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Lowe T, Dong XN, Griffin L. Hamstrings vibration reduces tibiofemoral compressive force following anterior cruciate ligament reconstruction. J Orthop Res 2024; 42:788-797. [PMID: 37975273 DOI: 10.1002/jor.25736] [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: 03/24/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Individuals who have undergone anterior cruciate ligament reconstruction (ACLR) are at greater risk of developing knee osteoarthritis (OA). This elevated risk of knee OA is associated with high tibiofemoral (TF) compressive force, due to a combination of low knee flexion angles and increased co-contraction of the hamstrings and quadriceps during limb loading. Prolonged vibration of the hamstrings fatigues the intrafusal muscle fibers, which reduces autonomic reflexive excitation of the hamstrings and alleviates reciprocal inhibition to the quadriceps. The aim of this study was to examine the effect of prolonged hamstrings vibration on TF compressive force in individuals who have undergone ACL reconstruction. Fourteen participants with unilateral ACLR and 14 participants without knee injury performed a single-leg drop-land task before and after prolonged (20 min) vibration of the hamstrings. Peak TF compressive force, knee flexion angle, and hamstrings/quadriceps co-contraction were calculated during the deceleration phase of the drop-land task before and after vibration. The ACLR group experienced an 18% decrease in TF compressive force, a 32% increase in knee flexion angle, and a 38% decrease in hamstrings/quadriceps co-contraction after hamstrings vibration. There was no difference in any of the parameters in the noninjured group after vibration. These data suggest that acute prolonged hamstrings vibration has the potential to mitigate TF compressive force, which may protect the knee joint in the long term. Clinical significance: The results of this research are expected to lead to improved clinical care for ACLR patients because it holds promise for mitigating altered joint mechanics and perhaps slowing down the onset of posttraumatic knee osteoarthritis.
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Affiliation(s)
- Timothy Lowe
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Xuanliang Neil Dong
- Department of Health and Kinesiology, The University of Texas at Tyler, Tyler, Texas, USA
| | - Lisa Griffin
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
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Scattone Silva R, Song K, Hullfish TJ, Sprague A, Silbernagel KG, Baxter JR. Patellar Tendon Load Progression during Rehabilitation Exercises: Implications for the Treatment of Patellar Tendon Injuries. Med Sci Sports Exerc 2024; 56:545-552. [PMID: 37847102 PMCID: PMC10925836 DOI: 10.1249/mss.0000000000003323] [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] [Indexed: 10/18/2023]
Abstract
PURPOSE This study aimed to evaluate patellar tendon loading profiles (loading index, based on loading peak, loading impulse, and loading rate) of rehabilitation exercises to develop clinical guidelines to incrementally increase the rate and magnitude of patellar tendon loading during rehabilitation. METHODS Twenty healthy adults (10 females/10 males, 25.9 ± 5.7 yr) performed 35 rehabilitation exercises, including different variations of squats, lunge, jumps, hops, landings, running, and sports specific tasks. Kinematic and kinetic data were collected, and a patellar tendon loading index was determined for each exercise using a weighted sum of loading peak, loading rate, and cumulative loading impulse. Then the exercises were ranked, according to the loading index, into tier 1 (loading index ≤0.33), tier 2 (0.33 < loading index <0.66), and tier 3 (loading index ≥0.66). RESULTS The single-leg decline squat showed the highest loading index (0.747). Other tier 3 exercises included single-leg forward hop (0.666), single-leg countermovement jump (0.711), and running cut (0.725). The Spanish squat was categorized as a tier 2 exercise (0.563), as was running (0.612), double-leg countermovement jump (0.610), single-leg drop vertical jump (0.599), single-leg full squat (0.580), double-leg drop vertical jump (0.563), lunge (0.471), double-leg full squat (0.428), single-leg 60° squat (0.411), and Bulgarian squat (0.406). Tier 1 exercises included 20 cm step up (0.187), 20 cm step down (0.288), 30 cm step up (0.321), and double-leg 60° squat (0.224). CONCLUSIONS Three patellar tendon loading tiers were established based on a combination of loading peak, loading impulse, and loading rate. Clinicians may use these loading tiers as a guide to progressively increase patellar tendon loading during the rehabilitation of patients with patellar tendon disorders and after anterior cruciate ligament reconstruction using the bone-patellar tendon-bone graft.
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Affiliation(s)
- Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences, Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Santa Cruz, BRAZIL
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ke Song
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Todd J. Hullfish
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Andrew Sprague
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | | | - Josh R. Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
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Freiberger C, Thomas CM, Lupica GM, O'Connell S, Stamm MA, Mulcahey MK. Hip Range of Motion During Passive and 1-Leg Exercises Is Greater in Women: A Meta-analysis and Systematic Review. Arthroscopy 2024; 40:495-512.e3. [PMID: 37116553 DOI: 10.1016/j.arthro.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To summarize sex-related differences in hip range of motion (ROM), including flexion, extension, abduction, adduction, internal rotation, and external rotation. METHODS We performed a systematic search of 3 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Embase). The search terms were as follows: hip, pelvis, range of motion, kinematic, men, and women. Included studies reported sex-specific data on hip ROM in healthy, uninjured adults. To generate hip ROM mean differences, a DerSimonian-Laird random-effects model was used. Effect sizes were pooled for each exercise. Subgroup analyses compared hip ROM by physical activity group: passive ROM, 1-leg hop or jump, 2-leg hop or jump, 2-leg drop or landing, 1-leg squat, 2-leg squat, walking, and jogging/running. Positive effect sizes represent greater ROM in women. RESULTS Thirty-eight studies with 3,234 total subjects were included; of these subjects, 1,639 were women (50.1%). The mean age was 25.3 years. An effect difference was considered statistically significant if P < .05 and clinically significant if the mean difference was greater than 4.0°. Women showed statistically and clinically significantly greater hip flexion in passive ROM (mean difference, 6.4°) and during the 1-leg hop or jump exercise (mean difference, 6.5°). Women also showed statistically and clinically significantly greater hip adduction during the 1-leg hop or jump (mean difference, 4.5°) and 1-leg squat (mean difference, 4.4°) exercises, as well as statistically and clinically significantly greater hip internal rotation in passive ROM (mean difference, 8.2°). In contrast, men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise (mean difference, -9.1°). No clinically significant differences in extension, abduction, or external rotation were found between women and men. CONCLUSIONS On average, women showed statistically and clinically significantly greater flexion, adduction, and internal rotation during passive and 1-leg exercises whereas men showed statistically and clinically significantly greater flexion during the 2-leg hop or jump exercise. LEVEL OF EVIDENCE Level IV, meta-analysis and systematic review of Level II-IV studies.
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Affiliation(s)
- Christina Freiberger
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Christina M Thomas
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Gregory M Lupica
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Samantha O'Connell
- Office of Academic Affairs and Provost, Tulane University, New Orleans, Louisiana, U.S.A
| | - Michaela A Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A..
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Miyamoto D, Saito A, Kimoto M, Terui Y, Okada K. Relationship between the knee valgus moment and the hip abductor and adductor activity during single-leg landing. Phys Ther Sport 2023; 61:129-134. [PMID: 37023591 DOI: 10.1016/j.ptsp.2023.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To reveal the relationship between the knee valgus moment (KVM) and the hip abductor and adductor activity during single-leg landing. DESIGN A cross-sectional study. SETTING Laboratory-based, between April 2020 and May 2021. PARTICIPANTS Thirty female collegiate athletes. MAIN OUTCOME MEASURES KVM, hip adduction angle, hip internal rotation angle, knee valgus angle (KVA), gluteus medius muscle activity, adductor longus muscle activity, adductor longus to gluteus medius activity ratio (ADD/GMED), and vertical component of the ground reaction force (vGRF). RESULTS Stepwise multiple regression analysis was performed. KVM was significantly positively associated with KVA (β = 0.613, p < 0.001), vGRF (β = 0.367, p = 0.010), and ADD/GMED (β = 0.289, p = 0.038). CONCLUSIONS Increased KVA, vGRF, and ADD/GMED were the independent factors that contributed to increased KVM during single-leg landing, and only ADD/GMED was found among the muscle activity values. The relative muscle activity of the gluteus medius and adductor longus, rather than those of the gluteus medius or adductor longus alone, may be useful in preventing anterior cruciate ligament injury during single-leg landing.
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Sritharan P, Muñoz MA, Pivonka P, Bryant AL, Mokhtarzadeh H, Perraton LG. Biomechanical Markers of Forward Hop-Landing After ACL-Reconstruction: A Pattern Recognition Approach. Ann Biomed Eng 2022; 50:330-342. [PMID: 35099657 PMCID: PMC8847210 DOI: 10.1007/s10439-022-02921-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
Biomechanical changes after anterior cruciate ligament reconstruction (ACLR) may be detrimental to long-term knee-joint health. We used pattern recognition to characterise biomechanical differences during the landing phase of a single-leg forward hop after ACLR. Experimental data from 66 individuals 12-24 months post-ACLR (28.2 ± 6.3 years) and 32 controls (25.2 ± 4.8 years old) were input into a musculoskeletal modelling pipeline to calculate joint angles, joint moments and muscle forces. These waveforms were transformed into principal components (features), and input into a pattern recognition pipeline, which found 10 main distinguishing features (and 8 associated features) between ACLR and control landing biomechanics at significance \documentclass[12pt]{minimal}
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\begin{document}$$\alpha =0.05$$\end{document}α=0.05. Our process identified known biomechanical characteristics post-ACLR: smaller knee flexion angle; less knee extensor moment; lower vasti, rectus femoris and hamstrings forces. Importantly, we found more novel and less well-understood adaptations: smaller ankle plantar flexor moment; lower soleus forces; and altered patterns of knee rotation angle, hip rotator moment and knee abduction moment. Crucially, we identified, with high certainty, subtle aberrations indicating landing instability in the ACLR group for: knee flexion and internal rotation angles and moments; hip rotation angles and moments; and lumbar rotator and bending moments. Our findings may benefit rehabilitation and assessment for return-to-sport 12–24 months post-ACLR.
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Affiliation(s)
- Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.
| | - Mario A Muñoz
- School of Mathematics & Statistics, University of Melbourne, Melbourne, Australia
| | - Peter Pivonka
- School of Mechanical, Medical & Process Engineering, Queensland University of Technology, Brisbane, Australia
| | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Hossein Mokhtarzadeh
- Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
| | - Luke G Perraton
- Department of Physiotherapy, Monash University, Melbourne, Australia
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Jones HSR, Moore IS, King E, Stiles VH, Laudani L, McCarthy-Ryan M, McFadden C, Daniels KAJ. Movement strategy correspondence across jumping and cutting tasks after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 2021; 32:612-621. [PMID: 34797936 DOI: 10.1111/sms.14104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 01/18/2023]
Abstract
There are currently a multitude of tests used to assess readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to establish the extent to which movement strategies transfer between three common assessment tasks to help improve design of athlete testing batteries following ACLR. A cohort of 127 male patients 8-10 months post-ACLR and 45 non-injured controls took part in the study. Three movement tasks were completed (unilateral and bilateral drop jump, and 90° pre-planned cut), while ground reaction forces and three-dimensional kinematics (250 Hz) were recorded. Compared to the bilateral drop jump and cut, the unilateral drop jump had a higher proportion of work done at the ankle (d = 0.29, p < 0.001 and d = -1.87, p < 0.001, respectively), and a lower proportion of work done at the knee during the braking phase of the task (d = 0.447, p < 0.001 and d = 1.56, p < 0.001, respectively). The ACLR group had higher peak hip moments than the non-injured controls, although the proportion of work done at the ankle, knee and hip joints were similar. Movement strategies were moderately and positively related at the ankle (rs = 0.728, p < 0.001), knee (rs = 0.638, p < 0.001) and hip (rs = 0.593, p < 0.001) between the unilateral and bilateral drop jump, but there was no relationship at the ankle (rs = 0.10, p = 0.104), knee (rs = 0.106, p = 0.166) and hip (rs = -0.019, p = 0.808) between the unilateral drop jump and the cut. Clinicians could therefore consider omitting one of the drop jumps from assessment batteries but should include both jumping and cutting tasks.
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Affiliation(s)
- Holly S R Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Enda King
- Sports Surgery Clinic, Dublin, Ireland
| | | | - Luca Laudani
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Molly McCarthy-Ryan
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Ciarán McFadden
- Sports Surgery Clinic, Dublin, Ireland.,Sport and Exercise Science Research Centre, University of Roehampton, London, UK
| | - Katherine A J Daniels
- Sports Surgery Clinic, Dublin, Ireland.,Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
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7
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Estimation of vertical ground reaction force parameters during athletic tasks using 2D video. Gait Posture 2021; 90:483-488. [PMID: 34624702 DOI: 10.1016/j.gaitpost.2021.09.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Given that elevated vertical ground reaction forces (vGRF) have been reported to contribute to various lower-extremity injuries, there is a need for a practical method to characterize movement behavior that is representative of elevated impact forces. RESEARCH QUESTION Can images obtained from 2D video be used to predict vGRF parameters during athletic tasks? Specifically, we sought to determine whether the 2D thigh angle obtained at peak knee flexion could be used to predict the peak vGRF and vGRF impulse during single limb and double limb landings and movements that involve a change of direction. METHODS 2D sagittal plane video and vGRFs were obtained simultaneously from 39 participants (15 males and 24 females) during 5 athletic tasks (drop jump, lateral shuffle, deceleration, triple hop, side-step-cut). Linear regression analysis was performed to determine if the 2D thigh angle at peak knee flexion predicted the first peak of the vGRF and vGRF impulse during the deceleration phase of each task. RESULTS The 2D thigh angle predicted the peak vGRF for all tasks except cutting (R2 = 0.17 to 0.47, all p < 0.01). However, the 2D thigh angle predicted the vGRF impulse for all 5 tasks (R2 = 0.13 to 0.39, all p < 0.025). SIGNIFICANCE An increased 2D thigh angle (which is representative of increased hip and knee flexion) was able to predict lower peak vGRFs and vGRF impulse during athletic tasks. The 2D thigh angle is a potential clinical method to characterize movement behavior that may expose individuals to high impact forces.
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Atkins LT, James CR, Yang HS, Sizer PS, Brismée JM, Sawyer SF, Powers CM. Immediate Improvements in Patellofemoral Pain Are Associated With Sagittal Plane Movement Training to Improve Use of Gluteus Maximus Muscle During Single Limb Landing. Phys Ther 2021; 101:6309591. [PMID: 34174077 DOI: 10.1093/ptj/pzab165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/16/2021] [Accepted: 05/15/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The authors sought to examine the immediate effects of movement training aimed at improving use of gluteus maximus (GMAX) in the sagittal plane on hip internal rotation and self-reported patellofemoral pain (PFP) during single-limb landing. METHODS Seventeen females with PFP participated. Lower extremity kinematics and kinetics, GMAX activation, and self-reported PFP were obtained before and after a single-session movement training program aimed at increasing the use of GMAX. Dependent variables of interest included self-reported PFP, average GMAX activation, average hip extensor moment, and peak hip internal rotation. Post-training changes were evaluated using paired t tests and Wilcoxon signed rank tests. RESULTS Following movement training, self-reported PFP decreased significantly (mean [standard deviation]) (3.9 [1.1] vs 0.8 [1.3] on a 0-10 scale). Additionally, significant increases were observed for the average hip extensor moment (0.6 [0.3] vs 1.8 [0.4] Nm/kg) and average GMAX activation (41.0% [18.3] vs 51.6% [25.7] maximum voluntary isometric contraction), whereas peak hip internal rotation decreased significantly (8.5 degrees [5.8] vs 6.0 degrees [5.3]). CONCLUSION Movement training aimed at improving the use of GMAX in the sagittal plane resulted in clinically relevant changes in self-reported pain, GMAX activation, and hip kinetics and kinematics. Improving the use of GMAX during movement merits consideration when designing rehabilitation programs for females with PFP. IMPACT The current study highlights the clinical utility of movement training for persons with PFP and provides a biomechanical rationale for its use as a potential intervention in this population.
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Affiliation(s)
- Lee T Atkins
- Department of Physical Therapy, Angelo State University, San Angelo, Texas, USA
| | - C Roger James
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Hyung Suk Yang
- Division of Kinesiology and Sport Management, University of South Dakota, Vermillion, South Dakota, USA
| | - Phillip S Sizer
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Steven F Sawyer
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
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Markström JL, Grinberg A, Häger CK. Fear of Reinjury Following Anterior Cruciate Ligament Reconstruction Is Manifested in Muscle Activation Patterns of Single-Leg Side-Hop Landings. Phys Ther 2021; 102:6373317. [PMID: 34554253 PMCID: PMC8860189 DOI: 10.1093/ptj/pzab218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether fear of re-injury is manifested in joint kinematics and muscle activation patterns during landings of a standardized rebound side-hop (SRSH), or in patient-reported outcome measures (PROMs), among individuals with anterior cruciate ligament reconstruction (ACLR). METHODS In this cross-sectional observational study, 38 individuals within 2 years post-ACLR were grouped into HIGH-FEAR (n = 21, median 11.2 months post-surgery) or LOW-FEAR (n = 17, median 10.1 months post-surgery) based on a discriminating question (Q9; Tampa Scale of Kinesiophobia-17). These individuals and 39 asymptomatic controls performed the SRSH. Three-dimensional motion recordings were used to calculate trunk, hip, and knee joint angles at initial contact and range of respective joint motion during landing. Surface electromyography registered mean amplitudes and co-contraction indexes for thigh muscles during pre-activation (50 ms) and landing phases. PROMs of knee function, knee health, and physical activity were also analyzed. RESULTS The HIGH-FEAR and LOW-FEAR classification was corroborated by distinct Tampa Scale of Kinesiophobia-17 total and subscale scores and revealed distinguishable muscle activation patterns. HIGH-FEAR demonstrated higher biceps femoris electromyography amplitude and higher anterior-posterior co-contraction index during landing than both LOW-FEAR and controls. However, there were no fear-related differences for kinematics or PROMs. Instead, both ACLR subgroups showed different kinematics at initial contact to controls; HIGH-FEAR with more trunk, hip, and knee flexion, and LOW-FEAR with more hip and knee flexion. CONCLUSION Individuals with ACLR who had high fear of re-injury seem to have adopted a protective strategy with higher muscular activation patterns, presumably to stabilize the knee joint, compared with individuals with low fear of re-injury and controls. SRSH landing kinematics or knee-related PROMs may not be as sensitive to fear of re-injury. IMPACT Fear of reinjury following anterior cruciate ligament injury should be evaluated as an independent psychological outcome throughout rehabilitation after ACLR for improved return to sport transition. LAY SUMMARY If you have an anterior cruciate ligament injury treated with reconstructive surgery, you might have a high fear of reinjury, and that can change how you activate the muscles around your knee. Your physical therapist can do a simple screening test in addition to functional tests to help reduce your fear and improve your treatment outcomes.
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Affiliation(s)
| | - Adam Grinberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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10
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Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury? ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42978-020-00080-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Sritharan P, Perraton LG, Munoz MA, Pivonka P, Bryant AL. Muscular Coordination of Single-Leg Hop Landing in Uninjured and Anterior Cruciate Ligament-Reconstructed Individuals. J Appl Biomech 2020; 36:235-243. [PMID: 32659745 DOI: 10.1123/jab.2019-0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/22/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022]
Abstract
This study compared lower-limb muscle function, defined as the contributions of muscles to center-of-mass support and braking, during a single-leg hopping task in anterior cruciate ligament-reconstructed (ACLR) individuals and uninjured controls. In total, 65 ACLR individuals and 32 controls underwent a standardized anticipated single-leg forward hop. Kinematics and ground reaction force data were input into musculoskeletal models to calculate muscle forces and to quantify muscle function by decomposing the vertical (support) and fore-aft (braking) ground reaction force components into contributions by individual lower-limb muscles. Four major muscles, the vasti, soleus, gluteus medius, and gluteus maximus, were primarily involved in support and braking in both ACLR and uninjured groups. However, although the ACLR group demonstrated lower peak forces for these muscles (all Ps < .001, except gluteus maximus, P = .767), magnitude differences in these muscles' contributions to support and braking were not significant. ACLR individuals demonstrated higher erector spinae (P = .012) and hamstrings forces (P = .085) to maintain a straighter, stiffer landing posture with more forward lumbar flexion. This altered landing posture may have enabled the ACLR group to achieve similar muscle function to controls, despite muscle force deficits. Our findings may benefit rehabilitation and the development of interventions to enable faster and safer return to sport.
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Markström JL, Grip H, Schelin L, Häger CK. Individuals With an Anterior Cruciate Ligament-Reconstructed Knee Display Atypical Whole Body Movement Strategies but Normal Knee Robustness During Side-Hop Landings: A Finite Helical Axis Analysis. Am J Sports Med 2020; 48:1117-1126. [PMID: 32168459 PMCID: PMC7163247 DOI: 10.1177/0363546520910428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Atypical knee joint biomechanics after anterior cruciate ligament reconstruction (ACLR) are common. It is, however, unclear whether knee robustness (ability to tolerate perturbation and maintain joint configuration) and whole body movement strategies are compromised after ACLR. PURPOSE To investigate landing control after ACLR with regard to dynamic knee robustness and whole body movement strategies during sports-mimicking side hops, and to evaluate functional performance of hop tests and knee strength. STUDY DESIGN Controlled laboratory study. METHODS An 8-camera motion capture system and 2 synchronized force plates were used to calculate joint angles and moments during standardized rebound side-hop landings performed by 32 individuals with an ACL-reconstructed knee (ACLR group; median, 16.0 months after reconstruction with hamstring tendon graft [interquartile range, 35.2 months]) and 32 matched asymptomatic controls (CTRL). Dynamic knee robustness was quantified using a finite helical axis approach, providing discrete values quantifying divergence of knee joint movements from flexion-extension (higher relative frontal and/or transverse plane motion equaled lower robustness) during momentary helical rotation intervals of 10°. Multivariate analyses of movement strategies included trunk, hip, and knee angles at initial contact and during landing and hip and knee peak moments during landing, comparing ACLR and CTRL, as well as legs within groups. RESULTS Knee robustness was lower for the first 10° motion interval after initial contact and then successively stabilized for both groups and legs. When landing with the injured leg, the ACLR group, as compared with the contralateral leg and/or CTRL, demonstrated significantly greater flexion of the trunk, hip, and knee; greater hip flexion moment; less knee flexion moment; and smaller angle but greater moment of knee internal rotation. The ACLR group also had lower but acceptable hop and strength performances (ratios to noninjured leg >90%) except for knee flexion strength (12% deficit). CONCLUSION Knee robustness was not affected by ACLR during side-hop landings, but alterations in movement strategies were seen for the trunk, hip, and knee, as well as long-term deficits in knee flexion strength. CLINICAL RELEVANCE Knee robustness is lowest immediately after landing for both the ACLR group and the CTRL and should be targeted in training to reduce knee injury risk. Assessment of movement strategies during side-hop landings after ACLR should consider a whole body approach.
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Affiliation(s)
- Jonas L. Markström
- Physiotherapy Unit, Department of
Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden,Jonas L. Markström, PhD,
Physiotherapy Unit, Department of Community Medicine and Rehabilitation, Umeå
University, Umeå, SE-901 87, Sweden (
)
| | - Helena Grip
- Department of Radiation Sciences,
Biomedical Engineering and Physics, Umeå University, Umeå, Sweden
| | - Lina Schelin
- Department of Statistics, Umeå School of
Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Charlotte K. Häger
- Physiotherapy Unit, Department of
Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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13
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Biomechanical and neuromuscular comparison of single- and multi-planar jump tests and a side-cutting maneuver: Implications for ACL injury risk assessment. Knee 2020; 27:324-333. [PMID: 31889614 DOI: 10.1016/j.knee.2019.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/10/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-contact anterior cruciate ligament (ACL) injuries are a major problem among adolescent female soccer and handball players. Therefore, the aim of this study was to examine if known biomechanical and neuromuscular ACL injury risk factors obtained from single-planar jump-landings and multi-planar side-jumps can resemble the demands of side-cutting maneuvers, a known high-risk ACL injury movement for this population. METHODS Twenty-four female soccer and handball players (mean ± SD: age: 17 ± 1 year; height: 172 ± 66 cm; mass: 67 ± 9 kg) performed a series of functional tasks including two single-planar jump-landings, two multi-planar side-jumps and a sports-specific side-cutting maneuver on their dominant leg. Frontal and sagittal plane knee and hip joint kinematics and kinetics were calculated from three-dimensional motion analysis, whereas hamstring and quadriceps muscle pre-activity levels were measured with surface electromyography. RESULTS The sports-specific side-cut was distinguished by more knee flexion at initial contact, greater abduction angles and external knee abduction moments, higher biceps femoris and semitendinosus muscle pre-activity levels than both the single-planar jump-landings and multi-planar side-jumps (p < .05). Whilst, poor-to-strong spearman rank correlation coefficients inconsistently were found for the biomechanical and neuromuscular ACL injury risk factors explored between the side-cut and the single-planar jump-landings (rs = 0.01-0.78) and multi-planar side-jumps (rs = 0.03-0.88) respectively. CONCLUSION Single-planar jump-landings and multi-planar side-jumps should be used with caution to test for non-contact ACL injury risk factors in adolescent female soccer and handball players, because they do not mimic the biomechanical nor neuromuscular demands of the most frequent injury situation.
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14
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Shih Y, Fisher BE, Smith JA, Powers CM. Corticomotor Excitability of Gluteus Maximus Is Associated with Hip Biomechanics During a Single-Leg Drop-Jump. J Mot Behav 2020; 53:40-46. [PMID: 32090700 DOI: 10.1080/00222895.2020.1723480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to determine the association between corticomotor excitability (CME) of gluteus maximus (GM) and hip biomechanics during a single-leg drop-jump task. Thirty-two healthy individuals participated. The slope of the input-output curve (IOC) obtained from transcranial magnetic stimulation was used to assess CME of GM. The average hip extensor moment and peak hip flexion angle during the stance phase of the drop jump task was calculated. The slope of the IOC of GM was found to be a predictor of the average hip extensor moment (r2 = 0.18, p = 0.016) and peak hip flexion angle (r2 = 0.20, p = 0.01). Our results demonstrate that greater functional use of the hip was associated with enhanced descending neural drive of GM.
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Affiliation(s)
- Yo Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Beth E Fisher
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jo Armour Smith
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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15
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Smeets A, Verheul J, Vanrenterghem J, Staes F, Vandenneucker H, Claes S, Verschueren S. Single-Joint and Whole-Body Movement Changes in Anterior Cruciate Ligament Athletes Returning to Sport. Med Sci Sports Exerc 2020; 52:1658-1667. [PMID: 32079913 DOI: 10.1249/mss.0000000000002308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Athletes returning to sport after anterior cruciate ligament reconstruction (ACLR) demonstrate prolonged changes in landing kinematics, kinetics, and muscle activation, predisposing them for reinjury, knee osteoarthritis, and/or knee instability. So far, researchers have been focusing on how kinematics and kinetics change in every joint separately. However, as the human body operates within a kinetic chain, we will assess whether single-joint changes are associated with whole-body changes. METHODS Twenty-one athletes who had an ACLR and 21 uninjured controls performed five unilateral landing tasks, whereas lower limb kinematics, kinetics, and muscle activations of vastus medialis, vastus lateralis, biceps femoris, semitendinosus, semimembranosus, gastrocnemius, and gluteus medius were recorded. Single-joint landing kinematics, kinetics, and muscle activations of the ACL-injured leg were compared with the uninjured leg and compared with the control group. Whole-body changes were assessed by decomposing movements into fundamental components using marker-based principal component analysis (PCA). RESULTS We found several single-joint changes in landing kinematics, kinetics, and muscle activations in the athletes with ACLR that were seen across all tasks and therefore of major interest as they are likely to occur during sports as well. Hamstrings activation increased and external knee flexion moments decreased in the ACL-injured leg compared with their uninjured leg. Furthermore, hip adduction moments and knee abduction angles decreased compared with the control group. The PCA could detect changes in whole-body movement, which were task-specific. CONCLUSIONS Athletes with ACLR still show protective task-independent single-joint kinematic, kinetic, and muscle activation changes during single-leg landings at the time of return to sport. These single-joint changes were not consistently accompanied by changes in whole-body movements (revealed by marker-based PCA). Whole-body expressions of the single-joint compensations are likely to be affected by the demands of the task.
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Affiliation(s)
- Annemie Smeets
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Jasper Verheul
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UNITED KINGDOM
| | - Jos Vanrenterghem
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Filip Staes
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | | | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Herentals, BELGIUM
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
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16
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Smale KB, Conconi M, Sancisi N, Alkjaer T, Krogsgaard MR, Parenti-Castelli V, Benoit DL. Relationship of Knee Forces to Subjective Function Pre- and Post-ACL Reconstruction. Med Sci Sports Exerc 2020; 52:1338-1346. [PMID: 31895297 DOI: 10.1249/mss.0000000000002258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Although basic objective measures (e.g., knee laxity, strength, and hop tests) have been related to subjective measures of function, associations between knee-specific objective and subjective measures have yet to be completed. The objective was to determine if knee joint contact and ligament forces differ between pre- and post-anterior cruciate ligament (ACL) reconstructed states and if these forces relate to their patient's respective subjective functional ability scores. METHODS Twelve patients performed a hopping task before and after reconstruction. Magnetic resonance images and OpenSim were used to develop patient-specific models in static optimization and joint reaction analyses. Questionnaires concerning each patient's subjective functional ability were also collected and correlated with knee joint contact and ligament forces. RESULTS No significant differences were observed between deficient and reconstructed groups with respect to knee joint contact or ligament forces. Nevertheless, there were several significant (P < 0.05) moderate to strong correlations between subjective and objective measures including Tegner activity level to contact force in both states (r = 0.67-0.76) and International Knee Documentation Committee to compressive and anterior shear forces (r = 0.64-0.66). CONCLUSION Knee-specific objective measures of a patient's functional capacity can represent their subjective ability, which explains this relationship to a greater extent than past anatomical and gross objective measures of function. This consolidation is imperative for improving the current rehabilitation schema as it allows for external validation of objective and subjective functional measures. With poor validation of subjective function against objective measures of function, the reinjury rate is unlikely to diminish, continuing the heavy financial burden on health care systems.
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Affiliation(s)
- Kenneth B Smale
- School of Human Kinetics, University of Ottawa, Ottawa, CANADA
| | - Michele Conconi
- Department of Industrial Engineering, University of Bologna, Bologna, ITALY
| | - Nicola Sancisi
- Department of Industrial Engineering, University of Bologna, Bologna, ITALY
| | | | - Michael R Krogsgaard
- Section for Sports Traumatology M51, Bispebjerg-Frederiksberg Hospital, Copenhagen, DENMARK
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17
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Tsai LC, Cooper E, Hetzendorfer K, Warren G, Chang YH, Willett N. Effects of treadmill running and limb immobilization on knee cartilage degeneration and locomotor joint kinematics in rats following knee meniscal transection. Osteoarthritis Cartilage 2019; 27:1851-1859. [PMID: 31437580 PMCID: PMC7576441 DOI: 10.1016/j.joca.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study examined the effects of reduced and elevated weight bearing on post-traumatic osteoarthritis (PTOA) development, locomotor joint kinematics, and degree of voluntary activity in rats following medial meniscal transection (MMT). DESIGN Twenty-one adult rats were subjected to MMT surgery of the left hindlimb and then assigned to one of three groups: (1) regular (i.e., no intervention), (2) hindlimb immobilization, or (3) treadmill running. Sham surgery was performed in four additional rats. Voluntary wheel run time/distance was measured, and 3D hindlimb kinematics were quantified during treadmill locomotion using biplanar radiography. Rats were euthanized 8 weeks after MMT or sham surgery, and the microstructure of the tibial cartilage and subchondral bone was quantified using contrast enhanced micro-CT. RESULTS All three MMT groups showed signs of PTOA (full-thickness lesions and/or increased cartilage volume) compared to the sham group, however the regular and treadmill-running groups had greater osteophyte formation than the immobilization group. For the immobilization group, increased volume was only observed in the anterior region of the cartilage. The treadmill-running group demonstrated a greater knee varus angle at mid-stance than the sham group, while the immobilization group demonstrated greater reduction in voluntary running than all the other groups at 2 weeks post-surgery. CONCLUSIONS Elevated weight-bearing via treadmill running at a slow/moderate speed did not accelerate PTOA in MMT rats when compared to regular weight-bearing. Reduced weight-bearing via immobilization may attenuate overall PTOA but still resulted in regional cartilage degeneration. Overall, there were minimal differences in hindlimb kinematics and voluntary running between MMT and sham rats.
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Affiliation(s)
- L.-C. Tsai
- Georgia State University, Atlanta, GA, USA,Address correspondence and reprint requests to: L.-C. Tsai, Department of Physical Therapy, Georgia State University, Atlanta, GA, USA. Tel: 404-413-1246. (L.-C. Tsai)
| | - E.S. Cooper
- Emory University, Atlanta, GA, USA,Georgia Institute of Technology, Atlanta, GA, USA
| | | | - G.L. Warren
- Georgia State University, Atlanta, GA, USA,Georgia Institute of Technology, Atlanta, GA, USA
| | - Y.-H. Chang
- Georgia Institute of Technology, Atlanta, GA, USA
| | - N.J. Willett
- Emory University, Atlanta, GA, USA,Georgia Institute of Technology, Atlanta, GA, USA,Atlanta VA Medical Center, Atlanta, GA, USA
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18
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Mueske NM, VandenBerg CD, Pace JL, Katzel MJ, Zaslow TL, Padilla RA, Wren TAL. Comparison of drop jump landing biomechanics and asymmetry among adolescents with hamstring, patellar and quadriceps tendon autografts for anterior cruciate ligament reconstruction. Knee 2018; 25:1065-1073. [PMID: 30249472 DOI: 10.1016/j.knee.2018.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/04/2018] [Accepted: 09/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adolescent anterior cruciate ligament reconstruction (ACLR) commonly utilizes hamstring (HT), patellar (PT) or quadriceps (QT) tendon autografts, but consensus is lacking regarding optimal graft choice. This study compared landing biomechanics and asymmetries among ACLR patients with HT, PT and QT grafts and uninjured controls. METHODS This retrospective study included 61 adolescents with unilateral ACLR (27 HT, 20 PT, 14 QT; four to 12 months post-surgery, mean 6.4; age 15.4, SD 1.4 years) and 27 controls (14.6, SD 0.9 years) who were evaluated during drop jump landings. Lower extremity 3D biomechanics and asymmetries were compared. RESULTS Compared to controls, all operative limbs exhibited 1) greater hip flexion and lower dorsiflexion angles; 2) higher hip and lower knee and ankle flexion moments; 3) higher energy absorption at the hip (HT and QT only) and lower at the knee and ankle; and 4) higher knee abduction moments. Asymmetries observed in all ACLR groups included 1) lower knee and ankle flexion angles; 2) lower knee and ankle flexion moments; 3) lower energy absorption at the knee and ankle; and 4) higher hip and knee abduction moments on the operative side. The PT and QT groups demonstrated greater asymmetry in hip and knee flexion moments compared to HT. CONCLUSIONS While adolescent ACLR limbs offloaded the knee and ankle, patients with PT or QT grafts demonstrated greater deficiencies during rehabilitation than those reconstructed with HT. Graft choice in ACLR should remain patient-specific and aim to optimize biomechanics with the ultimate goal of minimizing graft re-tear and donor site morbidity.
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Affiliation(s)
- Nicole M Mueske
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA.
| | - Curtis D VandenBerg
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
| | - J Lee Pace
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
| | - Mia J Katzel
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA.
| | - Tracy L Zaslow
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
| | - Ricardo A Padilla
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
| | - Tishya A L Wren
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
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19
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Effect of Dropping Height on the Forces of Lower Extremity Joints and Muscles during Landing: A Musculoskeletal Modeling. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:2632603. [PMID: 30079173 PMCID: PMC6051254 DOI: 10.1155/2018/2632603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/18/2018] [Accepted: 05/10/2018] [Indexed: 11/24/2022]
Abstract
The objective of this study was to investigate the effect of dropping height on the forces of joints and muscles in lower extremities during landing. A total of 10 adult subjects were required to landing from three different heights (32 cm, 52 cm, and 72 cm), and the ground reaction force and kinematics of lower extremities were measured. Then, the experimental data were input into the AnyBody Modeling System, in which software the musculoskeletal system of each subject was modeled. The reverse dynamic analysis was done to calculate the joint and muscle forces for each landing trial, and the effect of dropping-landing on the results was evaluated. The computational simulation showed that, with increasing of dropping height, the vertical forces of all the hip, knee, and ankle joints, and the forces of rectus femoris, gluteus maximus, gluteus medius, vastii, biceps femoris and adductor magnus were all significantly increased. The increased dropping height also resulted in earlier activation of the iliopsoas, rectus femoris, gluteus medius, gluteus minimus, and soleus, but latter activation of the tibialis anterior. The quantitative joint and muscle forces can be used as loading conditions in finite element analysis to calculate stress and strain and energy absorption processes in various tissues of the lower limbs.
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20
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Piccoli A, Rossettini G, Cecchetto S, Viceconti A, Ristori D, Turolla A, Maselli F, Testa M. Effect of Attentional Focus Instructions on Motor Learning and Performance of Patients with Central Nervous System and Musculoskeletal Disorders: a Systematic Review. J Funct Morphol Kinesiol 2018; 3:E40. [PMID: 33466969 PMCID: PMC7739330 DOI: 10.3390/jfmk3030040] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022] Open
Abstract
Exercise is one of the main rehabilitative interventions, commonly used to improve performance and motor learning. During the application of attentional focus strategies, External Focus of Attention (EFA) aiming at the movement effect has been reported to have more efficacy than Internal Focus of Attention (IFA) aiming at movement characteristics in healthy subjects. There are not many studies that compare the EFA and IFA instructions in people with Musculoskeletal (MSK) and Central Nervous System disorders (CNS). The purpose of this systematic review is to determine if IFA or EFA, in patients with CNS or MSK, may improve performance and have some effects on motor learning. Databases used for research: PubMed, CINAHL, Cochrane Library, PEDro, PsycINFO, SCOPUS. Inclusion criteria: Randomized Controlled Trial, quasi-Randomized Controlled Trial, enrolled subjects with CNS or with MSK and compared the efficacy of EFA and IFA. The studies suggest that the EFA is better than IFA in affecting the movement execution in patients with MSK, while conflicted findings emerge in presence of CNS disorders. Studies included in the qualitative analysis showed heterogeneous methodological features in study design and conductance, so results must be interpreted with caution.
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Affiliation(s)
- Alessandro Piccoli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | | | - Antonello Viceconti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Andrea Turolla
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
- Fondazione Ospedale San Camillo IRCCS, 30126 Venezia, Italy
| | - Filippo Maselli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, 17100 Savona, Italy
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21
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Elias ARC, Harris KJ, LaStayo PC, Mizner RL. Clinical Efficacy of Jump Training Augmented With Body Weight Support After ACL Reconstruction: A Randomized Controlled Trial. Am J Sports Med 2018; 46:1650-1660. [PMID: 29558161 DOI: 10.1177/0363546518759052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited knee flexion and increased muscle co-contraction during jump landing are believed to diminish outcomes after anterior cruciate ligament (ACL) reconstruction. The efficacy of jump training to improve patients' mechanical and neuromuscular deficits is understudied. HYPOTHESIS Jump training will improve functional, mechanical, and neuromuscular outcomes and higher repetition training augmented by body weight support will result in better retention of gains. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Thirty athletes (18 months after surgery) were screened, and 19 with mechanical deficits and limited clinical outcomes were enrolled in the trial. Testing included the International Knee Documentation Committee (IKDC) questionnaire, leg landing mechanics via motion analysis, knee joint effusion using a stroke test, and a surface electromyography-generated co-contraction index during a single-legged landing. Participants were randomly assigned to 1 of 2 groups: jump training with normal body weight (JTBW) and high-repetition jump training with body weight support (JTBWS). Knee effusion grading throughout training was used to assess joint tolerance. Changes in outcomes over time were analyzed with mixed-effects modeling. Immediate outcomes were compared with retention testing at 8 weeks after training by use of 2-way analyses of variance with effects of time and group. RESULTS Significant effects of time were found during the training phase for all outcome measures, but no effects of group or sex were found. IKDC score (pooled; mean ± SD) increased from 76 ± 12 to 87 ± 8 ( P < .001). Knee flexion during single-legged landing increased from 57° ± 11° to 73° ± 9° ( P < .001). Average co-contraction index decreased from 37 ± 15 to 19 ± 6 ( P < .001). All measures were retained over the retention period in both groups. The relative risk of knee effusion of the JTBW group versus the JTBWS group was 4.2 (95% CI, 2.25-7.71; P < .001). CONCLUSION Jump training mitigated some risk factors for second injury and osteoarthritis in patients after ACL reconstruction. Training made lasting improvements in physical function measures as well as mechanical and neuromuscular coordination deficits. Higher repetitions used with body weight support did not improve retention but substantially reduced risk for effusion. CLINICAL RELEVANCE Jump training is an efficacious intervention for athletes with poor outcomes after ACL reconstruction, and training with body weight support lessens the risk for excessive joint stress during practice. Registration: NCT02148172 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Audrey R C Elias
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Kari J Harris
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Paul C LaStayo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Ryan L Mizner
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
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22
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Bencke J, Aagaard P, Zebis MK. Muscle Activation During ACL Injury Risk Movements in Young Female Athletes: A Narrative Review. Front Physiol 2018; 9:445. [PMID: 29867521 PMCID: PMC5962681 DOI: 10.3389/fphys.2018.00445] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/10/2018] [Indexed: 11/13/2022] Open
Abstract
Young, adolescent female athletes are at particular high risk of sustaining a non-contact anterior cruciate ligament (ACL) injury during sport. Through the last decades much attention has been directed toward various anatomical and biomechanical risk factors for non-contact ACL injury, and important information have been retrieved about the influence of external loading factors on ACL injury risk during given sports-specific movements. However, much less attention has been given to the aspect of neuromuscular control during such movements and only sparse knowledge exists on the specific muscle activation patterns involved during specific risk conditions. Therefore, the aim of this narrative review was (1) to describe anatomical aspects, strength aspects and biomechanical aspects relevant for the understanding of ACL non-contact injury mechanisms in young female athletes, and (2) to review the existing literature on lower limb muscle activation in relation to risk of non-contact ACL-injury and prevention of ACL injury in young female athletes. Studies investigating muscle activity patterns associated with sports-specific risk situations were identified, comprising cohort studies, intervention studies and prospective studies. Based on the retrieved studies, clear gender-specific differences in muscle activation and coordination were identified demonstrating elevated quadriceps activity and reduced hamstring activity in young female athletes compared to their male counterparts, and suggesting young female athletes to be at elevated risk of non-contact ACL injury. Only few studies (n = 6) examined the effect of preventive exercise-based intervention protocols on lower limb muscle activation during sports-specific movements. A general trend toward enhanced hamstring activation was observed during selected injury risk situations (e.g., sidecutting and drop landings). Only a single study examined the association between muscle activation deficits and ACL injury risk, reporting that low medial hamstring activation and high vastus lateralis activation prior to landing was associated with an elevated incidence of ACL-injury. A majority of studies were performed in adult female athletes. The striking paucity of studies in adolescent female athletes emphasizes the need for increased research activities to examine of lower limb muscle activity in relation to non-contact ACL injury in this high-risk athlete population.
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Affiliation(s)
- Jesper Bencke
- Human Movement Analysis Laboratory Section 247, Department of Orthopedic Surgery Section 333, Hvidovre Hospital, Copenhagen University Hospital at Amager-Hvidovre, Copenhagen, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, Research Unit for Muscle Physiology and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mette K Zebis
- Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
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23
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Popovic T, Caswell SV, Benjaminse A, Siragy T, Ambegaonkar J, Cortes N. Implicit video feedback produces positive changes in landing mechanics. J Exp Orthop 2018; 5:12. [PMID: 29721781 PMCID: PMC5931948 DOI: 10.1186/s40634-018-0129-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implicit (IF) and explicit (EF) feedback are two motor learning strategies demonstrated to alter movement patterns. There is conflicting evidence on which strategy produces better outcomes. The purpose of this study was to examine the effects of reduced IF and EF video feedback on lower extremity landing mechanics. METHODS Thirty participants (24 ± 2 years, 1.7 ± 0.1 m, 70 ± 11 kg) were randomly assigned to three groups: IF (n = 10), EF (n = 10), and control (CG) (n = 10). They performed twelve box-drop jumps three times a week on the training sessions for six weeks. Only IF and EF groups received video feedback on the training sessions. IF was cued to focus their attention on the overall jump, while EF was cued to focus on position of their knees. 3D lower extremity biomechanics were tested on testing sessions with no feedback. All sessions were at least 24 h apart from another. Testing sessions included baseline testing (pretest), testing after 3 training sessions with 100% feedback (pst1), testing after 6 training sessions with 33.3% feedback (pst2), testing after 6 training sessions with 16.6% feedback (Pst3), and testing 1 month after with no feedback (retention - ret). ANOVA compared differences between groups and time at initial contact and peak for hip flexion (HF, °) and abduction angle (HA, °), hip abduction moment (HAM, Nm/kgm), knee flexion (KF, °) and abduction angle (KA, °), knee abduction moment (KAM, Nm/kgm) and VGRF (N) (p < 0.05). RESULTS A significant main effect for group was found between IF and EF groups for HA (IF = - 6.7 ± 4; EF = - 9.4 ± 4.1) and KAM (IF = 0.05 ± 0.2; EF = - 0.07 ± 0.2) at initial contact, and peaks HA (IF = - 3.5 ± 4.5; EF = - 7.9 ± 4.7) and HAM (IF = 1.1 ± 0.6; EF = 0.9 ± 0.4). A significant main effect for time at initial contact for HF (pre = 32.4 ± 3.2; pst2 = 36.9 ± 3.2; pst3 = 37.9 ± 3.7; ret. = 34.1 ± 3.7), HAM (pre = 0.1 ± 0.1; pst1 = 0.04 ± 0.1; pst3 = 0.1 ± 0.01), KA (pre = 0.7 ± 1.1; pst1 = 0.2 ± 1.2; pst3 = 1.7 ± 1), and KAM (pre = 0.003 ± 0.1; pst3 = 0.01 ± 0.1) was found. DISCUSSION/CONCLUSION We found that implicit feedback produced positive changes in landing mechanics while explicit feedback degraded motor learning. Our results indicate that implicit feedback should be used in programs to lower the ACL injury risk. We suggest that implicit feedback should be frequent in the beginning and not be reduced as much following the acquisition phase.
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Affiliation(s)
- Tijana Popovic
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA.,Department of Radiology and Biomedical Imaging, University of California, 185 Berry Street, Lobby 6, Suite 391, San Francisco, CA, 94107, USA
| | - Shane V Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA
| | | | - Tarique Siragy
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA.,School of Human Kinetics, Faculty of Health Sciences at the University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Jatin Ambegaonkar
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA
| | - Nelson Cortes
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, 10890 George Mason Circle Bull Run Hall 220, MSN 4E5, Manassas, VA, 20110, USA.
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Changes in patellofemoral pain resulting from repetitive impact landings are associated with the magnitude and rate of patellofemoral joint loading. Clin Biomech (Bristol, Avon) 2018; 53:31-36. [PMID: 29428687 DOI: 10.1016/j.clinbiomech.2018.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although a relationship between elevated patellofemoral forces and pain has been proposed, it is unknown which joint loading variable (magnitude, rate) is best associated with pain changes. The purpose of this study was to examine associations among patellofemoral joint loading variables and changes in patellofemoral pain across repeated single limb landings. METHODS Thirty-one females (age: 23.5(2.8) year; height: 166.8(5.8) cm; mass: 59.6(8.1) kg) with PFP performed 5 landing trials from 0.25 m. The dependent variable was rate of change in pain obtained from self-reported pain scores following each trial. Independent variables included 5-trial averages of peak, time-integral, and average and maximum development rates of the patellofemoral joint reaction force obtained using a previously described model. Pearson correlation coefficients were calculated to evaluate individual associations between rate of change in pain and each independent variable (α = 0.05). Stepwise linear multiple regression (αenter = 0.05; αexit = 0.10) was used to identify the best predictor of rate of change in pain. FINDINGS Subjects reported an average increase of 0.38 pain points with each landing trial. Although, rate of change in pain was positively correlated with peak force (r = 0.44, p = 0.01), and average (r = 0.41, p = 0.02) and maximum force development rates (r = 0.39, p = 0.03), only the peak force entered the predictive model explaining 19% of variance in rate of change in pain (r2 = 0.19, p = 0.01). INTERPRETATION Peak patellofemoral joint reaction force was the best predictor of the rate of change in pain following repetitive singe limb landings. The current study supports the theory that patellofemoral joint loading contributes to changes in patellofemoral pain.
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Lepley AS, Kuenze CM. Hip and Knee Kinematics and Kinetics During Landing Tasks After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. J Athl Train 2018; 53:144-159. [PMID: 29350551 DOI: 10.4085/1062-6050-334-16] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the current evidence concerning kinematic and kinetic strategies adopted during dynamic landing tasks by patients with anterior cruciate ligament reconstruction (ACLR). DATA SOURCES PubMed, Web of Science. STUDY SELECTION Original research articles that evaluated kinematics or kinetics (or both) during a landing task in those with a history of ACLR were included. DATA EXTRACTION Methodologic quality was assessed using the modified Downs and Black checklist. Means and standard deviations for knee or hip (or both) kinematics and kinetics were used to calculate Cohen d effect sizes and corresponding 95% confidence intervals between the injured limb of ACLR participants and contralateral or healthy matched limbs. Data were further stratified by landing tasks, either double- or single-limb landing. A random-effects-model meta-analysis was used to calculate pooled effect sizes and 95% confidence intervals. DATA SYNTHESIS The involved limbs of ACLR patients demonstrated clinically and significantly lower knee-extension moments during double-legged landing compared with healthy contralateral limbs and healthy control limbs (Cohen d range = -0.81 to -1.23) and decreased vertical ground reaction forces when compared with healthy controls, regardless of task (Cohen d range = -0.39 to -1.75). CONCLUSIONS During single- and double-legged landing tasks, individuals with ACLR demonstrated meaningful reductions in injured-limb knee-extension moments and vertical ground reaction forces. These findings indicate potential unloading of the injured limb after ACLR, which may have significant implications for secondary ACL injury and long-term joint health.
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The Effect of Teeth Clenching on Dynamic Balance at Jump-Landing: A Pilot Study. J Appl Biomech 2017; 33:211-215. [DOI: 10.1123/jab.2016-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze the effect of teeth clenching on dynamic balance at jump landing. Twenty-five healthy subjects performed jump-landing tasks with or without teeth clenching. The first 3 trials were performed with no instruction; subsequently, subjects were ordered to clench at the time of landing in the following 3 trials. We collected the data of masseter muscle activity by electromyogram, the maximum vertical ground reaction force (vGRFmax) and center of pressure (CoP) parameters by force plate during jump-landing. According to the clenching status of control jump-landing, all participants were categorized into a spontaneous clenching group and no clenching group, and the CoP data were compared. The masseter muscle activity was correlated with vGRFmax during anterior jump-landing, while it was not correlated with CoP. In comparisons between the spontaneous clenching and the no clenching group during anterior jump-landing, the spontaneous clenching group showed harder landing and the CoP area became larger than the no clenching group. There were no significant differences between pre- and postintervention in both spontaneous clenching and no clenching groups. The effect of teeth clenching on dynamic balance during jump-landing was limited.
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Nyland J, Gamble C, Franklin T, Caborn DNM. Permanent knee sensorimotor system changes following ACL injury and surgery. Knee Surg Sports Traumatol Arthrosc 2017; 25:1461-1474. [PMID: 28154888 DOI: 10.1007/s00167-017-4432-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/12/2017] [Indexed: 01/14/2023]
Abstract
The cruciate ligaments are components of the knee capsuloligamentous system providing vital neurosensory and biomechanical function. Since most historical primary ACL repair attempts were unsuccessful, reconstruction has become the preferred surgery. However, an increased understanding of the efficacy of lesion-site scaffolding, innovative suturing methods and materials, and evolving use of biological healing mediators such as platelet-rich plasma and stem cells has prompted reconsideration of what was once believed to be impossible. A growing number of in vivo animal studies and prospective clinical studies are providing increasing support for this intervention. The significance of ACL repair rather than reconstruction is that it more likely preserves the native neurosensory system, entheses, and ACL footprints. Tissue preservation combined with restored biomechanical function increases the likelihood for premorbid neuromuscular control system and dynamic knee stability recovery. This recovery should increase the potential for more patients to safely return to sports at their desired intensity and frequency. This current concepts paper revisits cruciate ligament neurosensory and neurovascular anatomy from the perspective of knee capsuloligamentous system function. Peripheral and central nerve pathways and central cortical representation mapping are also discussed. Surgical restoration of a more physiologically sound knee joint may be essential to solving the osteoarthritis dilemma. Innovative rehabilitative strategies and outcome measurement methodologies using more holistic and clinically relevant measurements that closely link biomechanical and neurosensory characteristics of physiological ACL function are discussed. Greater consideration of task-specific patient physical function and psychobehavioral links should better delineate the true efficacy of all ACL surgical and non-surgical interventions. Level of evidence IV.
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Affiliation(s)
- John Nyland
- Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA.
| | - Collin Gamble
- School of Medicine, University of Louisville, 323 East Chestnut Street, Louisville, KY, 40202, USA
| | - Tiffany Franklin
- Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA
| | - David N M Caborn
- Shea Orthopedic Group, KentuckyOne Health, 201 Abraham Flexner Way, Ste. 100, Louisville, KY, 40202, USA
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Pozzi F, Di Stasi S, Zeni JA, Barrios JA. Single-limb drop landing biomechanics in active individuals with and without a history of anterior cruciate ligament reconstruction: A total support analysis. Clin Biomech (Bristol, Avon) 2017; 43:28-33. [PMID: 28189981 DOI: 10.1016/j.clinbiomech.2017.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to characterize the magnitude and distribution of the total support moment during single-limb drop landings in individuals after anterior cruciate ligament reconstruction compared to a control group. METHODS Twenty participants after reconstruction and twenty control participants matched on sex, limb dominance and activity level were recruited. Motion analysis was performed during a single-limb drop landing task. Total support moment was determined by summing the internal extensor moments at the ankle, knee, and hip. Each relative joint contribution to the total support moment was calculated by dividing each individual contribution by the total support moment. Data were captured during a landing interval that started at initial contact and ended at the lowest vertical position of the pelvis. Data were then time-normalized and indexed at 25, 50, 75, and 100% of the landing interval. FINDINGS No between-group differences for total support moment magnitude were observed. At both 75% and 100% of the landing, the relative contribution of the knee joint was lower in those with a history of surgery (p<0.001). At the same instances, the relative contribution to the total support moment by the hip joint was greater in those with a history of surgery (p=0.004). INTERPRETATION In active participants after anterior cruciate ligament reconstruction, relative contributions to anti-gravity support of the center of mass shifted from the knee to the hip joint during single-limb landing, which became evident towards the end of the landing interval.
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Affiliation(s)
- Federico Pozzi
- Division of Biokinesiology and Physical Therapy, University of Southern California, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Department of Orthopaedics, The Ohio State University, USA
| | - Joseph A Zeni
- Department of Physical Therapy, University of Delaware, USA
| | - Joaquin A Barrios
- Department of Physical Therapy, University of Dayton, Raymond L. Fitz Hall, Room 209D, Dayton, OH, 45469-2925, USA.
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Motion Task Selection for Kinematic Evaluation After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2016; 32:1453-65. [PMID: 27103604 DOI: 10.1016/j.arthro.2016.01.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/26/2015] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the different motion tasks and the protocols used to objectively quantify dynamic stability in terms of knee kinematics at different stages of anterior cruciate ligament reconstruction (ACLR) recovery. METHODS A systematic search was done using OVID in Embase, Cochrane Central Register of Controlled Trials, Medline, PsychINFO, and AMED. A combination of the following keywords and their variations were used: anterior cruciate ligament, motion tasks (e.g., jump, hop, gait), and stability. The inclusion criteria were as follows: (1) ACLR subjects were recruited, (2) at least 1 motion task was performed and kinematics data were recorded, and (3) uninjured subjects or the contralateral uninjured limbs were included as a control group. Exclusion criteria were as follows: (1) non-English language publications, (2) retrospective studies and review articles, (3) animal studies, and (4) cadaveric studies. RESULTS The search returned 2,195 studies, and 56 were included in this review according to the criteria. A total of 1,086 ACLR subjects were included. Pivoting, landing, walking, running, stair negotiation, and squats were assessed using optoelectronic motion capture, electrogoniometry, or video-radiography. CONCLUSIONS The appropriate selection of motion tasks is an integral factor in dynamic stability testing as it evokes different kinematic outcomes in relation to the different stages of ACLR recovery. Stair negotiation and landing tasks are best performed during the early stages of recovery, and landing and pivoting are recommended 6 months after ACLR surgery. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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The Relationship Between Landing Sound, Vertical Ground Reaction Force, and Kinematics of the Lower Limb During Drop Landings in Healthy Men. J Orthop Sports Phys Ther 2016; 46:194-9. [PMID: 26813751 DOI: 10.2519/jospt.2016.6041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study, cross-sectional. BACKGROUND Soft-landing instruction, which is advocated in several injury prevention programs, is thought to have a qualitative relationship with decreased vertical ground reaction forces (vGRFs) and increased lower-limb joint excursions. OBJECTIVE To quantify the relationships among landing sound, vGRFs, and lower-limb kinematics during a drop-landing task. METHODS Twenty-six asymptomatic men aged 18 to 35 years were asked to perform 15 single-leg drop landings from a 30-cm height. Five trials were collected under 3 sound conditions: normal, quiet, and loud. The vGRF, lower-limb kinematics (sagittal plane), and impact sound were recorded during the deceleration phase. RESULTS A simple linear regression revealed a significant relationship between landing sound and vGRF (R(2) = 0.42, P<.001). A repeated-measures analysis of variance showed that ankle and knee excursion significantly increased by 7.0° and 11.7°, respectively, during quiet landing (compared to normal landing; P<.001). During the loud landing condition, ankle joint excursion significantly decreased by 9.4° compared to the normal landing condition (P<.001), and hip joint excursion significantly increased by 4.0° compared to normal landing condition (P<.045). CONCLUSION As landing sound decreases, so does vGRF during a drop-landing task. These reductions were achieved by increasing ankle and knee joint excursions. Conversely, as the landing sound increases, so does vGRF. This was the result of decreasing ankle joint excursion and increasing hip joint excursion.
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Changes in quadriceps and hamstring cocontraction following landing instruction in patients with anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2015; 45:273-80. [PMID: 25679342 DOI: 10.2519/jospt.2015.5335] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Pretest/posttest controlled laboratory study. OBJECTIVES To determine changes in the neuromuscular activation of the quadriceps and hamstrings following instructions aimed at improving knee flexion during a single-limb landing task in persons who have undergone anterior cruciate ligament reconstruction (ACLR). BACKGROUND Clinicians advise patients who have undergone ACLR to increase knee flexion during landing tasks to improve impact attenuation. Another long-standing construct underlying such instruction involves increasing cocontraction of the hamstrings with the quadriceps to limit anterior shear of the tibia on the femur. The current study examined whether cocontraction of the knee musculature changes following instruction to increase knee flexion during landing. METHODS Thirty-four physically active subjects with unilateral ACLR participated in a 1-time testing session. The kinetics and kinematics of single-leg landing on the surgical limb were analyzed before and after instruction to increase knee flexion and reduce the impact of landing. Vastus lateralis and biceps femoris activities were analyzed using surface electromyography and normalized to a maximal voluntary isometric contraction (MVIC). Cocontraction indices were integrated over the weight-acceptance phase of landing. RESULTS Following instruction, peak knee flexion increased (preinstruction mean ± SD, 56° ± 11°; postinstruction, 77° ± 12°; P<.001) and peak vertical ground reaction forces decreased (preinstruction, 3.50 ± 0.42 body mass; postinstruction, 3.06 ± 0.44 body mass; P<.001). Cocontraction also decreased following instruction (preinstruction, 30.88% ± 17.68% MVIC; postinstruction, 23.74% ± 15.39% MVIC; P<.001). The change in cocontraction was correlated with a decrease in hamstring activity (preinstruction, 23.79% ± 12.88% MVIC; postinstruction, 19.72% ± 13.92% MVIC; r = 0.80; P<.001). CONCLUSION Landing instruction produced both a statistically and clinically significant change in landing mechanics in persons post-ACLR. Conscious improvement of the absorptive power of the surgical limb was marked by decreased hamstring activity and cocontraction during single-limb landing.
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Gardinier ES, Di Stasi S, Manal K, Buchanan TS, Snyder-Mackler L. Knee contact force asymmetries in patients who failed return-to-sport readiness criteria 6 months after anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:2917-25. [PMID: 25318940 PMCID: PMC4314107 DOI: 10.1177/0363546514552184] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After anterior cruciate ligament (ACL) injury, contact forces are decreased in the injured knee when compared with the uninjured knee. The persistence of contact force asymmetries after ACL reconstruction may increase the risk of reinjury and may play an important role in the development of knee osteoarthritis in these patients. Functional performance may also be useful in identifying patients who demonstrate potentially harmful joint contact force asymmetries after ACL reconstruction. HYPOTHESIS Knee joint contact force asymmetries would be present during gait after ACL reconstruction, and performance on a specific set of validated return-to-sport (RTS) readiness criteria would discriminate between those who demonstrated contact force asymmetries and those who did not. STUDY DESIGN Descriptive laboratory study. METHODS A total of 29 patients with ACL ruptures participated in gait analysis and RTS readiness testing 6 months after reconstruction. Muscle and joint contact forces were estimated using an electromyography (EMG)-driven musculoskeletal model of the knee. The magnitude of typical limb asymmetry in uninjured controls was used to define limits of meaningful limb asymmetry in patients after ACL reconstruction. The RTS testing included isometric quadriceps strength testing, 4 unilateral hop tests, and 2 self-report questionnaires. Paired t tests were used to assess limb symmetry for peak medial and tibiofemoral contact forces in all patients, and a mixed-design analysis of variance was used to analyze the effect of passing or failing RTS testing on contact force asymmetry. RESULTS Among all patients, neither statistically significant nor meaningful contact force asymmetries were identified. However, patients who failed RTS testing exhibited meaningful contact force asymmetries, with tibiofemoral contact force being significantly lower for the involved knee. Conversely, patients who passed RTS testing exhibited neither significant nor meaningful contact force asymmetries. CONCLUSION Joint contact force asymmetries during gait are present in some patients 6 months after ACL reconstruction. Patients who demonstrated poor functional performance on RTS readiness testing exhibited significant and meaningful contact force asymmetries. CLINICAL RELEVANCE When assessing all patients together, variability in the functional status obscured significant and meaningful differences in contact force asymmetry in patients 6 months after ACL reconstruction. These specific RTS readiness criteria appear to differentiate between those who demonstrate joint contact force symmetry after ACL reconstruction and those who do not.
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Affiliation(s)
- Emily S. Gardinier
- Address correspondence to School of Kinesiology, University of Michigan, 104 Washtenaw Avenue, 1206 Central Campus Recreation Building, Ann Arbor, MI 48109, USA ()
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Martinez BR, Curtolo M, Lucato ACS, Yi LC. Balance control, hamstring flexibility and range of motion of the hip rotators in ballet dancers. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2014. [DOI: 10.3109/21679169.2014.933485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gokeler A, Benjaminse A, Welling W, Alferink M, Eppinga P, Otten B. The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Phys Ther Sport 2014; 16:114-20. [PMID: 25443228 DOI: 10.1016/j.ptsp.2014.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 03/21/2014] [Accepted: 06/09/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the effect of an internal and external attentional focus on single leg hop jump distance and knee kinematics in patients after ACL reconstruction (ACLR). DESIGN Experimental. SETTING Outpatient physical therapy facility. PARTICIPANTS Sixteen patients after ACLR. MAIN OUTCOME MEASURES Patients received either an instruction with an internal focus or an external focus before performing a single leg hop jump. The jump distance, knee valgus angle at initial contact, peak knee valgus angle, knee flexion angle at initial contact, peak knee flexion angle, total ROM and time to peak angles for the injured and non-injured legs were recorded. A repeated measures MANOVA was used to determine significance between the experimental conditions with the primary outcome measures as dependent variables. RESULTS The external focus group had significant larger knee flexion angles at initial contact, peak knee flexion, total ROM and time to peak knee flexion for the injured legs. CONCLUSIONS This study demonstrates the applicability of using an external focus during rehabilitation of patients after ACLR to enhance safer movement patterns compared to an internal focus of attention and subsequently may help to reduce second ACL injury risk.
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Affiliation(s)
- Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Anne Benjaminse
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands; School of Sport Studies, Hanze University Groningen, Zernikeplein 17, 9747 AS Groningen, The Netherlands
| | - Wouter Welling
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Malou Alferink
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Peter Eppinga
- Flytta Physical Therapy, Center for Sports and Rehabilitation, Boumaboulevard 41, 9723 ZS Groningen, The Netherlands; FC Groningen, Professional Dutch Soccer Club, Boumaboulevard 41, 9723 ZS Groningen, The Netherlands
| | - Bert Otten
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Gokeler A, Benjaminse A, Hewett TE, Paterno MV, Ford KR, Otten E, Myer GD. Feedback techniques to target functional deficits following anterior cruciate ligament reconstruction: implications for motor control and reduction of second injury risk. Sports Med 2014; 43:1065-74. [PMID: 24062274 DOI: 10.1007/s40279-013-0095-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary anterior cruciate ligament (ACL) injury prevention training has been shown to reduce the risk of injury. Less is known about the effect of prevention on second injury after ACL reconstruction (ACLR). Given recent findings that second injury rates exceed 20 % in only the first year following the return to sport, it is imperative that rehabilitation after ACLR is scrutinized so that second injury preventative strategies can be optimized. A potential limitation of current rehabilitative processes following ACLR could be a deficiency in the transition from conscious awareness achieved during rehabilitation sessions to unexpected and automatic movements required for athletic activities on the field. Learning strategies with an internally directed focus have traditionally been utilized but may be less suitable for acquisition of control of complex motor skills required for sport reintegration. Conversely, an externally focused rehabilitation strategy may enhance skill acquisition more efficiently and increase the potential to transfer to competitive sport. This article presents new insights gained from the motor learning domain that may improve neuromuscular training programmes via increased retention from improved techniques and may ultimately reduce the incidence of second ACL injuries.
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Affiliation(s)
- Alli Gokeler
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands,
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A preliminary study on the differences in male and female muscle force distribution patterns during squatting and lunging maneuvers. Comput Biol Med 2014; 52:57-65. [PMID: 25016289 DOI: 10.1016/j.compbiomed.2014.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 05/23/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
Abstract
In the United States, 250,000 people tear their anterior cruciate ligament (ACL) annually with females at higher risk of ACL failure than males. By predicting muscle forces during low impact maneuvers we may be able to estimate possible muscle imbalances that could lead to ACL failure during highly dynamic maneuvers. The purpose of this initial study was to predict muscle forces in males and females similar in size and activity level, during squat and lunge maneuvers. We hypothesized that during basic low impact maneuvers (a) distribution of quadriceps forces are different in males and females and (b) females exhibit quadriceps dominance when compared to males. Two males and three females performed squatting and lunging maneuvers while electromyography (EMG) data, motion capture data, and ground reaction forces were collected. Nine individual muscle forces for muscles that cross the knee were estimated using an EMG-driven model. Results suggest that males activate their rectus femoris muscle more than females, who in turn activate their vastus lateralis muscle at their maximum flexion angle, and more their vastus medialis muscle when ascending from a squat. During the lunge maneuver, males used greater biceps femoris force than females, throughout the lunge, and females exhibited higher semitendinosus force. Quadriceps dominance was evident in both males and females during the prescribed tasks, and there was no statistical difference between genders. Understanding individual muscle force distributions in males and females during low impact maneuvers may provide insights regarding failure mechanisms during highly dynamic maneuvers, when ACL injuries are more prevalent.
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Patellofemoral joint stress during weight-bearing and non-weight-bearing quadriceps exercises. J Orthop Sports Phys Ther 2014; 44:320-7. [PMID: 24673446 DOI: 10.2519/jospt.2014.4936] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Single-group, repeated-measures design. OBJECTIVE To compare patellofemoral joint (PFJ) stress among weight-bearing and non-weight-bearing quadriceps exercises. BACKGROUND An important consideration when prescribing exercises to strengthen the quadriceps in persons with patellofemoral pain is to minimize PFJ loading. Currently, there is disagreement in the literature as to which exercises and ranges of motion best accomplish this goal. METHODS Ten healthy subjects participated. Lower extremity kinematics, kinetics, and electromyography of the knee musculature were obtained during a weight-bearing squatting exercise and 2 non-weight-bearing knee extension exercises: (1) knee extension with variable resistance, and (2) knee extension with constant resistance. A previously described biomechanical model was used to estimate PFJ stress at 0°, 15°, 30°, 45°, 60°, 75°, and 90° of knee flexion. PFJ stress was compared among the 3 exercises using a 2-way analysis of variance with repeated measures. RESULTS Compared to the 2 non-weight-bearing exercises, the squat exercise produced significantly higher PFJ stress at 90°, 75°, and 60° of knee flexion. Conversely, the 2 non-weight-bearing exercises produced significantly higher PFJ stress at 30°, 15°, and 0° of knee flexion when compared to the squat exercise. The knee-extension-with-variable-resistance exercise produced significantly lower PFJ stress than the knee-extension-with-constant-resistance exercise at 90°, 75°, and 60° of knee flexion. CONCLUSION To minimize PFJ stress while performing quadriceps exercises, our data suggest that the squat exercise should be performed from 45° to 0° of knee flexion and the knee-extension-with-variable-resistance exercise should be performed from 90° to 45° of knee flexion.
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Schmitz RJ, Cone JC, Tritsch AJ, Pye ML, Montgomery MM, Henson RA, Shultz SJ. Changes in drop-jump landing biomechanics during prolonged intermittent exercise. Sports Health 2014; 6:128-35. [PMID: 24587862 PMCID: PMC3931337 DOI: 10.1177/1941738113503286] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: As injury rates rise in the later stages of sporting activities, a better understanding of lower extremity biomechanics in the later phases of gamelike situations may improve training and injury prevention programs. Hypothesis: Lower extremity biomechanics of a drop-jump task (extracted from a principal components analysis) would reveal factors associated with risk of anterior cruciate ligament injury during a 90-minute individualized intermittent exercise protocol (IEP) and for 1 hour following the IEP. Study Design: Controlled laboratory study. Level of Evidence: Level 4. Methods: Fifty-nine athletes (29 women, 30 men) completed 3 sessions. The first session assessed fitness for an IEP designed to simulate the demands of a soccer match. An experimental session assessed drop-jump biomechanics, after a dynamic warm-up, every 15 minutes during the 90-minute IEP, and for 1 hour following the IEP. A control session with no exercise assessed drop-jump performance at the same intervals. Results: Two biomechanical factors early in the first half (hip flexion at initial contact and hip loading; ankle loading and knee shear force) decreased at the end of the IEP and into the 60-minute recovery period, while a third factor (knee loading) decreased only during the recovery period (P ≤ 0.05). Conclusion: The individualized sport-specific IEP may have more subtle effects on landing biomechanics when compared with short-term, exhaustive fatigue protocols. Clinical Relevance: Potentially injurious landing biomechanics may not occur until the later stages of soccer activity.
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Affiliation(s)
- Randy J Schmitz
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - John C Cone
- Portland Timbers Football Club, Portland, Oregon
| | - Amanda J Tritsch
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, Florida
| | - Michele L Pye
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | | | - Robert A Henson
- Department of Educational Research Methodology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Sandra J Shultz
- Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
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Iguchi J, Tateuchi H, Taniguchi M, Ichihashi N. The effect of sex and fatigue on lower limb kinematics, kinetics, and muscle activity during unanticipated side-step cutting. Knee Surg Sports Traumatol Arthrosc 2014; 22:41-8. [PMID: 23666380 DOI: 10.1007/s00167-013-2526-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/06/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine how sex and fatigue affect lower limb kinematics, kinetics, and muscle activity during unanticipated side-step cutting. METHODS Twenty-three physically active subjects (men 11, women 12) performed 10 successful trials of cutting manoeuvres each to either side under unanticipated conditions in response to 2 light emitting diodes before and after fatigue conditions. Data were analysed and compared regarding sex and fatigue conditions using two-way repeated measures analysis of variance. RESULTS After fatigue-inducing exercise, women demonstrated larger impulses of ground reaction force (IGRF) during the first 50 ms (2.4 ± 0.8 vs. 2.1 ± 0.9, P < 0.05) than did men. Significant primary effects of sex indicated that women showed a smaller hip flexion angle at initial contact (40.4 ± 6.9° vs. 49.7 ± 9.1°, P < 0.05) and at maximum flexion angle (41.3 ± 7.7° vs. 51.4 ± 9.0°, P < 0.05) compared with men. Significant primary effects of fatigue were observed in the gluteus maximus muscle during 50 ms before initial contact (+21.5 ± 48.3 %, P < 0.05) and in the semimembranosus muscle during 50 ms before initial contact (-6.2 ± 20.1 %, P < 0.05) and the first 50 ms of side-step cutting (-7.9 ± 26.6 %, P < 0.05). CONCLUSIONS Our results suggest that sex differences, especially larger IGRF in a fatigue state combined with less hip flexion angle, lead to women having a higher risk for anterior cruciate ligament (ACL) injury. These findings may contribute to understanding the underlying mechanism of injury and development of preventive exercises against ACL injury.
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Affiliation(s)
- Junta Iguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan,
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