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Cobian DG, Oppenheim ZR, Roehl TJ, Joachim MR, Heiderscheit BC. Knee Extensor Torque Steadiness and Quadriceps Activation Variability in Collegiate Athletes 4, 6, and 12 Months After ACL Reconstruction. Orthop J Sports Med 2024; 12:23259671241253843. [PMID: 38867919 PMCID: PMC11168251 DOI: 10.1177/23259671241253843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/16/2023] [Indexed: 06/14/2024] Open
Abstract
Background Quadriceps performance after anterior cruciate ligament reconstruction (ACLR) is typically characterized by peak force/torque, but the ability to generate consistent knee extensor torque may be clinically meaningful. Purpose/Hypothesis The purpose of this study was to evaluate knee extensor torque steadiness and quadriceps activation variability in collegiate athletes 4 to 12 months after ACLR. It was hypothesized that between-limb asymmetries in torque steadiness and activation variability would be observed and that steadiness would be associated with activation variability and peak knee extensor torque symmetry. Study Design Case-control study; Level of evidence, 3. Methods A total of 30 National Collegiate Athletic Association Division I athletes completed maximal voluntary isometric contractions 4, 6, and 12 months after ACLR. Torque and surface electromyography of the superficial quadriceps were recorded. Torque steadiness was calculated as the mean difference between initial and low-pass filtered torque signals and was expressed as a percentage of peak torque. Quadriceps activation variability was calculated similarly and was expressed as a percentage of peak electromyography. Linear mixed models were used to assess change in torque steadiness and activation variability over time. Associations between torque steadiness of the operated limb, activation variability, and quadriceps strength symmetry were evaluated using the Spearman correlation coefficient. Results Limb-by-time interactions were detected for torque steadiness and activation variability (P < .001), with reductions (improvements) in limb steadiness and activation variability observed with increasing time since surgery. Between-limb differences in torque steadiness and activation variability were observed at 4 and 6 months postoperatively (P < .05). Significant associations between operated limb torque steadiness and quadriceps activation variability were observed at 4 months (P < .001) and 6 months (P < .01). Torque steadiness of the operated limb was associated with peak knee extensor torque symmetry at 4 months (r S = -0.49; P < .01) and 6 months (r S = -0.49; P < .01). Conclusion In collegiate athletes, impaired knee extensor torque steadiness of the operated limb and associated abnormal quadriceps activation patterns were observed 4 to 12 months after ACLR, and the consistency of knee extensor torque production was associated with greater quadriceps strength asymmetries, particularly 4 to 6 months after surgery. Operated limb torque steadiness and activation variability improved from 4 to 12 months after ACLR. Clinical assessment of knee extensor torque steadiness after ACLR may improve prognosis and specificity of rehabilitation efforts.
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Affiliation(s)
- Daniel G. Cobian
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Zachary R. Oppenheim
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Tyler J. Roehl
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Doctor of Physical Therapy Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Mikel R. Joachim
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Bryan C. Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Badger Athletic Performance Program, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA
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2
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Vallance P, Malliaras P, Vicenzino B, Kidgell DJ. Determining intracortical, corticospinal and alpha motoneurone excitability in athletes with patellar tendinopathy compared to asymptomatic controls. Scand J Med Sci Sports 2024; 34:e14579. [PMID: 38332685 DOI: 10.1111/sms.14579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Lower capacity to generate knee extension maximal voluntary force (MVF) has been observed in individuals affected with patellar tendinopathy (PT) compared to asymptomatic controls. This MVF deficit is hypothesized to emanate from alterations in corticospinal excitability (CSE). The modulation of CSE is intricately linked to the excitability levels at multiple sites, encompassing neurones within the corticospinal tract (CST), intracortical neurones within the primary motor cortex (M1), and the alpha motoneurone. The aim of this investigation was to examine the excitability of intracortical neurones, CST neurones, and the alpha motoneurone, and compare these between volleyball and basketball athletes with PT and matched asymptomatic controls. METHOD Nineteen athletes with PT and 18 asymptomatic controls participated in this cross-sectional study. Transcranial magnetic stimulation was utilized to assess CST excitability, corticospinal inhibition (silent period, and short-interval cortical inhibition). Peripheral nerve stimulation was used to evaluate lumbar spine and alpha motoneurone excitability, including the evocation of lumbar-evoked potentials and maximal compound muscle action potential (MMAX ), and CSE with central activation ratio (CAR). Knee extension MVF was also assessed. RESULTS Athletes with PT exhibited longer silent period duration and greater electrical stimulator output for MMAX , as well as lower MVF, compared to asymptomatic controls (p < 0.05). CONCLUSION These findings indicate volleyball and basketball athletes with PT exhibit reduced excitability of the alpha motoneurone or the neuromuscular junction, which may be linked to lower MVF. Subtle alterations at specific sites may represent compensatory changes to excitability aiming to maintain efferent drive to the knee extensors.
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Affiliation(s)
- Patrick Vallance
- Monash Musculoskeletal Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Monash Musculoskeletal Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Dawson J Kidgell
- Monash Exercise Neuroplasticity Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Riehm CD, Bonnette S, Rush JL, Diekfuss JA, Koohestani M, Myer GD, Norte GE, Sherman DA. Corticomuscular cross-recurrence analysis reveals between-limb differences in motor control among individuals with ACL reconstruction. Exp Brain Res 2024; 242:355-365. [PMID: 38092900 PMCID: PMC10872341 DOI: 10.1007/s00221-023-06751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 01/04/2024]
Abstract
Surgical reconstruction of the anterior cruciate ligament (ACL) and subsequent physical therapy can help athletes return to competition; however, re-injury rates remain disproportionately high due, in part, to lingering biomechanical and neurological factors that are not fully addressed during rehabilitation. Prior reports indicate that individuals exhibit altered electrical activity in both brain and muscle after ACL reconstruction (ACLR). In this investigation, we aimed to extend existing approaches by introducing a novel non-linear analysis of corticomuscular dynamics, which does not assume oscillatory coupling between brain and muscle: Corticomuscular cross-recurrence analysis (CM-cRQA). Our findings indicate that corticomuscular dynamics vary significantly between involved (injured) and uninvolved legs of participants with ACLR during voluntary isometric contractions between the brain and both the vastus medialis and lateralis. This finding points to a potential lingering neural deficit underlying re-injury for athletes after surgical reconstruction, namely the dynamical structure of neuromuscular (brain to quad muscle) coordination, which is significantly asymmetric, between limbs, in those who have ACLR.
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Affiliation(s)
- Christopher D Riehm
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA.
- Emory Sports Medicine Center, Atlanta, GA, USA.
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Scott Bonnette
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin L Rush
- Division of Physical Therapy, School of Rehabilitation Sciences, Ohio University, Athens, OH, USA
| | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Moein Koohestani
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Youth Physical Development Centre, Cardiff Metropolitan University, Wales, UK
| | - Grant E Norte
- Neuroplasticity, & Sarcopenia (CNS) Lab, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - David A Sherman
- Live4 Physical Therapy and Wellness, Acton, MA, USA
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
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Zarrin M, Nakhostin Ansari N, Naghdi S, Hasson S, Forogh B, Rezaee M. Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial. J Acupunct Meridian Stud 2023; 16:193-202. [PMID: 37885255 DOI: 10.51507/j.jams.2023.16.5.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/23/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Background : Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. Methods : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. Discussion : The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.
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Affiliation(s)
- Milad Zarrin
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
| | - Bijan Forogh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Orthopedics, School of Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Johnson AK, Rodriguez KM, Lepley AS, Palmieri-Smith RM. Quadriceps torque complexity before and after anterior cruciate ligament reconstruction. J Sci Med Sport 2023; 26:533-538. [PMID: 37775409 DOI: 10.1016/j.jsams.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The purpose of this project was to longitudinally examine quadriceps torque complexity in a group of individuals who tore their ACL and underwent ACL reconstruction. DESIGN Cohort analysis. METHODS Thirty-four individuals completed maximal effort bilateral isometric strength testing after ACL injury but pre-surgery, five months' post-surgery (mid-point of rehabilitation), and when cleared to return to activity. Sample entropy, a nonlinear analysis of quadriceps torque control (complexity), was calculated from maximal isometric contractions. Two 3 × 2 repeated measures analysis of variance were used to examine changes over time and between limbs for quadriceps torque complexity and peak torque. RESULTS Quadriceps peak torque was lower in the involved limb when compared to the uninvolved limb at every time point (p < 0.001). Peak torque of the involved limb was decreased at mid-point of rehabilitation compared to before surgery (p = 0.023) and at mid-point compared to return to activity (p = 0.041). Quadriceps sample entropy was higher in the involved limb compared to the uninvolved limb at the mid-point of rehabilitation (p < 0.001) and return to activity (p < 0.001), indicating greater complexity. The involved limb also demonstrated increased torque sample entropy from pre-surgery to mid-point of rehabilitation (p = 0.023), but not from pre-surgery to return to activity (p = 0.169) or from mid-point to return to activity (p = 0.541). CONCLUSIONS Not only does quadriceps strength decline with ACL reconstruction, but quality of the quadriceps muscle contraction is also compromised. Increased torque complexity experienced in the ACL limb after reconstruction may contribute to impaired physical function in individuals following ACL reconstruction.
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Affiliation(s)
| | | | | | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, USA; Department of Orthopedic Surgery, University of Michigan, USA
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6
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Criss CR, Lepley AS, Onate JA, Clark BC, Simon JE, France CR, Grooms DR. Brain activity associated with quadriceps strength deficits after anterior cruciate ligament reconstruction. Sci Rep 2023; 13:8043. [PMID: 37198275 PMCID: PMC10192374 DOI: 10.1038/s41598-023-34260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Prolonged treatment resistant quadriceps weakness after anterior cruciate ligament reconstruction (ACL-R) contributes to re-injury risk, poor patient outcomes, and earlier development of osteoarthritis. The origin of post-injury weakness is in part neurological in nature, but it is unknown whether regional brain activity is related to clinical metrics of quadriceps weakness. Thus, the purpose of this investigation was to better understand the neural contributions to quadriceps weakness after injury by evaluating the relationship between brain activity for a quadriceps-dominated knee task (repeated cycles of unilateral knee flexion/extension from 45° to 0°), , and strength asymmetry in individuals returned to activity after ACL-R. Forty-four participants were recruited (22 with unilateral ACL reconstruction; 22 controls) and peak isokinetic knee extensor torque was assessed at 60°/s to calculate quadriceps limb symmetry index (Q-LSI, ratio of involved/uninvolved limb). Correlations were used to determine the relationship of mean % signal change within key sensorimotor brain regions and Q-LSI. Brain activity was also evaluated group wise based on clinical recommendations for strength (Q-LSI < 90%, n = 12; Q-LSI ≥ 90%, n = 10; controls, all n = 22 Q-LSI ≥ 90%). Lower Q-LSI was related to increased activity in the contralateral premotor cortex and lingual gyrus (p < .05). Those who did not meet clinical recommendations for strength demonstrated greater lingual gyrus activity compared to those who met clinical recommendations Q-LSI ≥ 90 and healthy controls (p < 0.05). Asymmetrically weak ACL-R patients displayed greater cortical activity than patients with no underlying asymmetry and healthy controls.
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Affiliation(s)
- Cody R Criss
- Translational Biomedical Sciences, Graduate College, Ohio University, Athens, OH, USA
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
| | - Adam S Lepley
- School of Kinesiology; Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA
- Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Grover Center W283, 1, Ohio University, Athens, OH, 45701-2979, USA.
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA.
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Sherman DA, Baumeister J, Stock MS, Murray AM, Bazett-Jones DM, Norte GE. Weaker Quadriceps Corticomuscular Coherence in Individuals after ACL Reconstruction during Force Tracing. Med Sci Sports Exerc 2023; 55:625-632. [PMID: 36730761 DOI: 10.1249/mss.0000000000003080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare quadriceps corticomuscular coherence (CMC) and force steadiness between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a force tracing task. METHODS Individuals with ACLR ( n = 20) and controls ( n = 20) performed a knee extension force-control task at 50% of maximal voluntary effort. Electrocortical activity, electromyographic activity, and torque output were recorded concurrently. CMC in beta (13-30 Hz) and gamma (31-80 Hz) frequency bands was assessed using partial directed coherence between the contralateral motor cortex (e.g., C4-C2-Cz electrodes) and the ipsilateral quadriceps muscles (e.g., left vastus medialis and lateralis). Force steadiness was quantified using root-mean-square error and coefficient of variation. Active motor threshold was determined using transcranial magnetic stimulation. Differences between groups (ACLR vs control) and limbs (involved vs uninvolved) were assessed using peak knee extension strength and active motor threshold as a priori covariates. RESULTS Participants with ACLR had lower gamma band connectivity bilaterally when compared with controls (vastus medialis: d = 0.8; vastus lateralis: d = 0.7). Further, the ACLR group demonstrated worse quadriceps force steadiness (root-mean-square error, d = 0.5), lower involved limb quadriceps strength ( d = 1.1), and higher active motor threshold ( d = 1.0) compared with controls. CONCLUSIONS Lower quadriceps gamma band CMC in the ACLR group suggests lower cortical drive (e.g., corticomotor decoupling) to the quadriceps compared with matched controls. Further, the ACLR group demonstrated worse quadriceps force steadiness, suggesting impaired ability to modulate quadriceps neuromuscular control. Notably, CMC differences were present only in the gamma frequency band, suggesting impairments may be specific to multisensory integration and force modulation.
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Affiliation(s)
| | - Jochen Baumeister
- Exercise Science and Neuroscience Unit, Department of Exercise and Health, Faculty of Science, Paderborn University, Paderborn, GERMANY
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL
| | - Amanda M Murray
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, OH
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Laube W. Deafferenzierung durch Verletzung, Degeneration und Alter – arthrogene Muskelhemmung – implizites Lernen. MANUELLE MEDIZIN 2022. [DOI: 10.1007/s00337-022-00907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hipsley A, Hall M, Saxby DJ, Bennell KL, Wang X, Bryant AL. Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume. Knee Surg Sports Traumatol Arthrosc 2022; 30:1949-1957. [PMID: 34997247 DOI: 10.1007/s00167-021-06853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology. METHODS The involved limb of 51 ACLR participants (31 isolated ACLR; 20 combined meniscal pathology) aged 18-40 years were tested at 2.4 ± 0.4 years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°-50°, 50°-40°, 40°-30°, 30°-20°, 20°-10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression. RESULTS In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°-50° and 50°-40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume. CONCLUSION Higher quadriceps strength at knee flexion angles of 60°-40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anthony Hipsley
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.
| | - Michelle Hall
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Core Group for Innovation in Health Technology, Menzies Health Institute Queensland, Gold Coast, Australia.,Gold Coast Orthopaedic Research and Education Alliance, Gold Coast, Australia
| | - Kim L Bennell
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Xinyang Wang
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Department of Orthopaedic Surgery, Beijing Chao-Yang Hospital, Beijing, China
| | - Adam L Bryant
- Department of Medicine Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC, Australia
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10
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Winter L, Huang Q, Sertic JVL, Konczak J. The Effectiveness of Proprioceptive Training for Improving Motor Performance and Motor Dysfunction: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:830166. [PMID: 36188962 PMCID: PMC9397687 DOI: 10.3389/fresc.2022.830166] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 01/13/2023]
Abstract
Objective Proprioceptive training is any intervention aiming to improve proprioceptive function with the ultimate goal to enhance motor function and performance. It has been promoted as an approach to enhance athletic performance and as a tool for sensorimotor rehabilitation. Numerous studies sought to provide evidence on the effectiveness of the approach. However, many different training regimes claiming to train proprioception report a variety of sensorimotor measures that are not directly comparable. This, in turn, makes it difficult to assess effectiveness across approaches. It is the objective of this study to systematically review recent empirical evidence to gain an understanding of which outcome measures are most sensitive, which populations may benefit most from proprioceptive training, and what are the effects on proprioceptive and motor systems. Methods Four major databases were searched. The following inclusion criteria were applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function and not confounded by information from other sensory modalities. 4) The study reported of at least one quantified measure of motor performance. Results Of the 3,297 articles identified by the database search, 70 studies met the inclusion criteria and were included for further review. Across studies, proprioceptive training led to comparable gains in both proprioceptive (+46%) and motor performance (+45%). The majority of studies (50/70) applied active movement interventions. Interventions applying somatosensory stimulation were most successful in clinical populations. Joint position sense error (JPSE) was the most commonly used proprioceptive measure and presents a reliable and feasible measure for clinical use. Conclusion Proprioceptive training can lead to significant improvements in proprioceptive and motor function across a range healthy and clinical populations. Regimens requiring active movement of the trainee tended to be most successful in improving sensorimotor performance. Conclusive evidence on how long training gains are retained is still lacking. There is no solid evidence about the underlying long-term neuroplastic changes associated proprioceptive training.
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Affiliation(s)
- Leoni Winter
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Leoni Winter
| | - Qiyin Huang
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
| | - Jacquelyn V. L. Sertic
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, United States
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11
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Kantak SS, Johnson T, Zarzycki R. Linking Pain and Motor Control: Conceptualization of Movement Deficits in Patients With Painful Conditions. Phys Ther 2022; 102:6497839. [PMID: 35079833 DOI: 10.1093/ptj/pzab289] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 09/13/2021] [Accepted: 12/10/2021] [Indexed: 12/20/2022]
Abstract
UNLABELLED When people experience or expect pain, they move differently. Pain-altered movement strategies, collectively described here as pain-related movement dysfunction (PRMD), may persist well after pain resolves and, ultimately, may result in altered kinematics and kinetics, future reinjury, and disability. Although PRMD may manifest as abnormal movements that are often evident in clinical assessment, the underlying mechanisms are complex, engaging sensory-perceptual, cognitive, psychological, and motor processes. Motor control theories provide a conceptual framework to determine, assess, and target processes that contribute to normal and abnormal movement and thus are important for physical therapy and rehabilitation practice. Contemporary understanding of motor control has evolved from reflex-based understanding to a more complex task-dependent interaction between cognitive and motor systems, each with distinct neuroanatomic substrates. Though experts have recognized the importance of motor control in the management of painful conditions, there is no comprehensive framework that explicates the processes engaged in the control of goal-directed actions, particularly in the presence of pain. This Perspective outlines sensory-perceptual, cognitive, psychological, and motor processes in the contemporary model of motor control, describing the neural substrates underlying each process and highlighting how pain and anticipation of pain influence motor control processes and consequently contribute to PRMD. Finally, potential lines of future inquiry-grounded in the contemporary model of motor control-are outlined to advance understanding and improve the assessment and treatment of PRMD. IMPACT This Perspective proposes that approaching PRMD from a contemporary motor control perspective will uncover key mechanisms, identify treatment targets, inform assessments, and innovate treatments across sensory-perceptual, cognitive, and motor domains, all of which have the potential to improve movement and functional outcomes in patients with painful conditions.
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Affiliation(s)
- Shailesh S Kantak
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA.,Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Tessa Johnson
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
| | - Ryan Zarzycki
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
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12
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Arthrogenic Muscle Inhibition Following Anterior Cruciate Ligament Injury. J Sport Rehabil 2022; 31:694-706. [PMID: 35168201 DOI: 10.1123/jsr.2021-0128] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022]
Abstract
Arthrogenic muscle inhibition (AMI) is a common impairment in individuals who sustain an anterior cruciate ligament (ACL) injury. The AMI causes decreased muscle activation, which impairs muscle strength, leading to aberrant movement biomechanics. The AMI is often resistant to traditional rehabilitation techniques, which leads to persistent neuromuscular deficits following ACL reconstruction. To better treat AMI following ACL injury and ACL reconstruction, it is important to understand the specific neural pathways involved in AMI pathogenesis, as well as the changes in muscle function that may impact movement biomechanics and long-term structural alterations to joint tissue. Overall, AMI is a critical factor that limits optimal rehabilitation outcomes following ACL injury and ACL reconstruction. This review discusses the current understanding of the: (1) neural pathways involved in the AMI pathogenesis following ACL injury; (2) consequence of AMI on muscle function, joint biomechanics, and patient function; and (3) development of posttraumatic osteoarthritis. Finally, the authors review the evidence for interventions specifically used to target AMI following ACL injury.
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13
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Ebisu S, Kasahara S, Saito H, Ishida T. Decrease in force control among older adults under unpredictable conditions. Exp Gerontol 2021; 158:111649. [PMID: 34875350 DOI: 10.1016/j.exger.2021.111649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Falls in older adults generally occur during unpredictable situations. Controlling posture through fine-tuned muscle force before and after falls is necessary to avoid serious injuries. However, details regarding force control among older adults during unpredictable situations are unclear. This study determined the features of force control in a random force-tracking task among older adults. METHODS Ten healthy older adults (67-76 years) and eight healthy young adults (20-23 years) participated in three force-tracking tasks with ankle plantar flexion: low-range (LR), high-range (HR), and pseudo-random (PR) force tasks. Force control ability was assessed using the root mean square error (RMSE) between the target and muscle forces produced by the participants. Muscle activities from the lateral head of the gastrocnemius and the tibialis anterior during each task were measured using surface electromyography to calculate the co-contraction index (CCI). RESULTS In all tasks, older adults (RMSEs: 1.09-3.70, CCIs: 29.4-56.4) had a significantly greater RMSEs and CCIs than young adults (RMSEs: 0.49-1.83, CCIs: 11.7-20.6; all, p < 0.05). The RMSEs during force generation were significantly greater than those during force release (LR: p < 0.01, HR: p < 0.05), except for the random force-tracking task in older adults. CCIs during the force release phase in both groups (older adults: 27.8-56.4, young adults: 15.0-20.6) were consistently greater than those during force generation (older adults: 24.5-50.4, young adults: 11.7-17.2). CCIs in force-tracing tasks differed in older adults, whereas those in the random force-tracing task increased. RMSEs and CCIs in the random and LR force-tracing tasks were significantly negatively correlated with the functional reach test (all: r > 0.5, p < 0.05). CONCLUSION Force control in older adults declines in low-band and random muscle force output. Moreover, increased CCIs in older adults are particularly pronounced during unpredictable situations.
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Affiliation(s)
- Shunsuke Ebisu
- Department of Physical Therapy, Rehabilitation part, Hokuto Social Medical Corporation Tokachi Rehabilitation Center, Japan
| | - Satoshi Kasahara
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Hiroshi Saito
- Department of Physical Therapy, School of Rehabilitation, Tokyo Kasei University, Sayama, Japan
| | - Tomoya Ishida
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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14
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Bunn PDS, Lopes TJA, Terra BDS, Costa HF, Souza MP, Braga RM, Inoue A, Ribeiro FM, Alves DDS, Bezerra da Silva E. Association between movement patterns and risk of musculoskeletal injuries in navy cadets: A cohort study. Phys Ther Sport 2021; 52:81-89. [PMID: 34438262 DOI: 10.1016/j.ptsp.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the association of movement patterns evaluated by the Dynamic Movement Assessment (DMA) with the occurrence of musculoskeletal injuries in navy cadets. DESIGN Cohort study. SETTING Participants were filmed performing the six functional tests of the DMA (deep squat, step up, single-leg squat, hop, plank and side-plank tests). PARTICIPANTS 240 navy cadets. MAIN OUTCOME MEASUREMENTS Depending on the number of certain movement patterns on the Dynamic Movement Assessment (DMA), participants were classified as high, moderate, medium or low risk of developing injuries. Predictive associations between injuries and risk classification were examined using logistic regression analysis. RESULTS Considering sex, previous injuries and the type of secondary school as covariates, participants who were classified as high risk were not more likely to develop injuries. Non-military high school was an independent risk factor for any injuries (OR = 3.14, 95% CI [1.43,6.91]; OR = 4.57, 95% CI [1.92,10.83]), overuse injuries (OR = 2.58, 95% CI [1.05,6.30]; OR = 2.55, 95% CI [1.06, 6.14]) and acute injuries (OR = 4.88, 95% CI [1.19,19.99]), respectively. Previous musculoskeletal symptoms also increased the chance of AI (OR = 4.45, 95% CI [1.15,17.18]; OR = 5.91, 95% CI [1.13,30.88]). CONCLUSIONS Movement patterns evaluated by DMA are not associated with an increased risk of injuries. However, attendance of a non-military high school and previous musculoskeletal symptoms are associated with musculoskeletal injuries.
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Affiliation(s)
- Priscila Dos Santos Bunn
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil; Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil.
| | - Thiago Jambo Alves Lopes
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil
| | - Bruno de Souza Terra
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Hélcio Figueiredo Costa
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Márcio Puglia Souza
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Roberta Mendonça Braga
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Allan Inoue
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil; Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil; Programa de Pós-Graduação em Desempenho Humano Operacional (PPGDHO), Universidade da Força Aérea (UNIFA), Av. Marechal Fontenelle, 1200, Campo dos Afonsos, Rio de Janeiro, RJ, Brazil
| | - Fabrício Miranda Ribeiro
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Daniel de Souza Alves
- Centro de Educação Física Almirante Adalberto Nunes (CEFAN), Laboratório de Pesquisa em Ciências do Exercício (LABOCE), Avenida Brasil, 10.590, Penha, Rio de Janeiro, RJ, CEP: 21.012-350, Brazil
| | - Elirez Bezerra da Silva
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências do Exercício e do Esporte (PPGCEE), Rua São Francisco Xavier, n° 524, 9° floor; Block F; Room 9122, Rio de Janeiro, RJ, Brazil
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15
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Xie YJ, Wang S, Gong QJ, Wang JX, Sun FH, Miyamoto A, Ou X, Wang L, Wang SQ, Zhang C. Effects of electromyography biofeedback for patients after knee surgery: A systematic review and meta-analysis. J Biomech 2021; 120:110386. [PMID: 33794414 DOI: 10.1016/j.jbiomech.2021.110386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/10/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
There has been no systematic review evaluating the efficacy of electromyography (EMG) biofeedback after knee surgery recently. This meta-analysis aimed to determine whether EMG-biofeedback is effective for improving the range of motion (ROM), physical function, and pain relief in patients after knee. Randomized controlled trials (RCTs) assessing the effect of EMG-biofeedback after any knee surgery were retrieved from EMBASE, PubMed, Cochrane Library, Physiotherapy Evidence Database, ClinicalTrials.gov, ProQuest. This review identified 773 unique studies, and six RCTs were in the final meta-analysis. EMG-Biofeedback treatment has a significant difference compared to other rehabilitation therapy in knee ROM improving (SMD = -0.48, 95% CI = -0.82 to -0.14, p = 0.006, I2 = 37%). Moreover, there was no significant difference in pain (SMD = -0.33, 95% CI = -0.67 to0.02, p = 0.07, I2 = 41%) and physical function scores (MD = 1.83, 95% CI = -3.48 to7.14, p = 0.50, I2 = 0%). The results illustrate that EMG-biofeedback can improve knee ROM in patients after knee surgery. However, it is not superior to other rehabilitation methods for pain relief and physical function improvement.
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Affiliation(s)
- Yu-Jie Xie
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Shuang Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Qun-Jie Gong
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Jian-Xiong Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Fu-Hua Sun
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Akira Miyamoto
- Department of Physical Therapy Faculty of Rehabilitation of Kobe International University, Japan
| | - Xia Ou
- Nuclear Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Li Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Shi-Qi Wang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Chi Zhang
- Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.
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16
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Grooms DR, Criss CR, Simon JE, Haggerty AL, Wohl TR. Neural Correlates of Knee Extension and Flexion Force Control: A Kinetically-Instrumented Neuroimaging Study. Front Hum Neurosci 2021; 14:622637. [PMID: 33613205 PMCID: PMC7890238 DOI: 10.3389/fnhum.2020.622637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The regulation of muscle force is a vital aspect of sensorimotor control, requiring intricate neural processes. While neural activity associated with upper extremity force control has been documented, extrapolation to lower extremity force control is limited. Knowledge of how the brain regulates force control for knee extension and flexion may provide insights as to how pathology or intervention impacts central control of movement. Objectives: To develop and implement a neuroimaging-compatible force control paradigm for knee extension and flexion. Methods: A magnetic resonance imaging (MRI) safe load cell was used in a customized apparatus to quantify force (N) during neuroimaging (Philips Achieva 3T). Visual biofeedback and a target sinusoidal wave that fluctuated between 0 and 5 N was provided via an MRI-safe virtual reality display. Fifteen right leg dominant female participants (age = 20.3 ± 1.2 years, height = 1.6 ± 0.10 m, weight = 64.8 ± 6.4 kg) completed a knee extension and flexion force matching paradigm during neuroimaging. The force-matching error was calculated based on the difference between the visual target and actual performance. Brain activation patterns were calculated and associated with force-matching error and the difference between quadriceps and hamstring force-matching tasks were evaluated with a mixed-effects model (z > 3.1, p < 0.05, cluster corrected). Results: Knee extension and flexion force-matching tasks increased BOLD signal among cerebellar, sensorimotor, and visual-processing regions. Increased knee extension force-matching error was associated with greater right frontal cortex and left parietal cortex activity and reduced left lingual gyrus activity. Increased knee flexion force-matching error was associated with reduced left frontal and right parietal region activity. Knee flexion force control increased bilateral premotor, secondary somatosensory, and right anterior temporal activity relative to knee extension. The force-matching error was not statistically different between tasks. Conclusion: Lower extremity force control results in unique activation strategies depending on if engaging knee extension or flexion, with knee flexion requiring increased neural activity (BOLD signal) for the same level of force and no difference in relative error. These fMRI compatible force control paradigms allow precise behavioral quantification of motor performance concurrent with brain activity for lower extremity sensorimotor function and may serve as a method for future research to investigate how pathologies affect lower extremity neuromuscular function.
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Affiliation(s)
- Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Translational Biomedical Sciences Program, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Adam L Haggerty
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Grover Center, Athens, OH, United States.,Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Grover Center, Athens, OH, United States
| | - Timothy R Wohl
- Honors Tutorial College, Ohio University, Athens, OH, United States.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
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17
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Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Med 2021; 51:321-338. [PMID: 33247378 PMCID: PMC7846527 DOI: 10.1007/s40279-020-01386-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. OBJECTIVE To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. DESIGN Systematic review with meta-analyses. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. RESULTS A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. CONCLUSIONS Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. TRIAL REGISTRATION NUMBER PROSPERO CRD42019141850.
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Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.
| | | | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, E1 4DG, UK
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18
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Gamma Loop Dysfunction as a Possible Neurophysiological Mechanism of Arthrogenic Muscle Inhibition: A Narrative Review of the Literature. J Sport Rehabil 2021; 31:736-741. [DOI: 10.1123/jsr.2021-0232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/09/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022]
Abstract
Context: Quadriceps activation failure has been observed following various pathological conditions in a knee joint such as knee surgery, pain, effusion in knee, and osteoarthritis also could be aging matter. Those patients are unable to attain maximal quadriceps strength for a long period of time although their quadriceps itself is not damaged. This impairment is termed arthrogenic muscle inhibition (AMI). AMI has been of concern to clinicians because this weakness hinders the rehabilitation process considerably and delays recovery because strengthening protocols for the AMI could be largely ineffective. Clinically, it is important to understand neurophysiological mechanisms of the AMI to treat patients with the impairment. Objectives: This is a narrative review of the literature. The purpose of this review is to understand the following: (1) Why investigations of only peripheral spinal reflexive pathways are not enough for elucidation of the mechanisms of the AMI? (2) What we know about the role of the gamma spindle system in AMI so far? (3) Could a dysfunctional gamma spindle system contribute to AMI lead neural changes in upper central nervous system? and (4) Concerns that a clinician should take into consideration when deciding whether to apply therapeutic interventions for AMI. Data Sources: The databases PubMed, MEDLINE, SPORTDiscus, and CINAHL were searched with the terms arthrogenic muscle inhibition (AMI), reflex inhibition, joint mechanoreceptor, gamma loop, corticospinal pathway, spinal reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers. Conclusions: AMI is a limiting factor in the rehabilitation of joint injury. Motor unit recruitment could be hindered in patients with AMI as a result of a dysfunctional gamma spindle system. Clinicians should understand the mechanism of AMI well in order to establish effective rehabilitation programs for AMI. Indeed, AMI is not caused by a single factor, but rather, multiple neural factors can change over time following the appearance of AMI. Therefore, multiple interventions targeting different neural pathways should be combined to achieve the ideal therapeutic goal for the treatment of AMI.
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19
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Yu S, Lowe T, Griffin L, Dong XN. Single bout of vibration-induced hamstrings fatigue reduces quadriceps inhibition and coactivation of knee muscles after anterior cruciate ligament (ACL) reconstruction. J Electromyogr Kinesiol 2020; 55:102464. [PMID: 32942109 DOI: 10.1016/j.jelekin.2020.102464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022] Open
Abstract
Persistent quadriceps strength deficits in individuals with anterior cruciate ligament reconstruction (ACLr) have been attributed to arthrogenic muscle inhibition (AMI). The purpose of the present study was to investigate the effect of vibration-induced hamstrings fatigue on AMI in patients with ACLr. Eight participants with unilateral ACLr (post-surgery time: M = 46.5, SD = 23.5 months; age: M = 21.4, SD = 1.4 years) and eight individuals with no previous history of knee injury (age: M = 22.5, SD = 2.5 years) were recruited. A fatigue protocol, consisting of 10 min of prolonged local hamstrings vibration, was applied to both the ACLr and control groups. The central activation ratio (CAR) of the quadriceps was measured with a superimposed burst of electrical stimulation, and hamstrings/quadriceps coactivation was assessed using electromyography (EMG) during isometric knee extension exercises, both before and after prolonged local vibration. For the ACLr group, the hamstrings strength, measured by a load cell on a purpose-built chair, was significantly (P = 0.016) reduced about 14.5%, indicating fatigue was actually induced in the hamstrings. At baseline, the ACLr group showed a trend (P = 0.051) toward a lower quadriceps CAR (M = 93.2%, SD = 6.2% versus M = 98.1%, SD = 1.1%) and significantly (P = 0.001) higher hamstrings/quadriceps coactivation (M = 15.1%, SD = 6.2% versus M = 7.5%, SD = 4.0%) during knee extension compared to the control group. The fatigue protocol significantly (P = 0.001) increased quadriceps CAR (from M = 93.2%, SD = 6.2% to M = 97.9%, SD = 2.8%) and significantly (P = 0.006) decreased hamstrings/quadriceps coactivation during knee extension (from M = 15.1%, SD = 6.2% to M = 9.5%, SD = 4.5%) in the ACLr group. In conclusion, vibration-induced hamstrings fatigue can alleviate AMI of the quadriceps in patients with ACLr. This finding has clinical implications in the management of recovery for ACLr patients with quadriceps strength deficits and dysfunction.
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Affiliation(s)
- Shiqi Yu
- Department of Health and Kinesiology, The University of Texas at Tyler, Tyler, TX, USA
| | - Timothy Lowe
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Lisa Griffin
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Xuanliang Neil Dong
- Department of Health and Kinesiology, The University of Texas at Tyler, Tyler, TX, USA.
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20
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Nasseri A, Khataee H, Bryant AL, Lloyd DG, Saxby DJ. Modelling the loading mechanics of anterior cruciate ligament. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 184:105098. [PMID: 31698195 DOI: 10.1016/j.cmpb.2019.105098] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The anterior cruciate ligament (ACL) plays a crucial role in knee stability and is the most commonly injured knee ligament. Although ACL loading patterns have been investigated previously, the interactions between knee loadings transmitted to ACL remain elusive. Understanding the loading mechanism of ACL during dynamic tasks is essential to prevent ACL injuries. Therefore, we propose a computational model that predicts the force applied to ACL in response to knee loading in three planes of motion. METHODS First, a three-dimensional (3D) computational model was developed and validated using available cadaveric experimental data to predict ACL force. This 3D model was then combined with a neuromusculoskeletal model of lower limb and used to estimate in vivo ACL forces during a standardised drop-landing task. The neuromusculoskeletal model utilised movement data collected from female participants during a dynamic task and calculated lower limb joint kinematics and kinetics, as well as muscle forces. RESULTS The total ACL force predicted by the 3D computational ACL force model was in good agreement with cadaveric data, as strong correlation (r2 = 0.96 and P < 0.001), minimal bias, and narrow limits of agreement were observed. The combined model further illustrated that the ACL is primarily loaded through the sagittal plane, mainly due to muscle loading. CONCLUSIONS The proposed computational model is the first validated model that can provide an accessible tool to develop and test knee ACL injury prevention programs for people with normal ACL. This method can be extended to study the abnormal ACL upon the availability of relevant experimental data.
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Affiliation(s)
- Azadeh Nasseri
- School of Allied Health Sciences, Griffith University, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Hamid Khataee
- School of Mathematics and Physics, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Adam L Bryant
- Centre for Exercise, Health & Sports Medicine, University of Melbourne, Australia
| | - David G Lloyd
- School of Allied Health Sciences, Griffith University, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Australia
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