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Arrebola LS, Smith TO, de Oliveira VGC, de Oliveira PR, Wun PYL, de Carvalho RT, Pinfildi CE. Combined Hip and Knee Strengthening Compared With Knee Strengthening for Individuals With Lateral Patellar Dislocation: A Single-blind, Superiority, Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2024; 6:100334. [PMID: 39006111 PMCID: PMC11240038 DOI: 10.1016/j.arrct.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Objective To investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD). Design Single-blind, superiority, randomized controlled trial with 48 weeks follow-up. Setting Physiotherapy out-patient clinic. Participants Forty individuals aged 16 or older, with a history of non-traumatic LPD were randomized to a knee-based strengthening (KBSG) or quadriceps and hip strengthening exercise (HQSG) program (N=40). Inclusion criteria included a positive apprehension sign, pain on palpation along the medial retinaculum, and J sign. Exclusion criteria included restricted range of motion (<90° knee flexion), and traumatic or postsurgical LPD. Interventions Concealed randomization was performed using random permuted blocks of size 4. Individuals received their corresponding exercise program according to randomization and group allocation: knee-based strengthening (n=20) or combined hip and quadriceps strengthening (n=20) twice weekly for 8 weeks over 16 appointments. Main Outcome Measures Primary outcome was the Lysholm Knee Score. Secondary outcomes included Numerical Pain Ratings Scale (NPRS) at rest and during effort, Norwich Patellar Instability Score (NPIS), Kujala Anterior Knee Pain Scale (AKPS), Lower Extremity Functional Scale (LEFS), 4 domains of the WHOQOL-Bref, and recurrence rate. Patient-reported outcome measures were assessed from the baseline to 48 weeks. Assessments were performed by a physiotherapist who was blinded to the group allocation. Data were analyzed by using a repeated-measures ANOVA model with Tukey's post hoc test after an intention-to-treat principle. Results At the primary time-point of 8 weeks, there were no substantial between-group differences in the Lysholm Knee Score: mean difference=-6.8 (95% CI -14.3 to 3.7); NPIS: mean difference=23.5 (95% CI 5.6 to 41.3); AKPS: mean difference=-1.54 (95% CI -8.6 to 5.6), NPRS at rest and during effort (mean difference=0.32 (95% CI -0.37 to 1); and mean difference=0.68 (95% CI -0.9 to 1.86); LEFS mean difference=-1.08 (95% CI -5.9 to 2.4), WHOQOL-Bref domains (physical health: mean difference=-0.12, (95% CI -1.26 to 1.02); psychological: mean difference=-0.32 (95% CI -2.04 to 1.4); social relations: mean difference=-0.7 (95% CI -2.2 to 0.82); environment: mean difference=0.44 (95% CI -1 to 1.9), and recurrence rate (P=.69). Conclusion This study indicates that combined hip and knee muscle strengthening is not superior to knee-based strengthening for LPD treatment. The limitations stemming from the underpowered nature of the trial must be acknowledged, concerning the potential oversight of moderate intervention effects.
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Affiliation(s)
- Lucas Simões Arrebola
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Toby O. Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Vanessa Gonçalves Coutinho de Oliveira
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Pedro Rizzi de Oliveira
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Paloma Yan Lam Wun
- Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Rogério Teixeira de Carvalho
- Department of Orthopaedics, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Carlos Eduardo Pinfildi
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo, Brazil
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Macri EM, Culvenor AG, Morris HG, Whitehead TS, Russell TG, Khan KM, Crossley KM. Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:2622-2629. [PMID: 28488001 DOI: 10.1007/s00167-017-4571-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/03/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10-15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. METHODS Participants (aged 18-50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. RESULTS Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. CONCLUSIONS Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Erin M Macri
- Department of Family Practice, Centre for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Adam G Culvenor
- Institute of Anatomy, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Hayden G Morris
- Park Clinic Orthopaedics, St. Vincent's Private Hospital, 166 Gipps Street, East Melbourne, VIC, 3002, Australia
| | - Timothy S Whitehead
- OrthoSport Victoria, Epworth Healthcare, Level 5, 89 Bridge Road, Richmond, VIC, 3121, Australia
| | - Trevor G Russell
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Karim M Khan
- Department of Family Practice, Centre for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Kay M Crossley
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia.
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Macri EM, Felson DT, Zhang Y, Guermazi A, Roemer FW, Crossley KM, Khan KM, Stefanik JJ. Patellofemoral morphology and alignment: reference values and dose-response patterns for the relation to MRI features of patellofemoral osteoarthritis. Osteoarthritis Cartilage 2017; 25. [PMID: 28648740 PMCID: PMC5605424 DOI: 10.1016/j.joca.2017.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to (1) determine reference values for trochlear morphology and patellofemoral (PF) alignment in adults without magnetic resonance imaging (MRI)-defined PF full thickness cartilage damage or knee pain; and (2) evaluate dose-response patterns for these measures with prevalent MRI-defined PF structural damage and/or knee pain. DESIGN The Framingham Community Cohort is a population-based sample of ambulatory adults aged ≥50 years. We evaluated six morphology and alignment measures using MRI (n = 985), and reported reference values (mean ± 2SD) in a subsample without MRI-defined PF full thickness cartilage damage or knee pain (n = 563). With restricted cubic spline Poisson regression, we evaluated dose-response patterns of each of the six measures with prevalent MRI-defined PF structural damage or joint pain. Our primary outcome was full thickness cartilage damage. RESULTS For dose-response curves, prevalence ratios (PR) increased monotonically for all measures except patellar tilt, which rose with both lateral and medial tilt. Associations were generally strongest in the lateral PF compartment. PR for the strongest predictors of full thickness cartilage damage reached clinical relevance (PR > 1.5) at sulcus angle (SA) ≥135.0°; patellar tilt angle at ≤1.0° and ≥15.0°; and bisect offset ≥57.0%. Lateral trochlear inclination (LTI) achieved PR > 1.5 at ≤23.0° for full thickness cartilage damage with pain. CONCLUSIONS SA, patellar tilt, and bisect offset were most strongly associated with full thickness cartilage damage. LTI, patellar tilt and bisect offset had stronger associations with the addition of pain. These findings contribute to better identifying a subset of patients who may benefit from mechanically based interventions.
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Affiliation(s)
- E M Macri
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada; Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - D T Felson
- Clinical Epidemiology Research and Training Unit, School of Medicine, Boston University, Boston, USA; Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, UK.
| | - Y Zhang
- Clinical Epidemiology Research and Training Unit, School of Medicine, Boston University, Boston, USA; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, USA.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, School of Medicine, Boston University, Boston, USA.
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, School of Medicine, Boston University, Boston, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - K M Crossley
- College of Science Health and Engineering, School of Allied Health, La Trobe University, Melbourne, Australia.
| | - K M Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada; Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - J J Stefanik
- Clinical Epidemiology Research and Training Unit, School of Medicine, Boston University, Boston, USA; Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University Bouve College of Health Sciences, Boston, USA.
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Peng HT, Song CY. Effect of leg press training on patellar realignment in patients with patellofemoral pain. J Phys Ther Sci 2016; 27:3873-8. [PMID: 26834371 PMCID: PMC4713810 DOI: 10.1589/jpts.27.3873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effect of leg press and leg
press with hip adduction exercise training on patellar alignment and pain in patients with
patellofemoral pain (PFP). [Subjects and Methods] Seventeen patients participated in this
study. Eight weeks of leg press or leg press with hip adduction training, including
progressive lower-limb weight-training and stretching, was given. Patellar alignment (tilt
and displacement) and pain measurements were conducted before and after leg press or leg
press with hip adduction training. Patellar tilt angle and the bisect offset index were
measured on axial computed tomography scans of the fully extended knee position with the
quadriceps relaxed and contracted. Pain was assessed by using a 10-cm visual analog scale.
[Results] No differences were found in patellar tilt and displacement with the quadriceps
either relaxed or contracted after leg press and leg press with hip adduction. However,
significant pain reduction was evident in both leg press and leg press with hip adduction.
[Conclusion] The results indicated that patellar realignment does not appear to mediate
pain alleviation. Furthermore, hip adduction in addition to leg press training had no
additive beneficial effect on patellar realignment or pain reduction.
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Affiliation(s)
- Hsien-Te Peng
- Department of Physical Education, Chinese Culture University, Taiwan
| | - Chen-Yi Song
- Department of Health Promotion and Gerontological Care, Taipei College of Maritime Technology, Taiwan
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Lorenz D, Morrison S. CURRENT CONCEPTS IN PERIODIZATION OF STRENGTH AND CONDITIONING FOR THE SPORTS PHYSICAL THERAPIST. Int J Sports Phys Ther 2015; 10:734-47. [PMID: 26618056 PMCID: PMC4637911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
UNLABELLED The rehabilitation process is driven by the manipulation of training variables that elicit specific adaptations in order to meet established goals. Periodization is an overall concept of training that deals with the division of the training process into specific phases. Programming is the manipulation of the variables within these phases (sets, repetitions, load) that are needed to bring about the specific adaptations desired within that particular period. The current body of literature is very limited when it comes to how these variables are best combined in an injured population since most of the periodization research has been done in a healthy population. This manuscript explores what is currently understood about periodization, gives clinical guidelines for implementation, and provides the sports physical therapist with a framework to apply these principles in designing rehabilitation programs. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Daniel Lorenz
- Specialists in Sports and Orthopedic Rehabilitation, Overland Park, KS, USA
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Rehabilitation following first-time patellar dislocation: a randomised controlled trial of purported vastus medialis obliquus muscle versus general quadriceps strengthening exercises. Knee 2015; 22:313-20. [PMID: 25921095 DOI: 10.1016/j.knee.2015.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/19/2015] [Accepted: 03/31/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND We aimed to define whether distal vastus medialis (VM) muscle strengthening improves functional outcomes compared to general quadriceps muscle strengthening following first-time patellar dislocation (FTPD). METHODS Fifty patients post-FTPD were randomised to either a general quadriceps exercise or rehabilitation programme (n=25) or a specific-VM exercise and rehabilitation regime (n=25). The primary outcome was the Lysholm knee score, and secondary outcomes included the Tegner Level of Activity score, the Norwich Patellar Instability (NPI) score, and isometric knee extension strength at various knee flexion ranges of motion. Outcomes were assessed at baseline, six weeks, six months and 12months. RESULTS There were statistically significant differences in functional outcome and activity levels with the Lysholm knee score and Tegner Level of Activity score at 12months in the general quadriceps exercise group compared to the VM group (p=0.05; 95% confidence interval (CI): -14.0 to 0.0/p=0.04; 95% CI: -3.0 to 0.0). This did not reach a clinically important difference. There was no statistically significant difference between the groups for the NPI score and isometric strength at any follow-up interval. The trial experienced substantial participant attrition (52% at 12months). CONCLUSIONS Whilst there was a statistical difference in the Lysholm knee score and Tegner Level of Activity score between general quadriceps and VM exercise groups at 12months, this may not have necessarily been clinically important. This trial highlights that participant recruitment and retention are challenges which should be considered when designing future trials in this population. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Park JK, Lee DY, Kim JS, Hong JH, You JH, Park IM. Effects of visibility and types of the ground surface on the muscle activities of the vastus medialis oblique and vastus lateralis. J Phys Ther Sci 2015; 27:2435-7. [PMID: 26356407 PMCID: PMC4563284 DOI: 10.1589/jpts.27.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the effects of visibility and types of
ground surface (stable and unstable) during the performance of squats on the muscle
activities of the vastus medialis oblique (VMO) and vastus lateralis (VL). [Subjects and
Methods] The subjects were 25 healthy adults in their 20s. They performed squats under
four conditions: stable ground surface (SGS) with vision-allowed; unstable ground surface
(UGS) with vision-allowed; SGS with vision-blocked; and UGS with vision-blocked. The
different conditions were performed on different days. Surface electromyogram (EMG) values
were recorded. [Results] The most significant difference in the activity of the VMO and VL
was observed when the subjects performed squats on the UGS, with their vision blocked.
[Conclusion] For the selective activation of the VMO, performing squats on an UGS was
effective, and it was more effective when subjects’ vision was blocked.
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Affiliation(s)
- Jeong-ki Park
- Department of Physical Therapy, Sunmoon University: Galsan-ri, Tangjeong-myeon, Asan-si, Chungcheongnam-do 336-708, Republic of Korea
| | - Dong-yeop Lee
- Department of Physical Therapy, Sunmoon University: Galsan-ri, Tangjeong-myeon, Asan-si, Chungcheongnam-do 336-708, Republic of Korea
| | - Jin-Seop Kim
- Department of Physical Therapy, Sunmoon University: Galsan-ri, Tangjeong-myeon, Asan-si, Chungcheongnam-do 336-708, Republic of Korea
| | - Ji-Heon Hong
- Department of Physical Therapy, Sunmoon University: Galsan-ri, Tangjeong-myeon, Asan-si, Chungcheongnam-do 336-708, Republic of Korea
| | - Jae-Ho You
- Department of Physical Therapy, Sunmoon University: Galsan-ri, Tangjeong-myeon, Asan-si, Chungcheongnam-do 336-708, Republic of Korea
| | - In-mo Park
- Major in Physical Therapy, Department of Public Health, The Graduate School of Konyang University, Republic of Korea
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Franke RDA, Baroni BM, Rodrigues R, Geremia JM, Lanferdini FJ, Vaz MA. Neural and morphological adaptations of vastus lateralis and vastus medialis muscles to isokinetic eccentric training. MOTRIZ: REVISTA DE EDUCACAO FISICA 2014. [DOI: 10.1590/s1980-65742014000300011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vastus lateralis (VL) and vastus medialis (VM) are frequently targeted in conditioning/rehabilitation programs due to their role in patellar stabilization during knee extension. This study assessed neural and muscular adaptations in these two muscles after an isokinetic eccentric training program. Twenty healthy men underwent a four-week control period followed by a 12-week period of isokinetic eccentric training. Ultrasound evaluations of VL and VM muscle thickness at rest and electromyographic evaluations during maximal isometric tests were used to assess the morphological and neural properties, respectively. No morphological and neural changes were found throughout the control period, whereas both muscles showed significant increases in thickness (VL = 6.9%; p < .001 and VM = 15.8%; p < .001) post-training. Significant increases in muscle activity were observed in VM (47.8%; p = .003), but not in VL (19.8%; p > .05) post-training. Isokinetic eccentric training produces neural and greater morphological adaptations in VM compared to VL, which shows that synergistic muscles respond differently to an eccentric isokinetic strength training program
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Hyong IH, Kang JH. Activities of the Vastus Lateralis and Vastus Medialis Oblique Muscles during Squats on Different Surfaces. J Phys Ther Sci 2013; 25:915-7. [PMID: 24259884 PMCID: PMC3820212 DOI: 10.1589/jpts.25.915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 03/28/2013] [Indexed: 11/27/2022] Open
Abstract
[Purpose] The purpose of the present study was to examine the effects of squat exercises
performed on different surfaces on the activity of the quadriceps femoris muscle in order
to provide information on support surfaces for effective squat exercises. [Subjects and
Method] Fourteen healthy subjects performed squat exercises for five seconds each on three
different support surfaces: hard plates, foam, and rubber air discs. Their performance was
measured using electromyography. As the subjects performed the squat exercises on each
surface, data on the activity of the vastus medialis oblique and the vastus lateralis, and
the vastus medials oblique/vastus lateralis ratio, were collected. [Results] The activity
of the vastus medialis oblique and the vastus medialis oblique/vastus lateralis ratio were
found to be statistically significantly higher on rubber air discs than when the squats
were performed on hard plates or foam. [Conclusion] To activate the vastus medialis
obilique, and to enhance the vastus medialis oblique/vastus lateralis ratio, unstable
surfaces that are highly unstable should be selected.
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Lorenz A, Müller O, Kohler P, Wünschel M, Wülker N, Leichtle UG. The influence of asymmetric quadriceps loading on patellar tracking--an in vitro study. Knee 2012; 19:818-22. [PMID: 22633902 DOI: 10.1016/j.knee.2012.04.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/27/2012] [Accepted: 04/30/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND In patients with anterior knee pain and patellar instability, a specific training of the quadriceps muscle - especially the vastus medialis - is often recommended, although the practicability is discussed controversially and the proof of a measurable clinical effect is difficult. Therefore, this in vitro study investigates the influence of asymmetric muscle loading on the motion of the human patella. METHODS Seven human knee specimens were tested in a specially developed knee simulator. During simulated weight-bearing knee flexion, the kinematics of tibia, femur and patella were measured using an ultrasound motion capture system. The quadriceps forces were controlled to achieve a constant ankle force over the whole flexion range which is assumed to represent almost physiological loading. Three different force distributions of the quadriceps were tested - a central, equally distributed load as well as mainly lateral and medial loads. RESULTS A significant influence of different quadriceps force distributions was found for patellar tilt around a proximodistal axis (up to 1.7°) and patellar rotation around an anteroposterior axis (up to 3.8°) with respect to the femur. Interestingly, the patellar mediolateral shift was influenced only marginally (<1.5mm). CONCLUSIONS Specific muscle training might help patients with patellofemoral pain and cartilage damage by a slight modification of the kinematics, but we could show that even highly asymmetric quadriceps loads only led to a small alteration of the mediolateral shift in case of a physiologic anatomy of the trochlear groove.
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Affiliation(s)
- Andrea Lorenz
- Biomechanics Research Laboratory, Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Taekwondo training improves the neuromotor excitability and reaction of large and small muscles. Phys Ther Sport 2012; 13:163-9. [DOI: 10.1016/j.ptsp.2011.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 07/04/2011] [Accepted: 07/11/2011] [Indexed: 11/18/2022]
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Lorenz DS, Reiman MP, Walker JC. Periodization: current review and suggested implementation for athletic rehabilitation. Sports Health 2010; 2:509-18. [PMID: 23015982 PMCID: PMC3438871 DOI: 10.1177/1941738110375910] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinicians are constantly faced with the challenge of designing training programs for injured and noninjured athletes that maximize healing and optimize performance. Periodization is a concept of systematic progression-that is, resistance training programs that follow predictable patterns of change in training variables. The strength training literature is abundant with studies comparing periodization schemes on uninjured, trained, and untrained athletes. The rehabilitation literature, however, is scarce with information about how to optimally design resistance training programs based on periodization principles for injured athletes. The purpose of this review is to discuss relevant training variables and methods of periodization, as well as periodization program outcomes. A secondary purpose is to provide an anecdotal framework regarding implementation of periodization principles into rehabilitation programs. EVIDENCE ACQUISITION A Medline search from 1979 to 2009 was implemented with the keywords periodization, strength training, rehabilitation, endurance, power, hypertrophy, and resistance training with the Boolean term AND in all possible combinations in the English language. Each author also undertook independent hand searching of article references used in this review. RESULTS Based on the studies researched, periodized strength training regimens demonstrate improved outcomes as compared to nonperiodized programs. CONCLUSIONS Despite the evidence in the strength training literature supporting periodization programs, there is a considerable lack of data in the rehabilitation literature about program design and successful implementation of periodization into rehabilitation programs.
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