls, MU discharge rate increased as torque increased from 10%, 8.39 pps (7.25-9.53) to 20%, 10.07 pps (8.89-11.25, p < 0.001). There were no between-group difference in gastrocnemius medialis (GM) or soleus (SOL) MU discharge rates. We found no between-group differences in coefficient of variation of MU discharge rate in any of the TS muscles nor in TS torque steadiness. CONCLUSION Our data demonstrate that runners with AT may have a lower neural drive to GL, failing to increase MU discharge rate to adjust for the increase in torque demand. Further research is needed to understand how interventions focussing on increasing neural drive to GL would affect muscle function in runners with AT.
Collapse
|
25
|
Inns TB, Bass JJ, Hardy EJ, Wilkinson DJ, Stashuk DW, Atherton PJ, Phillips BE, Piasecki M. Motor unit dysregulation following 15 days of unilateral lower limb immobilisation. J Physiol 2022; 600:4753-4769. [PMID: 36088611 PMCID: PMC9827843 DOI: 10.1113/jp283425] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/19/2022] [Indexed: 01/12/2023] Open
Abstract
Disuse atrophy, caused by situations of unloading such as limb immobilisation, causes a rapid yet diverging reduction in skeletal muscle function when compared to muscle mass. While mechanistic insight into the loss of mass is well studied, deterioration of muscle function with a focus towards the neural input to muscle remains underexplored. This study aimed to determine the role of motor unit adaptation in disuse-induced neuromuscular deficits. Ten young, healthy male volunteers underwent 15 days of unilateral lower limb immobilisation with intramuscular electromyography (iEMG) bilaterally recorded from the vastus lateralis (VL) during knee extensor contractions normalised to maximal voluntary contraction (MVC), pre and post disuse. Muscle cross-sectional area was determined by ultrasound. Individual MUs were sampled and analysed for changes in motor unit (MU) discharge and MU potential (MUP) characteristics. VL CSA was reduced by approximately 15% which was exceeded by a two-fold decrease of 31% in muscle strength in the immobilised limb, with no change in either parameter in the non-immobilised limb. Parameters of MUP size were reduced by 11% to 24% with immobilisation, while neuromuscular junction (NMJ) transmission instability remained unchanged, and MU firing rate decreased by 8% to 11% at several contraction levels. All adaptations were observed in the immobilised limb only. These findings highlight impaired neural input following immobilisation reflected by suppressed MU firing rate which may underpin the disproportionate reductions of strength relative to muscle size. KEY POINTS: Muscle mass and function decline rapidly in situations of disuse such as bed rest and limb immobilisation. The reduction in muscle function commonly exceeds that of muscle mass, which may be associated with the dysregulation of neural input to muscle. We have used intramuscular electromyography to sample individual motor unit and near fibre potentials from the vastus lateralis following 15 days of unilateral limb immobilisation. Following disuse, the disproportionate loss of muscle strength when compared to size coincided with suppressed motor unit firing rate. These motor unit adaptations were observed at multiple contraction levels and in the immobilised limb only. Our findings demonstrate neural dysregulation as a key component of functional loss following muscle disuse in humans.
Collapse
Affiliation(s)
- Thomas B. Inns
- Centre Of Metabolism, Ageing & PhysiologyMRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham BRCUniversity of NottinghamDerbyUK
| | - Joseph J. Bass
- Centre Of Metabolism, Ageing & PhysiologyMRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham BRCUniversity of NottinghamDerbyUK
| | - Edward J.O. Hardy
- Centre Of Metabolism, Ageing & PhysiologyMRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham BRCUniversity of NottinghamDerbyUK
- Department of Surgery and AnaestheticsRoyal Derby HospitalDerbyUK
| | - Daniel J. Wilkinson
- Centre Of Metabolism, Ageing & PhysiologyMRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham BRCUniversity of NottinghamDerbyUK
| | - Daniel W. Stashuk
- Department of Systems Design EngineeringUniversity of WaterlooOntarioCanada
| | - Philip J. Atherton
- Centre Of Metabolism, Ageing & PhysiologyMRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham BRCUniversity of NottinghamDerbyUK
| | - Bethan E. Phillips
- Centre Of Metabolism, Ageing & PhysiologyMRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham BRCUniversity of NottinghamDerbyUK
| | - Mathew Piasecki
- Centre Of Metabolism, Ageing & PhysiologyMRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham BRCUniversity of NottinghamDerbyUK
| |
Collapse
|
26
|
Stenroth L, Bartholdy C, Schwarz Larsen J, Sørensen MS, Smale KB, Flaxman TE, Benoit DL, Krogsgaard MR, Alkjær T. Altered movement strategy during functional movement after an ACL injury, despite ACL reconstruction. Front Sports Act Living 2022; 4:994139. [PMID: 36267483 PMCID: PMC9576999 DOI: 10.3389/fspor.2022.994139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Knee joint functional deficits are common after anterior cruciate ligament (ACL) injury, but different assessment methods of joint function seem to provide contradicting information complicating recovery monitoring. We previously reported improved perceived knee function and functional performance (forward lunge ground contact time) in patients with an ACL injury from pre to 10 months post ACL reconstruction without improvement in knee-specific biomechanics. To further investigate this discrepancy, we additionally analyzed knee extensor and flexor muscle strength, and movement quality in the forward lunge (subjective and objective evaluations) and performed a full lower limb biomechanical analysis of the forward lunge movement. We included 12 patients with an ACL injury (tested before and after ACL reconstructive surgery) and 15 healthy controls from the previous study to the current investigation. Outcome measures were obtained pre and ~11 months post ACL reconstruction for the patients and at a single time point for the controls. Objective movement quality in the patients with an ACL injury showed an improvement from their pre reconstruction surgery visit to the post reconstruction visit but this was not observable in the subjective evaluation. Knee extensor muscle strength declined after the ACL reconstruction by 29% (p = 0.002) and both knee extensors (p < 0.001) and flexors (p = 0.027) were weaker in the patients post ACL reconstruction compared to healthy controls. ACL injured patients had an altered movement strategy in the forward lunge with reduced knee extensors contribution and increased hip extensor contribution compared to the controls both before and after the reconstruction. The altered movement strategy was associated with knee extensor muscle strength. This explorative study with a limited sample size found that clinicians should be aware that significant functional deficits in the knee extensor muscles, both in isolated muscle strength testing and during a functional movement, may be present although patients perceive an improvement in their knee function and present good functional performance without obvious movement quality issues.
Collapse
Affiliation(s)
- Lauri Stenroth
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jonas Schwarz Larsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kenneth B. Smale
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Teresa E. Flaxman
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Daniel L. Benoit
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Michael R. Krogsgaard
- Section for Sports Traumatology, M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Tine Alkjær
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| |
Collapse
|
27
|
Pethick J, Clark NC, Liew B. Alterations in peripheral joint muscle force control in adults with musculoskeletal disease, injury, surgery, or arthroplasty: A systematic review and meta-analysis. J Electromyogr Kinesiol 2022; 66:102696. [PMID: 35988532 DOI: 10.1016/j.jelekin.2022.102696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/23/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE To systematically review and analyse whether musculoskeletal conditions affect peripheral joint muscle force control (i.e. magnitude and/or complexity of force fluctuations). METHODS A literature search was conducted using MEDLINE, CINAHL and SPORTDiscus databases (from inception-8th April 2021) for studies involving: 1) participants with musculoskeletal disease, injury, surgery, or arthroplasty in the peripheral joints of the upper/lower limb; 2) comparison with an unaffected control group or unaffected contralateral limb; and 3) measures of the magnitude and/or complexity of force fluctuations during targeted isometric contractions. The methodological quality of studies was evaluated using a modified Downs and Black Quality Index. Studies were combined using the standardized mean difference (SMD) in a random-effects model. RESULTS 14 studies (investigating 694 participants) were included in the meta-analysis. There was a significant effect of musculoskeletal conditions on peripheral joint muscle force coefficient of variation (CV; SMD = 0.19 [95 % CI 0.06, 0.32]), whereby individuals with musculoskeletal conditions exhibited greater CV than controls. Subgroup analyses revealed that CV was only greater: 1) when comparison was made between symptomatic and asymptomatic individuals (rather than between affected and contralateral limbs; SMD = 0.22 [95 % CI 0.07, 0.38]); 2) for conditions of the knee (SMD = 0.29 [95 % CI 0.14, 0.44]); and 3) for ACL injury post-surgery (SMD = 0.56 [95 % CI 0.36, 0.75]). CONCLUSION Musculoskeletal conditions result in an increase in peripheral joint muscle force CV, with this effect dependent on study design, peripheral joint, and surgical status. The greater force CV is indicative of decreased force steadiness and could have implications for long-term tissue health/day-to-day function.
Collapse
Affiliation(s)
- Jamie Pethick
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, UK.
| | - Nicholas C Clark
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, UK
| | - Bernard Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, UK
| |
Collapse
|
28
|
Bartels T, Schwesig R, Brehme K, Pyschik M, Pröger S, Laube W, Kurz E. Beurteilung des neuromuskulären Funktionszustands bei Berufssportlern. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungIn den letzten Jahren wurden bedeutende Fortschritte in den chirurgischen Techniken, der postoperativen Rehabilitation und der Identifizierung von Risikofaktoren für eine zweite Verletzung des vorderen Kreuzbands (VKB) gemacht. Dies führte jedoch nicht zu einer Verringerung des sekundären VKB-Verletzungsrisikos. Die Wiederherstellung der anatomischen (operative Rekonstruktion) und anschließend insbesondere der trainingsbedingten funktionellen Stabilität sollte eine grundlegende Voraussetzung für die Rückkehr zu Pivot-Sportarten nach einer VKB-Verletzung sein. Das VKB hat eine bedeutende Rolle bei der Kniepropriozeption mit der Konsequenz einer eingeschränkten sensomotorischen Regulation im Verletzungsfall. Das Perturbationstraining stellt eine große Herausforderung in der spätrehabilitativen Phase nach VKB-Rekonstruktion dar. Die Diagnostik der Muskelaktivierung im Rehabilitationsverlauf nach VKB-Rekonstruktion hat deshalb eine enorme Bedeutung. Mit der entwickelten Software können Charakteristika der motorischen Einheiten knieführender Muskeln zeitnah objektiviert und somit eine mögliche Überlastung bei hochreaktivem Perturbationstraining im Rahmen der spätrehabilitativen Phase nach VKB-Rekonstruktion vermieden werden.
Collapse
|
29
|
Lulic-Kuryllo T, Greig Inglis J. Sex differences in motor unit behaviour: A review. J Electromyogr Kinesiol 2022; 66:102689. [DOI: 10.1016/j.jelekin.2022.102689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022] Open
|
30
|
Detecting motor unit abnormalities in amyotrophic lateral sclerosis using high-density surface EMG. Clin Neurophysiol 2022; 142:262-272. [PMID: 35902304 DOI: 10.1016/j.clinph.2022.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to detect specific motor unit (MU) abnormalities in people with amyotrophic lateral sclerosis (ALS) compared to controls using high-density surface electromyography (HD-SEMG). METHODS Sixteen people with ALS and 16 control subjects. The participants performed ramp up and sustained contractions at 30% of their maximal voluntary contraction. HD-SEMG signals were recorded in the vastus lateralis muscle and decomposed into individual MU firing behavior using a convolution blind source separation method. RESULTS In total, 339 MUs were detected (people with ALS; n = 93, control subjects; n = 246). People with ALS showed significantly higher mean firing rate, recruitment threshold, coefficient of variation of the MU firing rate, MU firing rate at recruitment, and motoneurons excitability than those of control subjects (p < 0.001). The number of MU, MU firing rate, recruitment threshold, and MU firing rate at recruitment were significantly correlated with disease severity (p < 0.001). Multivariable analysis revealed that an increased MU firing rate at recruitment was independently associated with ALS. CONCLUSIONS These results suggest increased excitability at recruitment, which is consistent with neurodegeneration results in a compensatory increase in MU activity. SIGNIFICANCE Abnormal MU firing behavior provides an important physiological index for understanding the pathophysiology of ALS.
Collapse
|
31
|
McMahon M, Gibson J, D Jones G. Dysfunctional neural drive to the vasti as a candidate mechanism in the rehabilitation of quadriceps weakness after anterior cruciate ligament repair. J Physiol 2022; 600:2557-2559. [PMID: 35451055 DOI: 10.1113/jp282931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/20/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael McMahon
- Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Jamie Gibson
- Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK.,Health Education England (HEE), Leeds, UK
| | - Gareth D Jones
- Department of Physiotherapy, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences (CHAPS), Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
32
|
De la Fuente C, Stoelben KJV, Silvestre R, Yañez R, Cheyre J, Guadagnin EC, Carpes FP. Steadiness training improves the quadriceps strength and self-reported outcomes in persistent quadriceps weakness following nine months of anterior cruciate ligament reconstruction and failed conventional physiotherapy. Clin Biomech (Bristol, Avon) 2022; 92:105585. [PMID: 35121351 DOI: 10.1016/j.clinbiomech.2022.105585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/02/2022] [Accepted: 01/24/2022] [Indexed: 02/07/2023]
Abstract
Background Persistent quadriceps weakness may occur after anterior cruciate ligament reconstruction, limiting the strength gain. However, steadiness strengthening might change the inability to gain strength. Hence, we determined whether strength training with force steadiness and visual biofeedback can improve knee quadriceps torque, self-reported pain and knee stability in patients with persistent quadriceps weakness after knee anterior cruciate ligament reconstruction. Methods Twenty-five patients (aged 43.7 ± 12.2 years) with persistent quadriceps weakness following knee anterior cruciate ligament reconstruction and 34-weeks of physiotherapy performed unilateral strength training for both lower limbs. Four-weeks of conventional physiotherapy at week-30 were given, confirming the inability to gain torque. Then, steadiness training (isometric knee extension with visual biofeedback) was given for 7-weeks. Knee quadriceps peak torque, strength improvement, determination of responders to the intervention, coherence of strength gain between limbs, and self-reported outcomes (pain and knee stability) were obtained. Descriptive statistics and data inference using mixed-ANOVA, McNemar test, and χ2 test were described. Findings Quadriceps torque in the reconstructed knee improved (98.2 ± 47.2-155.2 ± 78.9 Nm; p = 0.031) for most patients (84%). Nevertheless, the torque was lower than the healthy side maintaining asymmetry (155.2 ± 78.9 vs. 209.5 ± 101.8 Nm; p = 0.026). There was high (20%) and medium coherence (80%) between limbs. Knee stability and pain improved in 72% of the patients (p < 0.001). Interpretations Steadiness training after anterior cruciate ligament reconstruction followed 9 months of surgery and failed conventional physiotherapy, improves the persistent weakness and self-reported outcomes, but gain strength was dissimilar between limbs.
Collapse
Affiliation(s)
- Carlos De la Fuente
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile; Laboratory of Neuromechanics, Universidade Federal do Pampa, Uruguaiana, Brazil; Unidad de Biomecánica, Centro de Innovación, Clínica MEDS, Santiago, Chile
| | - Karine J V Stoelben
- Laboratory of Neuromechanics, Universidade Federal do Pampa, Uruguaiana, Brazil
| | - Rony Silvestre
- Unidad de Biomecánica, Centro de Innovación, Clínica MEDS, Santiago, Chile; Traumatología, Clínica MEDS, Santiago, Chile
| | - Roberto Yañez
- Unidad de Biomecánica, Centro de Innovación, Clínica MEDS, Santiago, Chile; Traumatología, Clínica MEDS, Santiago, Chile
| | | | - Eliane C Guadagnin
- Laboratory of Neuromechanics, Universidade Federal do Pampa, Uruguaiana, Brazil
| | - Felipe P Carpes
- Laboratory of Neuromechanics, Universidade Federal do Pampa, Uruguaiana, Brazil.
| |
Collapse
|