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Vassis K, Kanellopoulos A, Spanos S, Kakolyri D, Loukopoulou A, Papanikolakou V, Aivaliotis D, Poulis I. Association Between Isokinetic Knee Strength Characteristics and Single-Leg Hop Performance In Healthy Young Participants. J Chiropr Med 2023; 22:27-34. [PMID: 36844986 PMCID: PMC9948001 DOI: 10.1016/j.jcm.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 05/04/2022] [Accepted: 05/26/2022] [Indexed: 10/16/2022] Open
Abstract
Objective The purpose of this study was to determine the extent to which the mean peak moment (MPM) of knee flexors and extensors could predict performance in a group of healthy individuals. Methods Eighty-four healthy individuals-32 men and 52 women (mean age, 22.1 ± 3 years; range, 18-35 years)-participated in this study. Isokinetic unilateral concentric knee flexor and extensor MPM was assessed isokinetically at angular velocities of 60°/s and 180°/s. Functional performance was assessed using the single hop of distance (SHD). Results Positive moderate to good statistically significant correlations (r = .636 to r = .673) were found between knee flexor and extensor MPM at 60°/s and 180°/s for the SHD test. Knee flexor and extensor MPMs are strong predictors for the SHD test at 60°/s and 180°/s (R2 = .40 to R2 = .45). Conclusion Knee flexor and extensor strength was substantially correlated with SHD.
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Affiliation(s)
- Konstantinos Vassis
- Human Performance and Rehabilitation Laboratory, University of Thessaly, Lamia, Greece
| | | | - Savvas Spanos
- Human Performance and Rehabilitation Laboratory, University of Thessaly, Lamia, Greece
- Faculty of Physiotherapy, University of Thessaly, Lamia, Greece
| | | | | | | | | | - Ioannis Poulis
- Human Performance and Rehabilitation Laboratory, University of Thessaly, Lamia, Greece
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Hu S, Ma X, Ma X, Sun W, Zhou Z, Chen Y, Song Q. Relationship of strength, joint kinesthesia, and plantar tactile sensation to dynamic and static postural stability among patients with anterior cruciate ligament reconstruction. Front Physiol 2023; 14:1112708. [PMID: 36744033 PMCID: PMC9889938 DOI: 10.3389/fphys.2023.1112708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
Objective: Postural stability is essential for high-level physical activities after anterior cruciate ligament reconstruction (ACLR). This study was conducted to investigate the relationship of muscle strength, joint kinesthesia, and plantar tactile sensation to dynamic and static postural stability among patients with anterior cruciate ligament reconstruction. Methods: Forty-four patients over 6 months post anterior cruciate ligament reconstruction (age: 27.9 ± 6.8 years, height: 181.7 ± 8.7 cm, weight: 80.6 ± 9.4 kg, postoperative duration: 10.3 ± 3.6 months) participated in this study. Their static and dynamic postural stability, muscle strength, hamstring/quadriceps ratio, joint kinesthesia, and plantar tactile sensation were measured. Partial correlations were used to determine the correlation of the above-mentioned variables with time to stabilization (TTS) and root mean square of the center of pressure (COP-RMS) in anterior-posterior (AP) and mediolateral (ML) directions. Results: Both TTSAP and TTSML were related to muscle strength and joint kinesthesia of knee flexion and extension; COP-RMSAP was correlated with plantar tactile sensations at great toe and arch, while COP-RMSML was correlated with joint kinesthesia of knee flexion, and plantar tactile sensation at great toe and heel. Dynamic stability was sequentially correlated with strength and joint kinesthesia, while static stability was sequentially correlated with plantar tactile sensation and joint kinesthesia. Conclusion: Among patients with anterior cruciate ligament reconstruction, strength is related to dynamic postural stability, joint kinesthesia is related to dynamic and static postural stability, and plantar tactile sensation is related to static postural stability. Strength has a higher level of relationship to dynamic stability than joint kinesthesia, and plantar tactile sensation has a higher level of relationship to static stability than joint kinesthesia.
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Affiliation(s)
- Shanshan Hu
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Xiaoli Ma
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Xiaoyuan Ma
- Department of Orthopedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wei Sun
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Zhipeng Zhou
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Yan Chen
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China,*Correspondence: Qipeng Song,
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Cortico-muscular interaction to monitor the effects of neuromuscular electrical stimulation pedaling training in chronic stroke. Comput Biol Med 2021; 137:104801. [PMID: 34481180 DOI: 10.1016/j.compbiomed.2021.104801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/21/2022]
Abstract
Neuromuscular electrical stimulation (NMES) has been widely utilized in post-stroke motor restoration. However, its impact on the closed-loop sensorimotor control process remains largely unclear. This is the first study to investigate the directional changes in cortico-muscular interactions after repetitive rehabilitation training by measuring the noninvasive electroencephalogram (EEG) and electromyography (EMG) signals. In this study, 10 subjects with chronic stroke received 20 sessions of NMES-pedaling interventions, and each training session included three 10-min NMES-driven pedaling trials. In addition, pre- and post-intervention assessments of lower limb isometric contraction were conducted before and after the whole NMES-pedaling interventions. The EEG (128 channels) and EMG (3 bilateral lower limb sensors) signals were collected during the isometric contraction tasks for the paretic and non-paretic lower limbs. Both the cortico-muscular coherence (CMC) and generalized partial directed coherence (GPDC) values were analyzed between eight selected EEG channels in the central primary motor cortex and EMG channels. The results revealed significant clinical improvements. Additionally, rehabilitation training facilitated cortico-muscular interaction of the ipsilesional brain and paretic lower limbs (p = 0.004). Moreover, both the descending and ascending cortico-muscular pathways were altered after NMES-training (p = 0.001, p < 0.001). Therefore, the results implied potential applications of EEG-EMG in understanding neuromuscular changes during the post-stroke motor rehabilitation process.
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Veerkamp K, Waterval NFJ, Geijtenbeek T, Carty CP, Lloyd DG, Harlaar J, van der Krogt MM. Evaluating cost function criteria in predicting healthy gait. J Biomech 2021; 123:110530. [PMID: 34034014 DOI: 10.1016/j.jbiomech.2021.110530] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
Accurate predictive simulations of human gait rely on optimisation criteria to solve the system's redundancy. Defining such criteria is challenging, as the objectives driving the optimization of human gait are unclear. This study evaluated how minimising various physiologically-based criteria (i.e., cost of transport, muscle activity, head stability, foot-ground impact, and knee ligament use) affects the predicted gait, and developed and evaluated a combined, weighted cost function tuned to predict healthy gait. A generic planar musculoskeletal model with 18 Hill-type muscles was actuated using a reflex-based, parameterized controller. First, the criteria were applied into the base simulation framework separately. The gait pattern predicted by minimising each criterion was compared to experimental data of healthy gait using coefficients of determination (R2) and root mean square errors (RMSE) averaged over all biomechanical variables. Second, the optimal weighted combined cost function was created through stepwise addition of the criteria. Third, performance of the resulting combined cost function was evaluated by comparing the predicted gait to a simulation that was optimised solely to track experimental data. Optimising for each of the criteria separately showed their individual contribution to distinct aspects of gait (overall R2: 0.37-0.56; RMSE: 3.47-4.63 SD). An optimally weighted combined cost function provided improved overall agreement with experimental data (overall R2: 0.72; RMSE: 2.10 SD), and its performance was close to what is maximally achievable for the underlying simulation framework. This study showed how various optimisation criteria contribute to synthesising gait and that careful weighting of them is essential in predicting healthy gait.
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Affiliation(s)
- K Veerkamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre for Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University Gold Coast, Australia.
| | - N F J Waterval
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Univ of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - T Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - C P Carty
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre for Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University Gold Coast, Australia; Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Australia; Research Development Unit, Caboolture and Kilcoy Hospitals, Metro North Health, Australia
| | - D G Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre for Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University Gold Coast, Australia
| | - J Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Orthopaedics, Rotterdam, Erasmus Medical Center, the Netherlands
| | - M M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
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Lee JH, Lee DH, Park JH, Suh DW, Kim E, Jang KM. Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear. Knee Surg Relat Res 2020; 32:8. [PMID: 32660570 PMCID: PMC7219227 DOI: 10.1186/s43019-019-0027-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background Only limited data are available regarding postural stability between anterior cruciate ligament (ACL)-injured patients with medial meniscus (MM) tear and those with lateral meniscus (LM) tear. The purpose of this study was to compare preoperative postural stability for both involved and uninvolved knees in ACL rupture combined with MM and LM tears. It was hypothesized that there would be a significant difference in postural stability between these two groups. Methods Ninety-three ACL-injured patients (53 combined with MM tears vs. 40 combined with LM tears) were included. Static and dynamic postural stability were evaluated with the overall stability index (OSI), anterior–posterior stability index (APSI), and medial–lateral stability index (MLSI) using stabilometry. Knee muscle strength was evaluated using an isokinetic testing device. Results In the static postural stability test, none of the stability indices showed significant differences between the two groups for both knees (p > 0.05). In the dynamic postural stability test for involved side knees, the OSI and APSI were significantly higher in the LM tear group compared to the MM tear group (OSI: 2.0 ± 0.8 vs. 1.6 ± 0.5, p = 0.001; APSI: 1.5 ± 0.6 vs. 1.3 ± 0.5, p = 0.023), but not the MLSI (p > 0.05). In the static and dynamic postural stability tests in each group, there were no significant differences between the involved and uninvolved side knees (p > 0.05). There was no significant difference in the knee muscle strength between the two groups (p > 0.05). All postural stability showed no significant correlation with knee muscle strength (p > 0.05). Conclusion Dynamic postural stability was poorer in patients with ACL rupture combined with LM tear than in those with MM tear. Therefore, close monitoring for postural stability would be necessary during preoperative and postoperative rehabilitation, especially for patients with ACL rupture combined with LM tear. Level of evidence: Level III
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, , Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Hoon Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam, South Korea
| | - Eunseon Kim
- Department of Sports Medical Center, , Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, , Anam Hospital, Korea University College of Medicine, Seoul, South Korea. .,Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea.
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Nagelli CV, Hewett TE. Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations. Sports Med 2018; 47:221-232. [PMID: 27402457 DOI: 10.1007/s40279-016-0584-z] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anterior cruciate ligament (ACL) tears are common knee injuries sustained by athletes during sports participation. A devastating complication of returning to sport following ACL reconstruction (ACLR) is a second ACL injury. Strong evidence now indicates that younger, more active athletes are at particularly high risk for a second ACL injury, and this risk is greatest within the first 2 years following ACLR. Nearly one-third of the younger cohort that resumes sports participation will sustain a second ACL injury within the first 2 years after ACLR. The evidence indicates that the risk of second injury may abate over this time period. The incidence rate of second injuries in the first year after ACLR is significantly greater than the rate in the second year. The lower relative risk in the second year may be related to athletes achieving baseline joint health and function well after the current expected timeline (6-12 months) to be released to unrestricted activity. This highlights a considerable debate in the return to sport decision process as to whether an athlete should wait until 2 years after ACLR to return to unrestricted sports activity. In this review, we present evidence in the literature that athletes achieve baseline joint health and function approximately 2 years after ACLR. We postulate that delay in returning to sports for nearly 2 years will significantly reduce the incidence of second ACL injuries.
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Affiliation(s)
- Christopher V Nagelli
- Orthopedic Biomechanics Laboratories, Mayo Clinic, 200 First Street SW, RO_Gu_01_28BIOM, Rochester, MN, 55905, USA.,Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.,Department of Physiology and Biomedical Engineering and, Mayo Clinic, Rochester, MN, USA
| | - Timothy E Hewett
- Orthopedic Biomechanics Laboratories, Mayo Clinic, 200 First Street SW, RO_Gu_01_28BIOM, Rochester, MN, 55905, USA. .,Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, MN, USA. .,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA. .,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA. .,Department of Physiology and Biomedical Engineering and, Mayo Clinic, Rochester, MN, USA.
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7
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Kovalak E, Atay T, Çetin C, Atay IM, Serbest MO. Is ACL reconstruction a prerequisite for the patients having recreational sporting activities? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:37-43. [PMID: 29290539 PMCID: PMC6136326 DOI: 10.1016/j.aott.2017.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/28/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Whether surgical or conservative treatment is more effective in allowing patients to return to physical activity after anterior cruciate ligament (ACL) injury is controversial. We sought to compare mid-term outcome measures between isolated ACL tear patients who underwent reconstruction followed by closed kinetic chain exercises and those who underwent neuromuscular training only. METHODS We retrospectively evaluated patients with ACL tears who underwent post-surgery CKC strength training after ACL reconstruction (Group A), and patients who only underwent neuromuscular training (Group B) with a minimum follow-up time of 5 years. Surgical techniques, rehabilitation, assessment of subjective knee function, one-leg hop test, assessment of joint position sense, muscle strength, and the health profile of the patient were evaluated. RESULTS Overall, 43 patients were included in Group A (mean age, 32.56 ± 4.89; Tegner activity scale, 5) and 39 patients in Group B (31.67 ± 7.27; 5). Patients in both groups returned to their regular physical activity level after a similar time frame (Group A: average, 12 months; Group B, average, 13.4 months). The mean Lysholm knee score was 88.52 ± 7.65 in Group A and 86.21 ± 13.72 in Group B. Mean distances for the one-leg hop test for Group A were 135.21 ± 31.66 and 145.36 ± 42.10 mm in the reconstructed and uninjured knees, respectively. In Group B, the mean hop distances were 132.47 ± 28.13 and 147.89 ± 21.45 mm in the rehabilitated and uninjured knees, respectively. No statistical difference was observed between the groups for any of the parameters evaluated, including assessment of subjective knee function, one-leg hop test, assessment of joint position sense, muscle strength, and the health profile. CONCLUSION Our data suggest that early surgical reconstruction may not be a prerequisite to returning to recreational physical activities after injury in patients with ACL tears. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Emrah Kovalak
- Orthopedics and Traumatology Department of Süleyman Demirel University Medical School, Isparta, Turkey.
| | - Tolga Atay
- Orthopedics and Traumatology Department of Süleyman Demirel University Medical School, Isparta, Turkey
| | - Cem Çetin
- Sports Medicine Department of Süleyman Demirel University Medical School, Isparta, Turkey
| | - I Meltem Atay
- Psychiatry Department of Süleyman Demirel University Medical School, Isparta, Turkey
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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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Dingenen B, Janssens L, Claes S, Bellemans J, Staes FF. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. Clin Biomech (Bristol, Avon) 2016; 35:116-23. [PMID: 27149566 DOI: 10.1016/j.clinbiomech.2016.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/08/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies mainly focused on muscles at the operated knee after anterior cruciate ligament reconstruction, less on muscles around other joints of the operated and non-operated leg. The aim of this study was to investigate muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament reconstructed subjects. METHODS Lower extremity muscle activation onset times of both legs of 20 fully returned to sport anterior cruciate ligament reconstructed subjects and 20 non-injured control subjects were measured during the transition from double-leg stance to single-leg stance in eyes open and eyes closed conditions. Analysis of covariance (ANCOVA) was used to evaluate differences between groups and differences between legs within both groups, while controlling for peak center of pressure velocity. FINDINGS Significantly delayed muscle activation onset times were found in the anterior cruciate ligament reconstructed group compared to the control group for gluteus maximus, gluteus medius, vastus medialis obliquus, medial hamstrings, lateral hamstrings and gastrocnemius in both eyes open and eyes closed conditions (P<.05). Within the anterior cruciate ligament reconstructed group, no significant different muscle activation onset times were found between the operated and non-operated leg (P>.05). INTERPRETATION Despite completion of rehabilitation and full return to sport, the anterior cruciate ligament reconstructed group showed neuromuscular control deficits that were not limited to the operated knee joint. Clinicians should focus on relearning multi-segmental anticipatory neuromuscular control strategies after anterior cruciate ligament reconstruction.
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Affiliation(s)
- Bart Dingenen
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Luc Janssens
- KU Leuven Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; KU Leuven Cardiovascular and Respiratory Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Nederrij 133, 2200 Herentals, Belgium; Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Filip F Staes
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium
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Dingenen B, Janssens L, Luyckx T, Claes S, Bellemans J, Staes FF. Lower extremity muscle activation onset times during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Hum Mov Sci 2015; 44:234-45. [PMID: 26409102 DOI: 10.1016/j.humov.2015.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022]
Abstract
The goal of this study was to evaluate muscle activation onset times (MAOT) of both legs during a transition task from double-leg stance (DLS) to single-leg stance (SLS) in anterior cruciate ligament injured (ACLI) (n=15) and non-injured control subjects (n=15) with eyes open and eyes closed. Significantly delayed MAOT were found in the ACLI group compared to the control group for vastus lateralis, vastus medialis obliquus, hamstrings medial, hamstrings lateral, tibialis anterior, peroneus longus and gastrocnemius in both vision conditions, for gluteus maximus and gluteus medius with eyes open and for tensor fascia latae with eyes closed. Within the ACLI group, delayed MAOT of tibialis anterior with eyes open and gastrocnemius with eyes closed were found in the injured leg compared to the non-injured leg. All other muscles were not significantly different between legs. In conclusion, the ACLI group showed delayed MAOT not only around the knee, but also at the hip and ankle muscles compared to the non-injured control group. No differences between both legs of the ACLI group were found, except for tibialis anterior and gastrocnemius. These findings indirectly support including central nervous system re-education training to target the underlying mechanisms of these altered MAOT after ACL injury.
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Affiliation(s)
- Bart Dingenen
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Luc Janssens
- KU Leuven Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; KU Leuven Cardiovascular and Respiratory Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Thomas Luyckx
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Steven Claes
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium; Department of Orthopedic Surgery, AZ Herentals Hospital, Nederrij 133, 2200 Herentals, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Leuven, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Filip F Staes
- KU Leuven Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
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Dingenen B, Janssens L, Luyckx T, Claes S, Bellemans J, Staes FF. Postural stability during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects. Clin Biomech (Bristol, Avon) 2015; 30:283-9. [PMID: 25616933 DOI: 10.1016/j.clinbiomech.2015.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND An anterior cruciate ligament injury may lead to deteriorations in postural stability. The goal of this study was to evaluate postural stability during the transition from double-leg stance to single-leg stance of both legs in anterior cruciate ligament injured subjects and non-injured control subjects with a standardized methodology. METHODS Fifteen control subjects and 15 anterior cruciate ligament injured subjects (time after injury: mean (SD)=1.4 (0.7) months) participated in the study. Both groups were similar for age, gender, height, weight and body mass index. Spatiotemporal center of pressure outcomes of both legs of each subject were measured during the transition from double-leg stance to single-leg stance in eyes open and eyes closed conditions. Movement speed was standardized. FINDINGS The center of pressure displacement after a new stability point was reached during the single-leg stance phase was significantly increased in the anterior cruciate ligament injured group compared to the control group in the eyes closed condition (P<.001). No significant different postural stability outcomes were found between both legs within both groups (P>.05). No significant differences were found during the transition itself (P>.05). INTERPRETATION The anterior cruciate ligament injured group showed postural stability deficits during the single-leg stance phase compared to the non-injured control group in the eyes closed condition. Using the non-injured leg as a normal reference when evaluating postural stability of the injured leg may lead to misinterpretations, as no significant differences were found between the injured and non-injured leg of the anterior cruciate ligament injured group.
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Affiliation(s)
- Bart Dingenen
- KU Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Luc Janssens
- KU Leuven, Department of Electrical Engineering, Faculty of Engineering Technology Services, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium; KU Leuven, Cardiovascular and Respiratory Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
| | - Thomas Luyckx
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Steven Claes
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; Department of Orthopedic Surgery, AZ Herentals Hospital, Nederrij 133, 2200 Herentals, Belgium.
| | - Johan Bellemans
- Department of Orthopedics, University Hospitals Leuven, Campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
| | - Filip F Staes
- KU Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101 b1501, 3001 Heverlee, Belgium.
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Hart JM, Bessette M, Choi L, Hogan MV, Diduch D. Sensory response following knee joint damage in rabbits. BMC Musculoskelet Disord 2014; 15:139. [PMID: 24766654 PMCID: PMC4016734 DOI: 10.1186/1471-2474-15-139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 04/10/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Altered sensory information arising from damaged knee joint structures has been hypothesized as a contributing factor to persistent muscle dysfunction following injury. METHODS Composite femoral nerve sensory signal was measured in 24 rabbits randomly allocated (8 per group) to receive surgical anterior cruciate ligament (ACL) transection with or without autograft reconstruction or nothing (control). Two-weeks after the intervention composite afferent signals were recorded from the femoral nerve. Side-to-side ratios (surgical side vs contralateral healthy side) for peak femoral nerve afferent composite signal were used for comparison. RESULTS Femoral nerve afferent signal ratios were significantly higher in the ACL-R (2.21 ± 0.74) group when compared to the ACL-T (1.28 ± 0.61, P=0.02) group and Control group (1.31 ± 0.78, P=0.03). CONCLUSION The magnitude of sensory information recorded on the femoral nerve is increased following ACL injury and reconstruction surgery, but not after an isolated ACL injury in rabbits.
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Affiliation(s)
- Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA.
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13
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Smith AJ, Flaxman TE, Speirs AD, Benoit DL. Reliability of knee joint muscle activity during weight bearing force control. J Electromyogr Kinesiol 2012; 22:914-22. [DOI: 10.1016/j.jelekin.2012.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 03/19/2012] [Accepted: 03/26/2012] [Indexed: 01/12/2023] Open
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Rein S, Fabian T, Zwipp H, Rammelt S, Weindel S. Postural control and functional ankle stability in professional and amateur dancers. Clin Neurophysiol 2011; 122:1602-10. [DOI: 10.1016/j.clinph.2011.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/06/2011] [Accepted: 01/08/2011] [Indexed: 11/27/2022]
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Rein S, Fabian T, Weindel S, Schneiders W, Zwipp H. The influence of playing level on functional ankle stability in soccer players. Arch Orthop Trauma Surg 2011; 131:1043-52. [PMID: 21331548 DOI: 10.1007/s00402-011-1275-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The aim of this study was to compare the functional ankle stability between professional and amateur soccer players as well as controls. MATERIALS AND METHODS Thirty professional soccer players, 30 amateur soccer players and 30 controls were evaluated. All participants completed a questionnaire. Range of motion (ROM), peroneal reaction time (PRT) and ankle position sense were measured. Balance control was investigated with the Biodex Stability System, measuring the stable level 8 and the unstable level 2. RESULTS Professional soccer players cited significantly more frequent ankle sprains than all other groups (P = 0.002). They showed a significantly decreased dorsiflexion of the right foot (amateur: P = 0.017; controls: P = 0.004), an increased pronation of both feet (amateurs: right: P = 0.0048, left: P = 0.006; controls: right: P = 0.017, left: P = 0.007) and a decreased supination of the left foot in comparison to all other groups (amateurs: P = 0.003; controls: P = 0.004). Balance control showed no significant differences among all groups. Significant differences in angle reproduction were observed between professionals and amateurs for the left ankle joint at the positions of 105° (P = 0.0018) and 140° (P = 0.013). Professionals (P = 0.004) and amateurs (P = 0.001) showed a significantly delayed PRT of the right peroneus longus muscle compared to controls. In addition, the PRT of the right peroneus brevis muscle was significantly increased in professional soccer players in comparison to controls (P = 0.017). CONCLUSIONS Professional soccer players have shown more frequent ankle sprains, limited ROM, and delayed PRT of the right leg which reflects the higher risk of functional ankle instability due to intensified work-related use of feet. Therefore, proprioceptive exercises of the ankle in daily training programs are recommended in order to minimize the risk of ankle injuries and improve functional ankle stability.
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Affiliation(s)
- Susanne Rein
- Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Fetscherstrasse 74, Dresden, Germany.
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Rein S, Fabian T, Krishnan K, Benesch S, Schackert G, Zwipp H, Lindner C, Weindel S. EVALUATION OF THE PROPRIOCEPTIVE INFLUENCE OF THE CUTANEOUS AFFERENTS TO THE ANKLE IN PATIENTS AFTER SURAL NERVE HARVESTING. Neurosurgery 2009; 64:519-25; discussion 526. [DOI: 10.1227/01.neu.0000338954.93385.e4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Cutaneous afferent nerves contribute to joint proprioception. The aim of this study was to retrospectively analyze the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting in comparison to controls.
METHODS
The proprioception of the ankle in 24 patients after sural nerve harvesting was investigated. The sural nerve was harvested bilaterally in Group 1 (n = 10), in the right leg in Group 2 (n = 6), and in the left leg in Group 3 (n = 8). The proprioception of the ankle was also tested in controls (Group 4, n = 24). The peroneal reaction time (PRT) was measured on a tilting platform. The position sense test was performed. Balance control was investigated with the Biodex Stability System (Biodex Medical Systems, Shirley, NY) at the stable Level 8 and unstable Level 2.
RESULTS
No significant differences among the groups were seen in the position sense test, the PRT, and all scores of the Biodex Stability System. The PRT showed significant differences in comparison to the contralateral leg for the peroneus brevis muscle in Group 1 (P = 0.005) and Group 4 (P = 0.001) as well as for the peroneus longus muscle in Group 3 (P = 0.036) and Group 4 (P = 0.001).
CONCLUSION
The proprioception of the ankle in patients after sural nerve harvesting is not reduced in comparison to controls. Significant differences of the PRT between the left and right legs are attributable to leg dominance in most cases and not to a loss of innervation. Harvesting of the sural nerve does not result in ankle instability.
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Affiliation(s)
- Susanne Rein
- Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Kartik Krishnan
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Stefan Benesch
- Surgical Department, Military Hospital Ulm, Ulm, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Hans Zwipp
- Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Claudia Lindner
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Stefan Weindel
- Department of Plastic and Hand Surgery, Hospital of Sankt Gallen, Sankt Gallen, Switzerland
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Decreased quadriceps activation measured hours prior to a noncontact anterior cruciate ligament tear. J Orthop Sports Phys Ther 2008; 38:508-16. [PMID: 18678959 DOI: 10.2519/jospt.2008.2761] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Decreased quadriceps activation has been shown to be present following anterior cruciate ligament (ACL) injury, but its presence prior to ACL injury is unknown. The purpose of this case report was to describe the level of quadriceps activation measured hours before a noncontact ACL injury in an individual who previously demonstrated known biomechanical risk factors for ACL injury. CASE DESCRIPTION A 23-year-old female (height, 176.9 cm; mass, 72.4 kg), sustained a left noncontact ACL injury while landing from a jump stop during a recreational basketball game. This case was unique because data regarding landing biomechanics and quadriceps force and activation were gathered in 2 separate, unrelated studies prior to injury. OUTCOMES Peak external knee abduction moment (-65.3 Nm) during a drop jump landing 8 months prior to injury indicated elevated risk for ACL injury. Involved quadriceps central activation ratios (CAR) were obtained 1 week (CAR, 0.81) and 4 hours (CAR, 0.77) prior to injury. Strength and CAR (0.76) measurements changed very little within 36 hours of injury and both strength, and activation (CAR, 0.90) improved following surgical reconstruction and formal rehabilitation. DISCUSSION An individual with known biomechanical risk factors for ACL injury may compound risk for noncontact ACL injury if decreased quadriceps activation is also present. LEVEL OF EVIDENCE Prognosis, level 4.
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Ericsson YB, Dahlberg LE, Roos EM. Effects of functional exercise training on performance and muscle strength after meniscectomy: a randomized trial. Scand J Med Sci Sports 2008; 19:156-65. [PMID: 18397193 DOI: 10.1111/j.1600-0838.2008.00794.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Muscular deficits and functional limitations have been found years after meniscectomy of the knee. The purpose of this randomized controlled trial was to examine the effect of functional exercise training on functional performance and isokinetic thigh muscle strength in middle-aged patients subsequent to meniscectomy for a degenerative tear. Four years after meniscectomy, 45 patients (29 men, 16 women) were randomized to functional exercise training, supervised by a physical therapist, three times weekly for 4 months or to no intervention. The exercise program comprised of postural stability training and functional strength and endurance exercises for leg and trunk muscles. Outcomes were three functional performance tests and isokinetic muscle strength. Thirty patients (16 exercisers/14 controls) completed the study. Compared with control patients, the exercise group showed significant improvement in one-leg hop (change 8 vs 2 cm; P=0.040), hamstrings strength 60 degrees /s (P=0.033), and quadriceps endurance 180 degrees /s (P=0.001). Functional exercise training was well tolerated and improved functional performance and thigh muscle strength in this group of middle-aged subjects with a previous degenerative meniscal injury and partial meniscectomy.
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Affiliation(s)
- Y B Ericsson
- Department of Orthopedics, Malmö University Hospital, Lund University, Lund, Sweden.
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Boucher P, Descarreaux M, Normand MC. Postural Control in People with Osteoarthritis of the Cervical Spine. J Manipulative Physiol Ther 2008; 31:184-90. [DOI: 10.1016/j.jmpt.2008.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 10/18/2007] [Accepted: 10/18/2007] [Indexed: 11/27/2022]
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Abstract
This article describes the current outlook for professional practice for graduates majoring in exercise science. A review of professional and experimental literature reveals that graduates of undergraduate programmes in exercise science are not as prepared as they should be in order to provide professional and comprehensive advice on exercise and human performance, because of the focused academic and professional requirements of exercise physiology. In contrast to the direction of training in other allied health professions, this trend of narrowing of the exercise science curriculum to focus on exercise physiology, at the expense of other subdisciplines in kinesiology, has contributed to a decreasing scope of practice and lack of uniqueness, and has reduced the effectiveness of exercise science graduates. This review focuses on an accumulating body of evidence indicating that improving the training in biomechanics and motor behaviour could increase the professional expertise of exercise science graduates. Small improvements in the exercise science curriculum in biomechanics and motor behaviour are proposed that would move toward greater balance and integration of the academic disciplines in kinesiology and better professional practice in exercise science. The drift away from a balance and integration of academic preparation in exercise science represents a threat to the acceptance of exercise science graduates as exercise professionals that needs to be corrected for the field to advance.
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Affiliation(s)
- Jeffrey C Ives
- Department of Exercise and Sport Sciences, Ithaca College, Ithaca, New York 14850, USA.
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Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther 2006; 36:385-402. [PMID: 16776488 DOI: 10.2519/jospt.2006.2222] [Citation(s) in RCA: 277] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rehabilitation following anterior cruciate ligament (ACL) reconstruction has undergone a relatively rapid and global evolution over the past 25 years. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safe return to sport. Return-to-sport rehabilitation, progressed by quantitatively measured functional goals, may improve the athlete's integration back into sport participation. The purpose of the following clinical commentary is to introduce an example of a criteria-driven algorithm for progression through return-to-sport rehabilitation following ACL reconstruction. Our criteria-based protocol incorporates a dynamic assessment of baseline limb strength, patient-reported outcomes, functional knee stability, bilateral limb symmetry with functional tasks, postural control, power, endurance, agility, and technique with sport-specific tasks. Although this algorithm has limitations, it serves as a foundation to expand future evidence-based evaluation and to foster critical investigation into the development of objective measures to accurately determine readiness to safely return to sport following injury.
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Affiliation(s)
- Gregory D Myer
- Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA.
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Bizzini M, Gorelick M, Drobny T. Lateral meniscus repair in a professional ice hockey goaltender: a case report with a 5-year follow-up. J Orthop Sports Phys Ther 2006; 36:89-100. [PMID: 16494076 DOI: 10.2519/jospt.2006.36.2.89] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report of a professional ice hockey goaltender who underwent an arthroscopically assisted lateral meniscus repair. BACKGROUND Rehabilitation of isolated meniscal repairs is not well documented in the literature. There is little knowledge about the healing time and the choice of rehabilitation exercises to be applied to a repaired meniscus. The objective of this case report is to describe a criterion-based, supervised, sport-specific rehabilitation protocol for a high-level athlete with a lateral meniscus repair from the first postoperative day until return to competitive sport, including a 5-year follow-up. CASE DESCRIPTION The criterion-based protocol used with this athlete was based on a sport-specific neuromuscular rehabilitation approach. Data collected included range of motion, strength, neuromuscular control, and magnetic resonance images. OUTCOMES This high-level athlete was able to return to sport 103 days after surgery and no reinjury of the lateral meniscus occurred up to 5 years after surgery. DISCUSSION The sport-specific, criterion-based, supervised rehabilitation program described in this case report showed a safe return to sport and a good long-term outcome.
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Affiliation(s)
- Mario Bizzini
- Department of Orthopaedics, Sports Medicine and Rehabilitation, Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland.
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Millisdotter M, Strömqvist B. Early neuromuscular customized training after surgery for lumbar disc herniation: a prospective controlled study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 16:19-26. [PMID: 16421747 PMCID: PMC2198880 DOI: 10.1007/s00586-005-0044-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 11/21/2005] [Accepted: 12/06/2005] [Indexed: 11/25/2022]
Abstract
A prospective and controlled study of training after surgery for lumbar disc herniation (LDH). The objective was to determine the effect of early neuromuscular customized training after LDH surgery. No consensus exists on the type and timing of physical rehabilitation after LDH surgery. Patients aged 15-50 years, disc prolapse at L4-L5 or L5-S1. Before surgery, at 6 weeks, 4, and 12 months postoperatively, the following evaluations were performed: low back pain and leg pain estimated on a visual analog scale, disability according to the Roland-Morris questionnaire (RMQ) and disability rating index (DRI). Clinical examination, including the SLR test, was performed using a single blind method. Consumption of analgesics was registered. Twenty-five patients started neuromuscular customized training 2 weeks after surgery (early training group = ETG). Thirty-one patients formed a control group (CG) and started traditional training after 6 weeks. There was no significant difference in pain and disability between the two training groups before surgery. Median preoperative leg pain was 63 mm in ETG and 70 mm in the CG. Preoperative median disability according to RMQ was 14 in the ETG and 14.5 in the CG. Disability according to DRI (33/56 patients) was 5.3 in the ETG vs. 4.6 in the CG. At 6 weeks, 4 months, and 12 months, pain was significantly reduced in both groups, to the same extent. Disability scores were lower in the ETG at all follow-ups, and after 12 months, the difference was significant (RMQ P=.034, DRI P=.015). The results of the present study show early neuromuscular customized training to have a superior effect on disability, with a significant difference compared to traditional training at a follow-up 12 months after surgery. No adverse effects of the early training were seen. A prospective, randomized study with a larger patient sample is warranted to ultimately demonstrate that early training as described is beneficial for patients undergoing LDH surgery.
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Arampatzis A, Morey-Klapsing G, Brüggemann GP. The effect of falling height on muscle activity and foot motion during landings. J Electromyogr Kinesiol 2003; 13:533-44. [PMID: 14573368 DOI: 10.1016/s1050-6411(03)00059-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The aims of this study were: (a) to examine the effect of falling height on the kinematics of the tibiotalar, talonavicular and calcaneocuboid joints and (b) to study the influence of falling height on the muscle activity of the leg during landings. Six female gymnasts (height: 1.63 +/- 0.04 m, weight: 58.21 +/- 3.46 kg) participated in this study. All six gymnasts carried out barefoot landings, falling from 1.0, 1.5 and 2.0 m height onto a mat. Three genlocked digital high speed video cameras (250 Hz) captured the motion of the left shank and foot. Surface electromyography (EMG) was used to measure muscle activity (1000 Hz) from five muscles (gastrocnemius medialis, tibialis anterior, peroneus longus, vastus lateralis and hamstrings) of the left leg. The kinematics of the tibiotalar, talonavicular and calcaneocuboid joints were studied. The lower-leg and the foot were modelled by means of a multi-body system, comprising seven rigid bodies. The falling height does not show any influence on the kinematics neither of the tibiotalar nor of the talonavicular joints during landing. The eversion at the calcaneocuboid joint increases with increasing falling height. When augmenting falling height, the myoelectric activity of the muscles of the lower limb increases as well during the pre-activation phase as during the landing itself. The muscles of the lower extremities are capable of stabilizing the tibiotalar and the talonavicular joints actively, restricting their maximal motion by means of a higher activation before and after touchdown. Maximal eversion at the calcaneocuboid joint increases about 52% when landing from 2.0 m.
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Affiliation(s)
- Adamantios Arampatzis
- Institute for Biomechanics, German Sport University of Cologne, Carl-Diem-Weg 6, 50933 Cologne, Germany.
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Abstract
Proprioception and neuromuscular control of the knee are compromised after ligament injury and must be regained if the athlete is to return to high level sports at a normal injury risk level. The anterior cruciate ligament deficient and reconstructed knee will be used as a model to describe differences in proprioception and neuromuscular control to those of an uninjured knee. The purpose of the current review is threefold. First, the basic science of proprioception and neuromuscular control specific to the knee will be summarized and reviewed. The review will include an overview of terminology, neurophysiology, and the effects of injury on the function of both lower limbs. Second, tools used for assessment and rehabilitation of proprioceptive deficits will be evaluated. Specific rehabilitation procedures that incorporate prophylactic conditioning that focus on transitioning the injured athlete back into sport will be presented. Finally, the literature with respect to gender variation in proprioception and neuromuscular control will be evaluated. The goal of the current review is to provide the clinician and the clinical scientist with sufficient background information for the development of quantitative methods to evaluate a patient's functional capacity and to assist in preventative, preoperative, and postoperative decision-making strategies.
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Affiliation(s)
- Timothy E Hewett
- Cincinnati Children's Sports Medicine Biodynamics Center, Cincinnati, OH 45229, USA
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Chmielewski TL, Wilk KE, Snyder-Mackler L. Changes in weight-bearing following injury or surgical reconstruction of the ACL: relationship to quadriceps strength and function. Gait Posture 2002; 16:87-95. [PMID: 12127191 DOI: 10.1016/s0966-6362(01)00202-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Changes in weight-bearing an average of 1.5 months after ACL injury (ACLD) and up to 3 months after surgical reconstruction (ACLR) were investigated using a force platform. Correlations between force platform test variables, quadriceps strength and functional self-report scores were also examined. RESULTS Each force platform test revealed impaired weight-bearing by either ACLD and/or ACLR subjects. Many variables were correlated to quadriceps strength; therefore, improved strength in ACLR subjects by 6 weeks post-operative negated any weight-bearing impairment. No single force platform variable correlated with the subjects' perception of function. CONCLUSION Only the step up/over test provided insight into disability in these patients. Modification of force platform analysis programs may allow for other clinical questions to be answered.
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Affiliation(s)
- Terese L Chmielewski
- Biomechanics and Movement Science Program, University of Delaware, 301 McKinly Lab, Newark, DE 19716, USA.
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Ageberg E. Consequences of a ligament injury on neuromuscular function and relevance to rehabilitation - using the anterior cruciate ligament-injured knee as model. J Electromyogr Kinesiol 2002; 12:205-12. [PMID: 12086815 DOI: 10.1016/s1050-6411(02)00022-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The purpose of this article is to survey current knowledge concerning the consequences of a ligament injury on neuromuscular function and its relevance to rehabilitation, in relation to clinical practice. Although it deals with the ACL-injured knee, these views may also apply to other joints. The effects of a ligament injury on neuromuscular function are first considered - i.e., proprioception, postural control, muscle strength, functional performance, movement and activation pattern, central mechanisms, motor control and learning. The treatment and effects of rehabilitation on neuromuscular function are then discussed. The survey is concluded by discussing the clinical significance.
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Affiliation(s)
- Eva Ageberg
- Department of Rehabilitation, University Hospital, Lund, Sweden.
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Ageberg E, Zätterström R, Moritz U, Fridén T. Influence of supervised and nonsupervised training on postural control after an acute anterior cruciate ligament rupture: a three-year longitudinal prospective study. J Orthop Sports Phys Ther 2001; 31:632-44. [PMID: 11720296 DOI: 10.2519/jospt.2001.31.11.632] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective randomized longitudinal clinical trial with matched controls. OBJECTIVES To investigate the long-term effect of training on postural control and extremity function after an acute anterior cruciate ligament (ACL) injury. BACKGROUND ACL injuries may cause severe problems with recurrent giving way of the knee and reduced functional capacity. The effect of an acute ACL injury and the effect of various training programs on postural control, as well as the relation between postural control and extremity function after such an injury, have not been studied longitudinally. METHODS Sixty-three consecutive patients, 35 men and 28 women (median age 24 years, quartiles 19-33 years), with an acute nonoperated ACL injury, randomized to neuromuscular supervised or self-monitored training, were examined with stabilometry (amplitude and average speed of center of pressure movements) and a one-leg hop test for distance after 6 weeks (stabilometry only), and after 3, 12, and 36 months, and were compared to a control group. RESULTS Regardless of treatment, center of pressure amplitude was persistently higher in both the injured and uninjured legs during the 3-year follow-up, but average speed was less affected or unaffected compared to the control group. The one-leg hop had normalized in the neuromuscular group at the 12-month follow-up, but was shorter in both legs throughout the 3-year period in the self-monitored group. The median value (quartiles) for injured/uninjured legs at 3 months was 150 cm (120-174 cm)/177 cm (140-199 cm), at 12 months was 174 cm (140-200 cm)/180 cm (150-202 cm), and at 36 months was 172 cm (146-200 cm)/178 cm (150-200 cm) in the self-monitored group, compared to the control group (median 186 cm, quartiles 177-216 cm). CONCLUSIONS The higher center of pressure amplitude in both legs over the 3-year period indicate persistently impaired postural control in single-limb stance. However, functional performance, as measured with the one-leg hop test, was restored by neuromuscular training, but not by self-monitored training.
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Affiliation(s)
- E Ageberg
- Department of Rehabilitation, University Hospital, Lund, Sweden.
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Rehabilitation following knee osteotomy. OPER TECHN SPORT MED 2000. [DOI: 10.1016/s1060-1872(00)80029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
When pain and effusion have been minimized and patients assume appropriate knee posture at rest and during exercise, the extent of postinjury or postoperative quadriceps femoris neuromuscular inhibition and avoidance during locomotion is reduced. Restoring normal lower-extremity ROM and musculotendinous extensibility (with consideration for biarticular muscles) is foundational to the implementation of an exercise program that integrates the trunk, hip, and ankle muscles into dynamic knee-stabilization challenges while addressing isolated quadriceps femoris deficiencies. Cardiovascular conditioning should be addressed as early as feasible. Although programs generally address anaerobic and aerobic energy systems, increasing patients' fatigue resistance, as evidenced by prolonged maintenance of appropriate functional exercise techniques and body control without verbalized discomfort or observed movement-avoidance patterns, ensures therapists that neuromuscular responsiveness for dynamic knee stabilization is improving.
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Affiliation(s)
- J Nyland
- School of Physical Therapy, University of South Florida, College of Medicine, Tampa, USA
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Kern-Steiner R, Washecheck HS, Kelsey DD. Strategy of exercise prescription using an unloading technique for functional rehabilitation of an athlete with an inversion ankle sprain. J Orthop Sports Phys Ther 1999; 29:282-7. [PMID: 10342565 DOI: 10.2519/jospt.1999.29.5.282] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case study. OBJECTIVES To demonstrate how an exercise program can be designed with specific sets, repetitions, and rest periods, and to enhance the healing process in early stages of rehabilitation when injured tissues cannot tolerate full body weight. Our goal was to enhance ankle tissue healing by reducing gravitational force through a prescriptive exercise and unloading program. BACKGROUND This report describes a treatment method that we used to rehabilitate a collegiate soccer player with a Grade II inversion ankle sprain. This athlete sprained his ankle 6 weeks before the start of rehabilitation and was unable to participate in soccer due to persistent pain and impaired function. METHODS AND MEASURES A 2-week functional training program was implemented, consisting of exercises chosen for specific task simulation related to soccer. Gravitational force was mechanically altered by suspending the subject or by supporting the subject on a variable incline plane. Weight-bearing was controlled so that the subject could perform exercises without pain. The outcome measures were ankle range of motion (ROM), maximum pain-free isometric strength, vertical force during unilateral squats, and unilateral hop time and distance. RESULTS Pain-free weight-bearing capacity increased over the 2-week course of rehabilitation and the subject was able to return to playing soccer without pain. The ratios (involved to uninvolved extremity) at time of discharge from physical therapy were 87% to 103% for ankle ROM, 75% to 93% for isometric ankle strength, 91% for unilateral squats, 88% for unilateral hop time, and 86% for unilateral hop distance. CONCLUSIONS Return to function can be achieved in a short period by exercise that is performed with a gradual increase in pain-free weight-bearing capacity.
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Affiliation(s)
- R Kern-Steiner
- New Dimensions Physical Therapy, Austin, Tex 78746, USA.
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Abstract
Functional dynamic tests are increasingly used in rehabilitation after injuries of the lower extremities. In these tests quantitative measures (e.g. time, height, distance) are mainly used as parameters, whereas the quality of the neuromuscular performance is poorly evaluated. In the present study the neuromuscular performance of leg muscles in different motor tasks was investigated 10-16 months after ACL-reconstruction. In 39 subjects with arthroscopically assisted ACL-reconstruction and 20 controls, isometric knee extensor strength, thigh circumference, knee stability, subjective knee function and the neuromuscular performance (by kinematic data and EMG) during three dynamic tests (stair descending, one-legged drop jump, one-legged cyclic hops) were measured. During the strength measurements a superimposed twitch technique was used for the detection of neuromuscular inhibition. The results demonstrate a significantly reduced Lysholm-Score and a distinct strength deficit, but no neuromuscular inhibition and no differences in knee stability in the operated leg. Besides reduced motor abilities of the injured leg, significant differences of the neuromuscular performance could be detected. It was evident that different test conditions revealed different persisting changes of the neuromuscular performance, which could not be detected by kinematic parameters alone.
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Affiliation(s)
- K Pfeifer
- Department of Sports Medicine, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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Nyland JA, Shapiro R, Caborn DN, Nitz AJ, Malone TR. The effect of quadriceps femoris, hamstring, and placebo eccentric fatigue on knee and ankle dynamics during crossover cutting. J Orthop Sports Phys Ther 1997; 25:171-84. [PMID: 9048323 DOI: 10.2519/jospt.1997.25.3.171] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study attempted to determine the effect of eccentric quadriceps femoris, hamstring, and placebo fatigue on stance limb dynamics during the plant-and-cut phase of a crossover cut. Twenty female college students (task trained) were tested. Hamstring fatigue resulted in decreased peak impact knee flexion moments (p < or = .01), increased internal tibial rotation at peak knee flexion (p < or = .05), and decreased peak ankle dorisflexion (p < or = .05). Quadriceps fatigue resulted in increased peak ankle dorsiflexion moments (p < .01), decreased peak posterior braking forces (p < or .01), decreased peak knee extension moments (p < or = .01), delayed peak knee flexion (p < or = .01), delayed peak propulsive forces (p < .01), and delayed subtalar peak inversion moments (p < or = .05). Fatigue of either muscle group produced earlier peak ankle plantar flexion moments (p < = .05) and decreased peak propulsive knee flexion moments (p < or = .05). Variables requiring further study (p < or = .1) provide discussion data. Soleus, gastrocnemius, tibialis anterior, and deep posterior compartment calf muscles serve as dynamic impact force attenuators, compensating for fatigued proximal muscles.
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Affiliation(s)
- J A Nyland
- University of Kentucky, Sports Medicine Center, Lexington 40536, USA
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Manal TJ, Snyder-Mackler L. Practice guidelines for anterior cruciate ligament rehabilitation: a criterion-based rehabilitation progression. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s1048-6666(96)80019-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Comparison of Open versus Closed Kinetic Chain Test Positions for Measuring Joint Position Sense. J Sport Rehabil 1995. [DOI: 10.1123/jsr.4.3.165] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine if a difference exists in the reproducibility of knee joint flexion angles in an open versus a closed kinetic chain. Thirty generally healthy subjects (12 males, 18 females; mean age 23.8 years) participated. Subjects actively reproduced small, medium, and large knee flexion angles (with target angles of 15°, 45°, and 75°, respectively) in an open and a closed kinetic chain while being videotaped. Goniometric measurements were taken from the videotape of initial and reproduced joint angles. Data were analyzed using ANOVA with repeated measures on kinetic chain test position and joint angle. Subjects more accurately reproduced knee flexion angles in a closed kinetic chain position. The main effect for angle and the interaction of angle and test position were nonsignificant. The results indicate that knee joint position is more accurately reproduced in closed kinetic chain. Closed kinetic chain testing is also a more functional assessment of joint position sense, and thus closed kinetic chain assessment of lower extremity joint position sense is recommended.
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